肺部阴性的结核性变态反应综合征87例

Analysis of 87 cases of tuberculosis allergic syndrome with negative pulmonary radiography

目的探讨肺部阴性的结核性变态反应综合征的病因、发病机制、临床表现、诊断、误诊情况、治疗及预后。方法汇总分析在我院住院期间87例诊断为结核性变态反应综合征且无肺结核病灶的患者的临床资料。结果 47.13%的患者有不同程度发热,44.83%的患者出现多发性关节炎,59.77%的患者有皮肤损害,4.60%的患者出现心肌受累,73.56%的患者血沉增快,12.64%的患者出现抗"O"升高,结核菌素皮试强阳性反应90.8%,血清抗结核抗体检查71.26%阳性;临床误诊率81.61%;规则抗结核治疗率100%。结论肺部阴性的结核性变态反应综合征临床误诊率较高,结核杆菌感染所致变态反应是该综合征的始动因素,临床上以发热、皮肤结节性红斑及游走性的关节疼痛等为主要表现,血清抗结核抗体检查及结核菌素皮试有较高的诊断价值。

Objective To explore etiology, pathogenesis, clinical manifestations, diagnosis, misdiagnosis, treatment and progno- sis of patients in tuberculosis allergic syndrome with negative pulmonary radiography. Methods The clinical data of 87 patients of tubercu-losis allergic syndrome without tuberculosis lesions in radiography in our hospital from 2005 to 2010 were analyzed. Results There were 47. 13% of the cases with different degree of fever, 44.83% of the cases with polyarthritis, 59.77% with skin lesions, 4. 60% with car- diac injury, 73.56% with elevated ESR and 12. 64% with increased anti-＂ O＂. The strongly positive rate of tuberculin skin test was 90. 8% and 71.26% patients existed positive for TB in serum antibody test; the clinical misdiagnosis rate was 8l. 61% and the regular anti-TB treatment rate was 100%. Conclmion There is highly misdiagnosis rate in patients of tuberculosis allergic syndrome with negative pulmonary radiography; the initial factor of the syndrome is tubercle bacillus infection-induced allergy reaction. Fever, skin erythema no- dosum and migratory joint pain are the main clinical manifestations. Serum anti-TB antibody test and tuberculin skin test are high value in diagnosis.