49例下叶肺结核的临床特点及诊断程序分析

Analysis of 49 tuberculosis in lower lobe cases of clinical features and diagnostic program

目的探讨下叶肺结核的临床特点及合理的诊断程序。方法对49例下叶肺结核患者进行回顾分析,总结其临床特点及诊断方法。结果下叶肺结核多见于青壮年,60岁以下占77.6%;临床表现以咳嗽、咳痰为主,占69.4%;痰液抗酸杆菌阳性率(34.7%);X线表现多种多样,片状影10例(20.4%);其中斑片影35例(71.4%),斑片影伴斑点、结节影16例(32.7%),伴空洞影4例,伴条索影2例。通过查痰AFB确诊17例(34.7%);胸部CT检查诊断14例(28.6%);纤维支气管镜检查刷检、灌洗诊断11例(22.4%);PPD皮试及诊断性抗痨确诊7例(14.3%)。结论认识下叶肺结核的临床特点,按痰中找结核菌、胸部CT、纤维支气管镜检查、诊断性抗痨的诊断程序,可减少误诊。

Objective To explore the Clinical features and diagnostic program of tuberculosis in lower lobe.Methods The date of 49 patients suffering from tuberculosis in lower lobe were retrospectively analyzed and summarized the Clinical features and diagnostic program.Result Tuberculosis in lower lobe was found mostly in young adults（77.6% under 60 years）;the common clinical manifestation were coughing、expectoration（69.4%）,the positive rate of acid-fast bacilli in sputum（34.7%）.Chest radiography showed patches shadows in 10 cases（20.4%）,mottling in 35 cases（71.4%）; patches shadows with mottling and nodule in 16 cases （32.7%） ,with cavitation in 4cases and with streak in 2 cases.Final diagnosis were made in 17 cases of tuberculosis through AFB in sputum（34.7%）,14 case through thoracic CT（28.6%）,11 cases through flexible fiberoptic bronchoscopy brush specimens and BALF （22.4%）, 7 cases through Tuberculin test and diagnostictuberculin（14.3%）.Conclusion It is to reduce misdiagnosis if we recognize the Clinical features of tuberculosis in lower lobe and follow the diagnosis procedure： tubercle bacillus in sputum,thoracic CT,flexible fiberoptic bronchoscopy examine and diagnostictuberculin.