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中国防痨杂志 ›› 2020, Vol. 42 ›› Issue (7): 747-751.doi: 10.3969/j.issn.1000-6621.2020.07.019

• 临床病例讨论 • 上一篇    下一篇


曾谊*, 高卫卫, 宫素岗, 侯代伦()   

  1. 211131 南京中医药大学附属南京医院 南京市第二医院 南京市公共卫生医疗中心结核科(曾谊、高卫卫);同济大学附属上海市肺科医院肺循环科(宫素岗);首都医科大学附属北京胸科医院影像中心(侯代伦)
  • 收稿日期:2019-12-21 出版日期:2020-07-10 发布日期:2020-07-09
  • 通信作者: 侯代伦
  • 基金资助:

Analysis on clinical diagnosis and treatment of two cases with mediastinal fibrosis caused by tuberculosis infection

ZENG Yi*, GAO Wei-wei, GONG Su-gang, HOU Dai-lun()   

  1. *Department of Tuberculosis, the Second Hospital of Nanjing, Nanjing Hospital of Nanjing University of Chinese Medicine, Nanjing Public Health Medical Center, Nanjing 211131, China
  • Received:2019-12-21 Online:2020-07-10 Published:2020-07-09
  • Contact: HOU Dai-lun


通过分析2例结核所致纵隔纤维化(mediastinal fibrosis,MF)患者的临床诊治过程,增强临床医师对MF的认识,提高对该疾病的诊断能力。经过多学科讨论后发现,该2例结核所致MF患者在临床表现、影像学特征、气管镜检查、诊治过程等方面具有一定的共性特征:(1)慢性病程,临床症状缺乏特异性,易误诊为慢性阻塞性肺疾病(COPD)。(2)影像学检查可见纵隔及肺门处不规则软组织影伴钙化,气道和肺血管变形狭窄。(3)气管镜检查可见黏膜多发性色素沉着,支气管狭窄或闭塞。(4)根据患者既往病史、抗结核药品不规则治疗史、结核免疫学指标阳性等可提示MF与结核感染有关。(5)药品治疗效果欠佳,血管介入治疗对改善临床症状有一定的价值。结核感染作为MF的致病因素应加以重视,需早期发现早期治疗。

关键词: 结核, 纵隔, 纤维化, 诊断, 总结性报告(主题)


This study analyzed the clinical diagnosis and treatment of 2 patients with mediastinal fibrosis (MF) caused by tuberculosis, aiming to enhance the clinicians’ understanding of MF and improve the diagnosis ability of this disease. After multidisciplinary discussions, we found that these 2 patients had certain common characteristics in clinical manifestations, imaging features, bronchoscopy, diagnosis and treatment process. First, due to the chronic course and lack of specificity of clinical symptoms, it was easily misdiagnosed as chronic obstructive pulmonary disease (COPD). Second, imaging examination showed irregular soft tissue shadows in the mediastinum and hilar with calcification, and deformed stenosis of airways and pulmonary vessels. Third, tracheoscopy revealed multiple pigmentation of the mucous membranes, bronchial stenosis or occlusion. Fourth, according to the patient’s previous medical history, anti-tuberculosis irregular treatment history, and positive tuberculosis immunological indicators, it was suggested that MF might be related to tuberculosis infection. Fifth, although poor drug treatment, vascular interventional therapy had certain value for improving clinical symptoms. Thus, tuberculosis infection as a causative factor of MF should be taken seriously, and early detection and treatment are necessary.

Key words: Tuberculosis, Mediastinum, Fibrosis, Diagnosis, Consensus development conferences as topic