免疫受损与非免疫受损患者并发肺结核的临床对照研究

A comparative study on the clinical manifestations of ICP and Non-ICP with pulmonary tuberculosis

目的 总结免疫受损患者 (immunocompromisedpatient,ICP)与非免疫受损患者 (Non ICP)并发肺结核的临床异同 ,为临床诊治和预防提供依据。方法 回顾性分析 1993～ 2 0 0 1年间我院收治的 3 9例ICP并发肺结核和同期 76例Non ICP并发肺结核的临床特征。结果 与Non ICP并发肺结核相比 ,ICP并发肺结核的临床表现不典型 :高热略多 ,但差异无显著性 (P >0 .0 5 ) ;咳痰与肺部湿音较多 (P <0 .0 1) ;粟粒型肺结核发生率高 (P <0 .0 0 1) ;浸润性病灶缺乏常见的多形性片状特征 (P <0 .0 1) ;胸水、肺门或纵隔淋巴结肿大发生率高(P <0 .0 5 ) ;发生空洞和胸膜肥厚、粘连较少 ;非肺结核好发部位的肺结核多 ,易误诊为肺炎 ;结核菌素试验和胸水腺苷脱氨酶的诊断价值低。结论 ICP并发肺结核的临床表现不典型 ,易误诊且治疗困难 ,应引起临床医师在诊断。

Objective To study the clinical manifestations of immunocompromised patients(ICP) and non ICP with pulmonary tuberculosis. Methods To analyze 115 tuberculosis cases retrospectively, including 39 ICP and 76 non ICP with pulmonary tuberculosis by SPSS statistical software. Results Compared with non ICP, the ICP group had more sputum expectoration (64.10% vs 35.53%); pulmonary moist rale (41.02% vs 9.21%),miliary tuberculosis (30.77% vs 2.63%) and pleural effusions (48.72% vs 25.00%) hilar lymphadenopathy(17.95% vs 3.95%), less pulmonary cavitation (15.38% vs 22.37%) and pleural thickening(15.38% vs 23.68%), which could be misdiagnosed as pneumonia(23.08% vs 6.58%) and neoplastic pleural effusion(7.69% vs 3.95%). The diagnostic value of PPD test and pleural adenosine deaminase were limited in ICP. Conclusion The clinical manifestations of ICP with pulmonary tuberculosis are not typical and often lead to misdiagnosis with poorer prognosis.This should highly alert the clincians to the diagnosis and treatment of pulmonary tuberculosis in ICP.