气管支气管淀粉样变合并肺结核一例并文献复习

Tracheobronchial amyloidosis with tuberculosis:report of one case and review of literature

目的提高对气管支气管淀粉样变(TBA)的认识。方法回顾性分析1例TBA合并肺结核患者的病例资料,同时进行相关文献复习。以“气管支气管淀粉样变”为检索词检索中国知网数据库,以“tracheobronchialamyloidosis”为检索词检索PubMed数据库,检索时间为2012年6月至2017年6月。结果患者,女,69岁。因“咳嗽咳痰伴发热2个月余”入院。痰抗酸杆菌阳性,支气管镜检查见声门下气管全程、隆突向左右主支气管延伸见不规则隆起伴管腔高度狭窄,黏膜活检病理刚果红染色阳性。结合TBA确诊标准诊断为TBA合并肺结核,并予以抗结核治疗联合支气管镜下处理。文献检索经过筛选,最终收集23篇文献进行归纳总结。TBA患者临床表现无特异性,CT及支气管镜检查有助于早期诊断,早期治疗。结论支气管镜检查是明确TBA的重要方法,病理为其诊断金标准。对于肺结核患者应警惕是否有合并症,尤其对于咳嗽伴反复发热的患者可行支气管镜检查协助诊断。

Objective To study the tracheobronchial amyloidosis(TBA)and improve understanding of the disease.Methods A retrospective analysis was conducted on a case of TBA complicated with pulmonary tuberculosis.The literature review was carried out with"tracheobronchial amyloidosis”as the research terms respectively in CNKI and PubMed database.Search time ranged from June 2012 to June 2017.Results The 69-year-old female patient complained of fever,cough and expectoration for 2 months in hospital,positive sputum,bronchoscopy tracheal carina.Bronchoscopy showed subglottic full to the left main bronchus extending irregular projections with lumen stenosis height,mucosa biopsy staining of Congo red.Combined with the diagnostic criteria of TBA,it was diagnosed as TBA with pulmonary tuberculosis,and received antituberculosis treatment combined with cryotherapy under bronchoscope.A total of 23 literratures were reviewed in above-mentioned databases.The clinical manifestations were nonspecific,chest CT scan and bronchoscopy played important roles in the diagnosis of mucormycosis.Conclusions Bronchoscopy is an important method for the diagnosis of TBA,and pathology is the gold standard for diagnosis.Patients with pulmonary tuberculosis should be aware of complications,especially for patients with cough and recurrent fever,bronchoscopy is helpful for diagnosis.