肺结核合并肺外结核242例临床分析

Clinical characteristics of patients with pulmonary and extra-pulmonary tuberculosis

目的 探讨肺结核合并肺外结核的临床特点及继发性肺结核与血行播散性肺结核合并肺外结核的异同。方法 对242例继发性肺结核合并肺外结核和血行播散性肺结核合并肺外结核患者的临床资料以及实验室检查进行回顾性分析。结果 两组患者以21～30岁的年轻人为最多。血行播散性肺结核组有贫血与低蛋白血症的患者明显高于继发性肺结核组（P〈0.01）。血行播散性肺结核组有发热的患者明显高于继发性肺结核组（P〈0.01）。血行播散性肺结核组合并≥3种肺外结核的患者明显高于继发性肺结核组（P〈0.05）。继发性肺结核组痰涂片阳性率明显高于血行播散性肺结核组（P〈0.01）。在继发性肺结核组,肺部病灶范围分布在6个肺野的患者最多。血行播散性肺结核组合并结核性脑膜炎/脑结核的患者明显高于继发性肺结核组（P〈0.01）。继发性肺结核组合并浅表淋巴结结核的患者明显高于血行播散性肺结核组（P〈0.01）。继发性肺结核组合并胸壁结核的患者明显高于血行播散性肺结核组（P〈0.01）。两组合并脊柱结核、肠结核、喉结核、泌尿系结核、结核性腹膜炎无差异（P〉0.05）。结论 对年轻、肺部结核病灶范围广、全身情况差的肺结核患者,要警惕同时合并肺外结核,尤其是合并结核性脑膜炎/脑结核、浅表淋巴结结核、脊柱结核。

Objective To analyze the clinical characteristics of patients with pulmonary tuberculosis （PTB） and extra-pulmonary tuberculosis（EPTB）. Methods 242 patients with PTB and EPTB were divided into two groups： secondary tuberculosis group（ secondary group, n = 183 ） and hematogenous disseminated pulmonary tuberculosis group （ hematogenous group, n = 59 ）, the clinical data of two groups were retrospectively analyzed. Results Age group 21 -30 years was the largest one in both groups. The rate of anemia and hypoproteinemia was significantly higher in hematogenous group than that in secondary group （P 〈 0. 01 ）. The proportion of fever cases was significantly higher in hematogenous group than that in secondary group （ P 〈 0. 01 ）. The proportion of cases with ≥ 3locations of EBTB was significantly higher in hematogenous group than that in secondary group （ P 〈 0. 05）. The positive rate of sputum smear was significantly higher in secondary group than that in hematogenous group （ P 〈 0. 05 ）. More patients with tuberculosis in 6 lung fields in secondary group. The proportion of tuberculous meningitis/cerebral tuberculosis was significantly higher in hematogenous group than that in secondary group（ P 〈 0. 01 ）. The proportion of peripheral tuberculous lymphadenitis was significantly higher in secondary group than in hematogenous group（P 〈0. 01 ）. The proportion of chest wall tuberculosis was significantly higher in secondary group than thai in hematogenous group （P 〈 0. 01 ）. There were no significant differences in proportion of spinal tuberculosis, intestinal tuberculosis, laryngeal tuberculosis, urinary tuberculosis and peritoneal tuberculosis between two groups（ P 〉 0. 05 ）. Conclusion Clinicians should be aware of the possibility of extra-pulmonary tuberculosis in pulmonary patients, especially tuberculous meningitis/cerebral tuberculosis, peripheral tuberculous lymphadenitis, spinal tuberculosis in young TB patients, or TB patients with more lung involvement or with anemia and hypoproteinemia.