67例老年肺结核的临床特点分析

Clinical Characteristic Analysis of 67 Cases of Senile Pulmonary Tuberculosis

目的探讨老年肺结核患者的临床特点。方法回顾67例老年肺结核患者病例资料(设为老年组),以30例中青年肺结核患者为对照,比较两组的临床表现、实验室检查、胸部X线结果。结果老年组中23.8%(16/67)有肺结核病史,而对照组仅6.7%(2/30)有结核感染史(P<0.05);老年组以咳嗽、盗汗、纳差及体重减轻为多见,对照组则以咳嗽、咯血、发热多见;老年组外周血WBC均值为(6.64±1.2)×109,显著低于对照组(P<0.05),两组中性粒细胞均升高,ESR均明显升高,而CRP仅轻中度升高,两组比较均无显著性差异(P>0.05);胸片提示老年肺结核患者的病灶呈非常规分布(双侧和/或中下肺野),而对照组多呈常规分布(单侧和/或上肺),其差异有统计学意义(P<0.05),两组肺部X线病灶性质无明显差别(P>0.05)。结论老年肺结核患者常有结核病感染史,以消耗性表现为主,ESR可更好地评估活动状态,肺X线表现常不典型。

Objective To explore the clinical features of senile pulmonary tuberculosis patients. Methods The clinical data of 67 cases of elderly patients with pulmonary tuberculosis （senile group） were analyzed retrospectively, and compared with 30 cases of middle-young patients with pulmonary tuberculosis （control group） in the clinical manifestations, laboratory tests, and chest X-ray results. Results 23.8% （16/67） of senile group had the history of pulmonary tuberculosis, while there were only 6.7% （2/30） of control group patients with such history. The common features of senile patients were cough, night sweat, poor appetite and loss of weight, while those of the control group were cough, hemoptysis and fever. In the senile group, the average of peripheral blood WBC were （6.64 _＋ 1.2） x 109, which was remarkably lower than that of the control group （P〈0.05）. On the other hand, there were neutrophil counts being elevated, ESR being significantly raised and CRP mildly increasing in both groups, and there was no significant difference between the two groups （P 〉0.05）. Chest X ray results showed that the nidus of elderly pulmonary tuberculosis patients seemed to be in unconventional distributions （bilateral chests and/or middle and lower lung field）, which had remarkably difference from the control group, of which the nidus were in conventional distributions （unilateral chest and/or upper lung field） （P 〈0.05）. However, there was no significant difference between the two groups in the lung X-ray properties. Conclusions Senile pulmonary tuberculosis patients often has the history of tuberculosis, and the main clinical features are wasting manifestations; ESR can be better evaluation methods of the active state of tuberculosis, and the chest X-ray characters seem atypical.