老年慢性阻塞性肺疾病合并肺结核感染的临床观察

Clinical observation of elderly COPD patients combined with tuberculosis

目的研究老年慢性阻塞性肺疾病合并肺结核感染的临床表现,指导临床诊断和治疗老年慢性阻塞性肺疾病合并肺结核感染的临床观察。方法回顾性分析2012年1月-2013年10月在医院进行诊治的老年慢性阻塞性肺疾病合并肺结核感染的患者92例,48例患者具备典型的肺结核症状的老年慢性阻塞性肺疾病患者视为治疗组,对于初治患者采用2RHZE/4HR方案,对于复治患者采用3DLVE/6DLE治疗方案;44例不具备典型肺结核症状的老年慢性阻塞性肺疾病患者,按一般的慢性阻塞性肺疾病进行治疗为对照组,对比两组患者临床指标,数据采用SPSS13.0进行统计分析。结果经过15-30d的治疗后,治疗组患者中双肺斑片状阴影消失的34例占70.8%,44例对照组患者中双肺斑片状阴影消失的患者12例占29.2%,经检验治疗组患者双肺斑片状阴影消失的比例明显高于对照组,差异有统计学意义（P〈0.05%）;48例治疗组患者中空洞闭合或缩小的患者13例占27.1%,44例对照组患者中空洞闭合或缩小的患者26例占59.1%,经检验治疗组患者空洞闭合或缩小的比例明显低于对照组,差异有统计学意义（P〈0.05%）。结论应加强对老年慢性阻塞性肺疾病合并肺结核感染的临床诊断,对于确诊的患者,临床医护人员应根据老年患者自身的情况,制定相应的化疗方案,选择不良反应小的抗结核药物对老年慢性阻塞性肺疾病合并肺结核的患者进行长期的治疗。

OBJECTIVE To observe the clinical manifestation of elderly patients with chronic obstructive pulmonary disease（COPD）combined with tuberculosis,and provide some knowledge for diagnosis and treatment of elderly COPD patients combined with tuberculosis.METHODS Totally 92 cases of elderly COPD patients combined with tuberculosis treated during Jan.2012 to Oct.2013 were chosen,among which 48 patients with obvious tuberculosis symptoms was set as the treatment group and 44 patients without obvious tuberculosis symptoms as the control group.The patients of first visit in the treatment group were treated with 2RHZE/4HR regimen and the patients of return visit treated with 3DLVE/6DLE regimen.The control group received routine treatment for common COPD.Clinical indexes were compared between the two groups and the software SPSS13.0was used for statistical analysis.RESULTS After 15-30days of treatment,bilateral patchy shadows disappeared in 34cases（70.8%）in the treatment group and 12cases（29.2%）in the control group.And the analysis confirmed that the ratio of patchy shadow disappearance was higher in the treatment group than in the control group,the difference was significant（P〈0.5）.Cavity closure or reduction occurred in 13cases（27.1%）in the treatment group and 26 cases in the control group.And the analysis confirmed that the ratio of cavity closure or reduction was lower in the treatment group than in the control group,the difference was significant（P〈0.5）.CONCLUSION Medical staffs should be careful in diagnosis and treatment for elderly COPD patients combined with tuberculosis.And for patients diagnosed as COPD combined with tuberculosis,corresponding individual chemotherapy and antitubercular drugs with low adverse events should be chosen for treatment.