肌肉结核20例临床分析

Clinical analysis of 20 cases of muscular tuberculosis

目的了解肌肉结核的临床表现特点，分析肌肉结核的可能高危因素。方法对象为2000至2010年国内文献报道的血源性肌肉结核19例，以及北京协和医院收治住院患者诊断肌肉结核1例。20例患者中男9例，女11例，平均年龄43．5岁。结果20例患者均表现为局部包块，19例为单发性肌肉受累，1例为多发肌肉受累，其中病灶单发于腓肠肌9例。9例有结核病史或同时合并其他部位结核。3例患者合并免疫系统疾病，曾使用激素治疗。11例患者行结核菌素试验，其中1例为强阳性，余10例均为阴性。20例均经手术后进行肌肉组织病理确诊。20例均抗结核治疗。结论肌肉结核以局限性痛性或无痛性肌肉包块为主要表现，多为单发肌肉受累，既往有结核病史、其他部位结核、免疫系统疾病患者易发生肌肉结核，诊断主要依靠活检部位的病原学培养和病理检查，抗结核治疗有效。

Objective To explore the clinical manifestations of muscular tuberculosis （MT） and analyze its risk factors. Methods Twenty MT patients were recruited from our department during 2000 - 2010. There were 9 males and 11 females with an average age of 43.5 years old. And their clinical manifestations were recorded and analyzed. Results All patients had local masses. And 19 patients had the involvement of single muscle and multiple muscles were involved in 1 patient. Gastrocnemius was affected in 9 patients. Nine patients had a previous history of tuberculosis or suffered concurrent tuberculosis of other body parts. Three patients with immune system disease received glucocorticoid therapy. And 11 patients underwent PPD （purified protein derivative ） test and only 1 was strongly positive while 10 others were negative. MT was confirmed by pathological examinations in 20 cases. All patients underwent muscle biopsy and received effective chemotherapy. Conclusion As a kind of systemic disease, MT is mainly characterized by painful or painless muscle mass. The patients with a history of tuberculosis, tuberculosis of other body parts and immune system disease are susceptible to MT. Diagnosis is mainly made through biopsy. And chemotherapy is effective.