菌阴肺结核患者442例的临床分析

Clinical analysis of 442 cases of sputum smear negative pulmonary tuberculosis

目的探讨菌阴肺结核患者的临床特点。方法对2009-01～2010-12在北京结核病控制研究所门诊部登记并治疗的442名菌阴肺结核患者的临床情况进行回顾性分析。结果 442例菌阴肺结核患者中,有可疑肺结核症状者204例,占46.2%;无症状健康体检发现238例,占53.8%。418例肺部病变符合一般活动性肺结核的特点,病变范围以上叶尖后段和下叶背段多见,占94.6%;结核菌素皮试≥15 mm者367例,占83.8%,抗结核抗体阳性者277例,占72.5%。确诊后积极给予正规抗结核治疗,420例患者完成疗程,占95.0%。结论菌阴肺结核临床表现无特殊,但本组病例大多数患者胸片表现具备一般活动性肺结核特点,故诊断仍要以胸部影像学为重要依据,同时结合其他实验室辅助检查进行综合分析和鉴别诊断,确诊后积极抗结核治疗。

Objective To investigate the clinical characteristics of sputum smear negative pulmonary tuberculosis.Methods Records,chest X-ray,register cards and treatment of 442 cases of sputum smear negative tuberculosis from January 2009 to December 2010 in Beijing Research Institute for Tuberculosis Control were investigated and analyzed.Results Of 442 cases,238 had no symptoms,and 204 showed suspicious tuberculosis symptoms.Chest X-ray showed lung shadows at the apical or posterior segment of the upper lobes and the apical segment of the lower lobes in 418 cases.TST reaction≥15 mm was found in 367 cases（83.8%）.Anti-TB antibody positive rate was 72.5%（277/382）.After confirmed,420 cases（95.0%） finished the treatment.Conclusion The clinical manifestation of sputum smear negative TB is not specific.Most cases are present with active TB by chest X-ray.Diagnosis of sputum smear negative pulmonary tuberculosis mainly depends on chest X-ray.Other comprehensive measures such as TST skin test,anti-TB antibody,experimental therapy should also be adopted for the diagnosis of sputum smear negative tuberculosis.Standard treatment regimen should be adopted.