原发性鼻结核荟萃分析

Meta-analysis of primary nasal tuberculosis

目的了解原发性鼻结核的临床特点,以减少误诊。方法对纳入的原发性鼻结核患者26例(诊断为原发性鼻结核患者1例及国内发表的原发性鼻结核文献报道的患者25例)进行分析,探讨原发性鼻结核的临床特征及诊断方法。结果原发性鼻结核少见,女性好发,仅2例患者有接触史。其临床表现不典型,主要临床症状常见鼻塞(18例)、头痛或鼻痛(10例)、脓性鼻涕(10例)及血性鼻涕(10例)等。侵犯部位为上颌窦(9例)、鼻中隔(7例)等。从胸部X射线片检查(26例)、鼻窦CT检查(19例)、结核抗体检查(7例)等发现,确诊前均有误诊,有3例通过分泌物查找抗酸杆菌确诊,其余23例通过活检或手术确诊。随访时间最短1个月,最长5年,平均(17.7±14.7)个月,症状均好转,未见复发。结论鼻结核临床少见,通过接触史及单纯胸部X射线片、CT检查等难以确诊,诊断需依赖细菌学或组织学检查。经正规抗结核治疗,预后较好。

Objiective To investigate the clinical characteristics of primary nasal tuberculosis for reducing misdiagnosis. Methods 26 cases of primary nasal tuberculosis （ 1 case of primary nasal tuberculosis was diagnosed in this hospital and 25 cases were reported by the domestic literature） were performed the meta analysis. Results Primary nasal tuberculosis was rare and more common in females. Only 2 cases had the contact history.The clinical manifestations were atypical.The common clinical manifestations were nasal obstruction （18 cases）., headache or nasal pain （10 cases）, purulent rhinorrhea （10 cases） and bloody rhinorrhea（ 10 cases）. The most common invaded sites were maxillary sinus（9 cases） and nasal septum（7 cases）. The X-ray chest radiography（26 cases）,nasal sinus CT examination（19 cases） and tuberculosis antibody detection（7 cases） found that misdiag- nosis existed before definite diagnosis. 3 cases were diagnosed by detecting acid-fast bacillus in rhinal secretion and other 23 cases were diagnosed by biopsy or surgery. The mean fellow-up time was （17.7±14.7）months, with the shortest follow up peri- od of 1 month and the longest period of 5 years. The symptoms all were improved without relapse. Conclusion Primary nasal tuberculosis is rare in clinic. Simple X-ray chest radiography and CT are difficult to diagnose. Its diagnosis is based on bacteriolo- gy or histopathology examinations. After regular antitubereulosis treatment, the prognosis is good.