非结核分枝杆菌肺病50例误诊分析

Nontuberculous mycobacterial lung disease:misdiagnosis analysis of 50 cases

目的 分析与研究非结核分枝杆菌肺病的临床特点,减少误诊.方法 对我院2012年5月～2013年9月期间收治的50例非结核分枝杆菌肺病患者的临床资料进行回顾性分析,将50例非结核分枝杆菌肺病患者作为研究组,另外抽取我院50例涂阳肺结核患者作为对照组,对比两组患者的一般资料、临床症状、胸部影像学特征、PPD试验结果以及药敏试验结果.结果 Х^2检验结果显示,研究组患者不同程度咯血、有肺部基础疾病、中老年发病（＞45岁）、空洞直径＜3 cm、耐一线抗结核药物一种或以上、耐多药均多于对照组,胸腔积液、肺门淋巴结肿大、弥漫粟粒状结节影、干酪坏死灶、钙化灶少于对照组,两组差异具有统计学意义（P＜0.05）;两组发热、咳嗽、盗汗、性别、空洞、纤维增殖灶、PPD试验阴性差异无统计学意义（P＞0.05）.结论 非结核分枝杆菌肺病与肺结核病在临床特征方面存在差异,应多次进行痰培养及菌种鉴定明确诊断,避免误诊.

Objective To analyze and research the clinical features of nontuberculous mycobacterial lung disease for misdiagnosis reduction. Methods The records of 50 patients with nontuberculous mycobacterial lung disease in our hospital from May 2012 to September 2013 were retrospectively analyzed. Fifty patients with nontuherculous mycobacterial lung disease were selected as a research group, and 50 cases of patients with smear-positive tuberculosis （TB） were selected as control group. The general information, clinical symptoms, chest radiographic features, PPD test results, and susceptibility test results in the two groups were com- pared. Results In the Chi square test, the different degree hemoptysis rate, pulmonary underlying diseases rate, elderly incidence （aged over 45 years）, hole diameter〈3 cm number, one or more first-line anti-TB drug resistance cases and multi-drug resistance cases in research group were more than those in the control group; the incidence rates of the pleural effusion, hilar lymphadenopathy, diffused miliary nodules, cheese necrosis, and calcification of research group were lower than the control group, there were statistically significant differences （ P 〈0.05）. The fever, cough, night sweats, gender, cavity, fiber proliferation focus, negative results with PPD test of two groups had no significant differences （ P 〉0.05）. Conclusion The nontubercu lous mycobacterial lung disease and TB have significant differences in clinical characteristics. So repeated spu tum culture and strain identification should be carried out to confirm the diagnosis, for avoiding misdiagnosis.