摘要
目的 探讨初治肺结核患者临床治愈后残留空洞的诊断再评价。方法 2003 年1 月- 2007 年6 月, 67 例初治痰菌阳性肺结核患者在完成短程化疗后痰菌阴转, 达到临床治愈, 但X 线胸片检查仍残留空洞, 通过支气管肺泡灌洗( BAL)经皮肺穿刺活检( PLB) , 对肺结核合并疾病的诊断进行再评价。结果 67 例患者均进行BAL, 证实结核分枝杆菌阴性, 经知情并同意后, 其中的59 例患者进行PLB 62 例次, 发现肺癌2 例次( 鳞癌1 例次、腺癌1 例次) , 真菌感染5 例次( 曲霉感染2例次、隐球菌感染2 例次、白假丝酵母感染1 例次) , 结核分枝杆菌阳性5 例次, 细菌培养阳性3 例次( 铜绿假单胞菌、鲍曼不动杆菌、产酸克雷伯菌各1 例次) 。结论 即使在肺结核诊断成立并且治疗有效, 对肺结核合并疾病的诊断仍应受到高度重视,临床治愈后若残留空洞, 仍有必要对诊断进行评价, 以免延误肺结核合并的肿瘤和感染性疾病的诊断, 必要时需进行BAL 或PLB 明确诊断。
Abstract
Objective To elucidate the need of reassessing the diagnosis when residual pulmonary tuberculosis( TB) cavities still exist. Methods FromJan2003 to Jun2007, sixty-seven patients who were initially diagnosed with pulmonary TB and had already completed a short course treatment were enrolled in the current study. All the patients were negative for the sputumTB tests, but still had residual pulmonary cavities. Within three months after the short course treatment, these patients were re-evaluated by bronchoalveolar lavage ( BAL) . Fifty-nine of themwere also re - evaluated by CT-guided percutaneous lung needle biopsy ( PLB) after receiving the informed consent fromthe patients. Results None of the sixty-seven patients was found TB positive by BAL. Among 59 of these patients who had CT-guided PLB, 62 PLB specimens were collected: two specimens were positive for cancer, five for fungi and five for TB, and three for various bacteria. Conclusion Even when the diagnosis of pulmonary TB infection is confirmed and the anti - TB therapy is effective, the diagnosis of other diseases complicated with TB infection should still be considered, especially when there are residual pulmonary TB cavities. To avoid delayed diagnosis of cancer or other infectious disease in pulmonary TB patients, repeated evaluation by using PLB or BAL is encouraged.
关键词
活组织检查 /
感染, 真菌 /
肺癌.
Key words
Tuberculosis, pulmonary /
Percutaneous lung needle biopsy /
Infection, fungi /
Lung cancer
卢水华1;席秀红1;王婷萍2;沈 勇1;吴文娟1;冯艳玲1;朱召芹1.
肺结核残留空洞的诊断再评价[J]. 微生物与感染. 2008, 4(4): 212-214
LU Shui-hua;XI Xiu-hong;WANG Ting-ping;Shen Yong; Wu Wen-juan;Feng Yan-ling;Zhu Zhao-qin
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Reassessment of the diagnosis of residual pulmonary tuberculosis cavities among healing TB patients[J].
Journal of Microbes and Infections. 2008, 4(4): 212-214
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