慢阻肺合并肺结核临床特点分析及早期诊治探讨

Clinical characteristics and early diagnosis and treatment in COPD patients complicated with pulmonary tuberculosis

目的分析慢阻肺急性加重(AECOPD)合并活动性肺结核(PTB)的临床特点,探讨早期诊断线索并制定合理治疗方案。方法回顾性分析80例AECOPD合并PTB患者(A组)临床特点,并与166例单纯AECOPD患者(B组)及152例单纯PTB患者(C组)的临床症状、营养学指标、感染学指标、结核分枝杆菌涂片阳性率、肺CT结核感染灶累及部位进行比较分析。结果临床症状上,A组发热及盗汗的发生率较B组高(45%vs21.68%;10%vs2.4%),咳嗽、咳痰、胸闷/气促发生率较C组高(95%vs74.34%;90%vs61.18%;82.5%vs22.37%),痰血/咯血发生率较C组低(6.25%vs27.63%),差异有统计学意义(P<0.05)。感染指标中,A组C反应蛋白计数及红细胞沉降率较B组高[28.8(8.8,63.9)vs 11.6(2.6,36.7);37(21.5,53.5)vs 11(5,25)],淋巴细胞计数百分比较C组低[18.5(10.02,25.2)vs 21.24(13.05,27.67)],差异有统计学意义(P<0.05)。营养指标中,A组体质指数、血清白蛋白、血红蛋白计数较B组低[22.44(20.41,24.8)vs 24.33(22.29,26.19);36.4(31.4,40.07)vs 39.2(37,43.1);134(121.2,144)vs 141(129,154)],淋巴细胞计数较C组低[1.1(0.8,1.4)vs 1.4(0.9,1.8)],血红蛋白计数较C组高[134(121.2,144)vs 127(116,141)],差异有统计学意义(P<0.05)。A组痰涂片阳性率较C组低(16.25%vs34.87%),病灶累及双肺、累及两叶及两叶以上的发生率较C组高(67.5%vs 49.34%;75%vs 55.26%),累及典型结核病好发部位的发生率较C组低(48.75%vs 63.8%;27.5%vs 48.68%),差异有统计学意义(P<0.05)。结论慢阻肺急性加重合并活动性肺结核患者临床以慢阻肺症状为主,结核中毒症状仅发热和盗汗稍多见,感染指标中C反应蛋白及血沉较高,但痰涂片阳性率低,病灶以累及双肺、多肺叶浸润为主,典型结核感染灶少见,故临床应对各项资料进行综合评估,必要时完善其他检查协助诊断,同时积极补充营养物质,以促进病情恢复。

Objective To analyze the clinical features of AECOPD patients complicated with active pulmonary tuberculosis( PTB),and to investigate clues for early diagnosis and treatment. Methods The clinical features of 80 AECOPD patients complicated with PTB( the group A) were analyzed retrospectively,and their symptoms,clinical date,and imaging performance were compared with another 166 AECOPD patients( the group B) and another152 PTB patients( the group C) respectively. Results The incidence of fever and night sweat was higher in the group A than in the group B( 45% vs 21. 68%; 10% vs 2. 4%),and the incidence of cough,expectoration and tachypnea was higher,but the incidence of hemoptysis was lower in the group A than in the group C( 95% vs74. 34%; 90% vs 61. 18%; 82. 5% vs 22. 37%; 6. 25% vs 27. 63%)( P < 0. 05). The values of C-reactive protein( CRP) and erythrocyte sedimentation rate( ESR) in the group A were higher than those in the group B [28. 8( 8. 8,63. 9) vs 11. 6( 2. 6,36. 7); 37( 21. 5,53. 5) vs 11( 5,25) ],but the value of lymphocyte percentage was lower in the group A than in the group C [18. 5( 10. 02,25. 2) vs 21. 24( 13. 05,27. 67) ]( P < 0. 05). The nutritive indexes of BMI,albumin,hemoglobin were lower in the group A in the group B [22. 44( 20. 41,24. 8) vs24. 33( 22. 29,26. 19); 36. 4( 31. 4,40. 07) vs 39. 2( 37,43. 1); 134( 121. 2,144) vs 141( 129,154) ],but the lymphocyte count was lower and the hemoglobin was higher in the group A than in the group C [1. 1( 0. 8,1. 4)vs 1. 4( 0. 9,1. 8); 134( 121. 2,144) vs 127( 116,141) ]( P < 0. 05). The positive rate of TB Smear and typical areas in imaging changesare lower in the group A than in the group C( 16. 25% vs 34. 87%; 48. 75% vs 63. 8%;27. 5% vs 48. 68%),and the incidence of multiple pulmonary lobars and double lungs involved was higher in the group A than in the group C( 67. 5% vs 49. 34%; 75% vs 55. 26%)( P < 0. 05). Conclusion AECOPD patients complicated with PTB show the features of AECOPD symptoms,and typical PTB symptoms are only fever and night sweats. The value of CRP and ESR is high,but the positive rate of TB smear and typical areas in imaging changes are low. Those patients' image features mainly show that: the range of lesions is more extensive and multiple pulmonary lobars are involved. So clinical date about those patients should be used to make a comprehensive assessment,in order to diagnose early and improve the clinical cure rate.