菌阴肺结核患者早期发现的探讨

Exploration on the early detection of smear-negative pulmonary tuberculosis patients

目的通过进行菌阴菌阳肺结核临床特征对比及对患者发现方式的分析，探讨如何更好地早期发现肺结核患者。方法收集自2011年至2013年以来在门诊确诊并治疗的肺结核患者相关资料，依据细菌学检查结果分为菌阴组和菌阳组，分析两组间的相关特征。结果菌阴肺结核病例的临床症状，如咳嗽、咳痰和发热等症状显著低于菌阳患者（P〈0．05）。胸部X线空洞特征两组比较差异有统计学意义（P〈0．01）。患者的发现方式主要是病人到非结核医疗机构就诊和健康检查。结论菌阴肺结核临床症状较轻或无症状，病灶特异性不强，易造成误诊和漏诊。早期发现有赖于非结核医疗机构的重视及时报病转诊和增强人们每年进行健康检查的意识。

Objective To compare the clinical features of smear-negative pulmonary tuberculosis （PT-） and the smear-positive pulmonary tuberculosis （PT＋）, and analyze the patient discovery way, to provide clues for early detection of smear-negative tuberculosis diagnosis. Methods We collected the data of the tuberculosis patients consecutively enrolled in our hospital from 2011-2013. We then divided the patients into two groups as PT- group and PT＋ group based on the bacteriology examination results and performed comparative analysis between the two groups. Re.suits PT- group had mild clinical symptoms and lower frequencies of cough, expectoration and fever while compared to PT＋ group. Tuberculosis cavity also had statistical significant difference between PT- and PT＋ groups. Furthermore, seeing a doctor in medical institutions and health examination were the main ways for tuberculosis patient discovery. Conclusion Smear-negative pulmonary tuberculosis was difficult for diagnosis because of their mild or even no clinical symptoms and without focus specificity, which could easily lead to misdiagnosis and missed diagnosis. Non-tuberculosis medical institutions should pay more attention and people＇ s annual routine health examination should be recommended for smear-positive pulmonary tuberculosis early detection.