李龙芸 赵秋霞 罗慰慈 朱元珏 杨金波 薛安斌 100730 中国医学科学院、中国协和医科大学 北京协和医院呼吸科 中华内科杂志 1998 0 0 12


    关键词：结核，肺；诊断 期刊 zhnkzz 0 论 著 fur -->


    

【摘要 】 目的 提高对血行播散型肺结核的认识。方法 分析1960～1996年血行播散型肺结核182例的临床资料。所有病例均经痰涂片、X线胸片、活检等检查。结果 急性血行播散型肺结核165例，亚急性及慢性血行播散型肺结核17例。29.1%的患者X线胸片早期表现为肺间质改变；痰找抗酸杆菌阳性率为41.4%；入院时误诊率为44.5%；尸检证实，结核病变主要累及肺、肝及脾。其中1980～1996年患者的伴发病明显增多(48.5%～71.9%)，以结缔组织病为主；34.8%～65.7%的患者由于使用糖皮质激素而造成结核病播散；抗结核治疗后体温下降至正常及X线胸片显示病灶吸收缓慢；抗结核治疗后，对肝脏的毒性增加。80年代的病死率较前有所增高。结论 临床医师应加强对结核病诊断的警惕性；应慎用肾上腺糖皮质激素；痰抗酸菌涂片及纤维支气管镜检查是快速正确诊断本病的方法之一。

An analysis of 182 cases ofhematogenous disseminated pulmonary tuberculosis Li Longyun, Zhao Qiuxia, Luo Weici, et al. Department ofRespiratory Diseases, Peking Union Medical College Hospital, Peking Union Medical College,Chinese Academy Medical Sciences, Beijing 100730

【Abstract 】 Objective Tocomprehend the clinical characteristics and treatment of hematogenous disseminatedpulmonary tuberculosis before and after 1980. Methods 182 cases of hematogenous disseminated pulmonary tuberculosis from1960 to 1996 were analyzed with systemic retrospective method. Results Among these patients 165 were acute and 17 subacute or chronic. Inthe initial phase of the disease, 29.1% of the chest X-rays showed pulmonary interstitiallesion. The positive rate of sputum for acid fast bacilli was 41.4%. Autopsy showed thatthe main organs involved were lung, liver and spleen. Compared with the patients before1980, the patients after 1980 were more frequently accompanied by concomitant diseases(48.5%～71.9%) mainly desmosis. The rate ofdisseminated tuberculosis was increased because of the use of corticosteriod (34.8%～65.7%). The temperature control and X-ray absorption were delayedand hepatotoxicity after antituberculosis chemotherapy was more frequent than before. Themortality in the 1980s was higher than that in the period from 1960 to 1979. Conclusion Physicians should be alert of the occurrence of hematogenousdesseminated pulmonary tuberculosis, especially in immunologically compromised patients.Corticosteriod should be used carefully in patients with desmosis. Fibreoptic bronchoscopyand direct smear examination of sputum are the best methods for the rapid and correctdiagnosis.

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