综合医院住院患者抗酸杆菌阳性肺结核50例回顾性分析

Diagnosis for smear- or culture-positive pulmonary tuberculosis in 50 patients admitted to a general hospital-A retrospective analysis

目的探讨由综合医院诊断出的抗酸杆菌阳性（菌阳）肺结核患者的临床特点，以提高对菌阳肺结核患者的诊断水平。方法回顾性分析2006年1月至2009年6月由北京协和医院106712例住院患者中确诊的50例菌阳肺结核患者的临床资料。结果男性、60岁以上老年人，退休人员和农民是菌阳肺结核的好发人群。主要症状为发热（80％）、咳嗽（94％）、咯痰（92％），多数（84％）患者有血红细胞沉降率增快。影像学检查提示病变部位以双肺弥漫病变或中上肺病变为主，病变形态以斑片渗出影、结节影和空洞影为主。痰直接涂片抗酸染色阳性的41例（82％），痰分枝杆菌培养阳性3例（6％），气管镜刷片检查或支气管肺泡灌洗液涂片抗酸染色阳性6例（12％）。入院至确诊的平均时间为14d。结论在综合医院应大力宣传、普及结核病防治基本知识，提高结核病诊断警惕性，并将痰直接涂片查抗酸杆菌作为有呼吸系统症状者的常规检查项目，必要时可考虑做气管镜刷片或支气管肺泡灌洗液检查，以提高菌阳肺结核的发现率。

Objective To investigate clinical characteristics of smear- or culture-positive pulmonary tuberculosis （TB） in patients hospitalized at a general hospital to improve its diagnosis. Methods Clinical data of smear- or culture-positive pulmonary TB diagnosed in 50 patients hospitalized at Peking Union Medical College Hospital, Beijing during 2006 to 2009 were analyzed retrospectively. Results Seventeen （34%） of 50 cases of smear- or culture-positive pulmonary TB aged more than 60 years, with 30 males （32%）, 16 retirees and nine farmers （18%）. Their main symptoms included fever （80%）, cough （94%） and sputum expectoration （92%）, with elevated erythrocyte sedimentation rate （ESR） in 38 of 45 patients （84%）. Chest X-ray examinations showed that lesions located mostly in the upper lobes or in both of the lungs diffusedly, with patchy infiltrations, nodular opacities and cavities. Acid-fast bacilli were demonstrated on sputum smear in 41 （82%） and in specimens of six （ 12% ） cases obtained through brouchoscopy with brush or bronchoalveolar lavage fluid （BALF） , and M. tuberculosis was cultured from sputum specimens in three （6%）. Mean time interval between admission and diagnoses averaged 14 days. Conclusions Basic knowledge about prevention and control of pulmonary tuberculosis should be publicized comprehensively in general hospital keeping alert in its diagnosis with acid-fast staining for sputum smear as a routine test for patients with respiratory symptoms, and in some cases, bronchoscopy procedures （brush or BALF） are reasonable options to improve its detection.