应用免疫抑制剂过程中并发肺结核35例临床分析

Clinicalanalysison 35caseswithpulmonarytuberculosiscomplicatedinapplyingimmunosuppressant

目的 对35例免疫抑制剂应用过程中并发肺结核的临床特点、诊断和治疗进行探讨。方法35例均来自临床,长期或间断应用免疫抑制剂,免疫抑制剂使用距发病时间2～24个月。临床症状及X线表现均不典型。诊断采用细菌学及病理学手段。35例均规则抗痨治疗。结果 35例疗程结束时痰菌阴转率达857%(24/28),X线胸片复查明显吸收485%(16/33),吸收303%(10/33),停药后随访1年无复发,2例在停药半年后死于原发疾病。结论 免疫损害宿主并发肺结核,只要规则抗痨,疗程至少一年,均能取得显著疗效。在抗痨中根据原发病病情,适当加用免疫抑制剂,不影响抗痨的疗效。

Objective Todelveintotheclinicalcharacteristics ,diagnosisandtreatmentofpulmonarytuber culosiscomplicatedinapplyingimmunosuppressanton 35cases.Methods These 35casesareallclinicalpa tients,applyingimmunosuppressantforalongperiodordiscontinuouslyafter 2～ 2 4monthswhenthepatients arepathogenic.ClinicalsymptomsandX -rayhaven’tgivenobviousshow .Diagnosisusesthemeansofpathol ogyandbacteriology .The 35casesareallregularlyantiphthisic.Results Whenthecoursesoftreatmentsof the 35casesfinished ,therateofsputumbacteriatransferingintonegativereached 85 .7% (2 4 / 2 8) ,chestexam inationbyX -rayshowedthat 4 8.5 % (1 6 / 33)wereabsolutelyabsorbedand 30 .3% (1 0 / 33)werepartlyab sorbed .Afterwithdrawal,inthefollow -upsurvey ,therewerenocasesofrecurrenceinoneyearand 2casesof dyingofprimarydiseasesafter 6months.Conclusion Immunocompromisedhostcomplicatedbypulmonary tuberculosiscanbemadetangibletherapeuticeffectivenessifusingregularantiphthisicwithatleastoneyear courseoftreatment.Inaccordancewiththestateoftheprimarydisease,immunosuppressantcanbeappliedap propriatelyandthatwillnotinfluencetheantiphthisiceffectiveness.