肾上腺结核并发Addison病的临床与CT表现特征(附二例报告并文献复习)

doi:10.3969/j.issn.1000-6621.2020.03.018

摘要/Abstract

摘要：

Addison病临床较少见,在我国首要病因为肾上腺结核。笔者通过收集武汉市肺科医院收治的2例及国内外文献报道的135例肾上腺结核并发Addison病患者的临床资料,分析其临床特点和诊治经过,认为此类患者以腹胀、乏力、纳差、恶心呕吐,以及皮肤皱褶处色素沉着等为常见临床表现;特征性CT扫描征象为外周环形强化及钙化。肾上腺皮质功能减退、肾上腺外结核证据、肾上腺穿刺活检或手术组织标本病理检查、肾上腺及肾上腺外结核CT表现特点、实验室结核感染证据、诊断性抗结核药物治疗均有助于肾上腺结核的诊断。除对患者进行规范化抗结核药物治疗外,肾上腺皮质激素(糖皮质激素或加服盐皮质激素)替代治疗同样重要。

关键词: 结核, 肾上腺疾病, 肾上腺功能减退, 疾病特征, 诊断显像, 总结性报告(主题)

Abstract:

Addison’s disease is rare and in China, adrenal tuberculosis is the main cause. Clinical data of 2 cases of adrenal tuberculosis complicated with Addison’s disease in Wuhan Pulmonary Hospital and 135 cases of adrenal tuberculosis reported in literatures were collected. By analyzing the clinical characteristics, diagnosis and treatment, it is found that abdominal distention, accompanied with asthenia, poor appetite, nausea and vomiting, and pigmentation in the skin folds are the main clinical manifestations;and the enhanced and calcified peripheral ring is characteristic sign in CT scan.The manifestations of adreno-surgical tissue specimen, CT features of adrenal and extra-adrenal tuberculosis, evidence of tuberculosis infection in laboratory, and diagnostic anti-tuberculous drug treatment are all helpful to the diagnosis of adrenal tuberculosis. Besides the standardized anti-tuberculous drug treatment, the adrenal cortex replacement therapy is equally important.

Key words: Tuberculosis, Adrenal glands diseases, Adrenal insufficiency, Disease attributes, Diagnostic imaging, Consensus development conferences as topic

杨澄清,杜荣辉,曹探赜,周萌,梅春林,陈淑芳,欧佳莉. 肾上腺结核并发Addison病的临床与CT表现特征(附二例报告并文献复习)[J]. 中国防痨杂志, 2020, 42(3): 276-281. doi: 10.3969/j.issn.1000-6621.2020.03.018

YANG Cheng-qing,DU Rong-hui,CAO Tan-ze,ZHOU Meng,MEI Chun-lin,CHEN Shu-fang,OU Jia-li. Clinical and CT characteristic of adrenal tuberculosis complicated with Addison’s disease[J]. Chinese Journal of Antituberculosis, 2020, 42(3): 276-281. doi: 10.3969/j.issn.1000-6621.2020.03.018

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