43例成人不典型肺结核的临床分析(1)
[摘要] 目的 研究分析我國肺结核病患者中各项资料的不典型表现。 方法 选取2012年9月～2014年10月在我院入院治疗的前期不典型最后确诊为肺结核病的43例患者，经多科室通力合作，搜集资料汇总后整理，给予总结分析。 结果 本组所有患者均有很好的自我表述能力。通过观察该组病例结果发现，以往临床常见的肺结核典型的症状如咳嗽、咳痰的比例相对其他肺部临床症状及无明显肺部临床症状患者比例为高(咳嗽、咳痰22例，占比51.16%)，较为符合以往诊断经验。同时亦发现一定比例的患者并无明显以往肺结核的典型咳嗽、咳痰症状(占比34.88%)亦称为无反应型肺结核。在肺部体征方面，均由临床工作多年的医师仔细查体，发现无明显肺部体征患者较以往体征明显(呼吸音减弱，湿啰音等)患者比例显著为高(无肺部体征27例，占比62.79%)，因该组所有观察病例均排除常见肺部基础疾病，故数据较为准确。在肺部影像学上我们均采用肺部高清X线检查，由影像科经验丰富医师帮助阅片。影像表现上我们发现，具有叶、段肺实质性改变及肺不张的病例数较高(22例，占比51.16%)，而以往认为典型结核影像学改变如大小不等结节影、粟类影、云絮影、空洞等所占比例并无明显优势。实验室检查方面所有病例均为单纯肺结核病患者，无合并肺内感染性病变，发现血沉指标升高较为显著，余无明显特征性改变，同以往经验较为相符。 结论 不典型肺结核患者的临床诊断应进行多项检查并对资料进行综合分析，不能轻易对疾病诊断下结论。
[关键词] 成人非典型肺结核；临床体征及表现；肺部体征；影像检查；实验室检查
[中图分类号] R521 [文献标识码] B [文章编号] 1673-9701(2017)20-0072-03
[Abstract] Objective To study and analyze the atypical findings of various data in the patients with pulmonary tuberculosis in China. Methods 43 patients who were admitted to our hospital from September 2012 to October 2014， and were finally diagnosed of pulmonary tuberculosis with initial atypical symptoms were selected. By the multi-departmental cooperation， data were collected and summarized， and summary and analysis were given. Results All patients in this group had a good self-expression ability. Through the observation results of the cases in the group， it was found that the proportion of the patients with previous typical clinical symptoms of tuberculosis， such as cough， sputum， was higher than that of the patients with other pulmonary symptoms or without obvious pulmonary symptoms(cough， sputum in 22 cases， accounting for 51.16 %)， which was more in line with the past diagnostic experience. At the same time， it was also found that a certain proportion of patients did not have obvious typical tuberculosis in the past， such as cough， sputum(accounting for 34.88%)， which was also known as nonresponsive tuberculosis. In the pulmonary signs， the physician check-up was carefully performed by the experienced clinical physicians， which found that the proportion of patients without obvious pulmonary signs was significantly higher than that of the patients with previous signs (weakened breath sounds， wet rales， etc.) (27 cases without pulmonary signs， accounting for 62.79%). Because the common lung diseases were excluded for all the observed cases， so the data were more accurate. In the lung imaging， high-definition lung X-ray examination was applied， and X-ray photos were reviewed by the experienced physicians in the Imaging Department. For the imaging performance， it was found that the number of cases with lobe and segmental substantial changes and atelectasis was higher(22 cases， accounting for 51.16%). In the past， it was considered that the proportion of typical changes in tuberculosis imaging， such as different sizes of the nodular shadow， millet shadow， cloud shadow， cavity was of no obvious advantages. Laboratory examination showed that all cases were patients with single pulmonary tuberculosis， without the complicated pulmonary infection with lesions. It was found that the increased index of erythrocyte sedimentation rate was more significant， without other significant characteristic changes， which was consistent with the previous experience. Conclusion The clinical diagnosis of atypical pulmonary tuberculosis should be given multiple examinations and comprehensive analysis should be carried out for the data. The disease diagnosis cannot be given a haste conclusion., 百拇医药(梁新峰)
[关键词] 成人非典型肺结核；临床体征及表现；肺部体征；影像检查；实验室检查
[中图分类号] R521 [文献标识码] B [文章编号] 1673-9701(2017)20-0072-03
[Abstract] Objective To study and analyze the atypical findings of various data in the patients with pulmonary tuberculosis in China. Methods 43 patients who were admitted to our hospital from September 2012 to October 2014， and were finally diagnosed of pulmonary tuberculosis with initial atypical symptoms were selected. By the multi-departmental cooperation， data were collected and summarized， and summary and analysis were given. Results All patients in this group had a good self-expression ability. Through the observation results of the cases in the group， it was found that the proportion of the patients with previous typical clinical symptoms of tuberculosis， such as cough， sputum， was higher than that of the patients with other pulmonary symptoms or without obvious pulmonary symptoms(cough， sputum in 22 cases， accounting for 51.16 %)， which was more in line with the past diagnostic experience. At the same time， it was also found that a certain proportion of patients did not have obvious typical tuberculosis in the past， such as cough， sputum(accounting for 34.88%)， which was also known as nonresponsive tuberculosis. In the pulmonary signs， the physician check-up was carefully performed by the experienced clinical physicians， which found that the proportion of patients without obvious pulmonary signs was significantly higher than that of the patients with previous signs (weakened breath sounds， wet rales， etc.) (27 cases without pulmonary signs， accounting for 62.79%). Because the common lung diseases were excluded for all the observed cases， so the data were more accurate. In the lung imaging， high-definition lung X-ray examination was applied， and X-ray photos were reviewed by the experienced physicians in the Imaging Department. For the imaging performance， it was found that the number of cases with lobe and segmental substantial changes and atelectasis was higher(22 cases， accounting for 51.16%). In the past， it was considered that the proportion of typical changes in tuberculosis imaging， such as different sizes of the nodular shadow， millet shadow， cloud shadow， cavity was of no obvious advantages. Laboratory examination showed that all cases were patients with single pulmonary tuberculosis， without the complicated pulmonary infection with lesions. It was found that the increased index of erythrocyte sedimentation rate was more significant， without other significant characteristic changes， which was consistent with the previous experience. Conclusion The clinical diagnosis of atypical pulmonary tuberculosis should be given multiple examinations and comprehensive analysis should be carried out for the data. The disease diagnosis cannot be given a haste conclusion., 百拇医药(梁新峰)