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中国防痨杂志 ›› 2013, Vol. 35 ›› Issue (11): 927-929.

• 论著 • 上一篇    下一篇

33例老年急性血行播散性肺结核临床分析

黄麦玲 吴晓光 马丽萍 高孟秋 陈红梅 刘荣梅 谢莉 张立群   

  1. 101149  首都医科大学附属北京胸科医院结核二科
  • 收稿日期:2013-09-12 出版日期:2013-11-10 发布日期:2013-11-03
  • 通信作者: 张立群 E-mail:liqunzhang2005@aliyun.com

Clinical analysis on 33 elder patients with acute hematogenous disseminated pulmonary tuberculosis

HUANG Mai-ling,WU Xiao-guang,MA Li-ping,GAO Meng-qiu,CHEN Hong-mei,LIU Rong-mei,XIE Li,ZHANG Li-qun   

  1. The 2nd Department of Tuberculosis, Beijing Chest Hospital,Capital Medical University,Beijing 101149,China
  • Received:2013-09-12 Online:2013-11-10 Published:2013-11-03
  • Contact: ZHANG Li-qun E-mail:liqunzhang2005@aliyun.com

摘要: 目的 探讨老年急性血行播散性肺结核临床特点。 方法 回顾性分析首都医科大学附属北京胸科医院2007年1月至2013年3月间收治的33例老年急性血行播散性肺结核患者的临床资料。 结果 33例患者以发热及咳嗽、咯痰、倦怠乏力、纳差为主要临床表现;涂阳患者7例,痰结核分枝杆菌罗氏培养阳性患者4例;影像学检查表现为双肺大小、密度、分布“三均匀”的粟粒结节影32例;营养风险评估≥3分32例,30例合并低蛋白血症,29例患者全血总淋巴细胞计数≤1.2×109/L;32例患者合并高危或慢性基础疾病,并发结核性脑膜炎8例,骨关节结核6例;有16例患者出现误诊;30例患者接受个体化抗结核治疗,25例患者病情好转。 结论 老年急性血行播散性肺结核患者多病情危重,合并症多,临床表现不典型,误诊率高,营养不良多见,但经积极个体化治疗后,大多数患者病情可以好转。

关键词: 结核, 肺/传播, 老年人

Abstract: Objective  To evaluate clinical characteristics of elder patients with acute hematogenous disseminated pulmonary tuberculosis. Methods  We analyzed retrospectively the clinical data from 33 elder patients with acute hemotogenous pulmonary tuberculosis hospitalized in Beijing Chest Hospital Affiliated Capital Medical University in recent 6 years. Results  In 33 patients, the mainly clinical symptoms presented were fever, cough, fatigue and anorexia. Seven cases with positive smear,while 4 cases with positive sputum culture. The chest X-ray or computed tomography (CT) showed miliary nodules in whole lung field of double lungs in 32 cases. Nutritional risk assessment score were more than 3 scores in 32 cases, 30 cases were complicated with hypoalbuminemia, 29 cases with total lymphocyte counts below 1.2×109/L. Thirty-two patients with high-risk or chronic diseases, 8 patients with tuberculous meningitis, 6 cases with bone joint tuberculose and 16 cases were misdiagnosed with other diseases. Thirty cases were treated with individual anti-tuberculosis therapy regimens and 25 patients were improved. Conclusion  Acute hematogenous disseminated pulmonary tuberculosis in elder patients is serious, with many complications, untypical clinical manifestations, high rate of misdiagnosis and malnutrition. However most patients can get better when they are treated individually.

Key words: Tuberculosis pulmonary/transmission, Aged