吸收延迟肺炎误诊肺结核16例分析及误诊原因探讨

中国防痨杂志 ›› 2010, Vol. 32 ›› Issue (9): 101-103.

吸收延迟肺炎误诊肺结核16例分析及误诊原因探讨

刘昕, 武文清

北京结核病控制研究所,北京,1000

出版日期:2010-09-20 发布日期:2010-09-20

Analysis on 16 delayed absorption pneumonia cases misdiagnosed as pulmonary tuberculosis

Liu Xin; Wu Wenqing

Beijing control and research institute of tuberculosis; Beijing 100035; China;

Online:2010-09-20 Published:2010-09-20
Contact: Wu Wenqing E-mail:wuwenqing1961@126.com

摘要/Abstract

摘要： 目的探讨吸收延迟肺炎误诊肺结核的原因，提高对两种疾病的鉴别诊断能力。方法对16例吸收延迟肺炎误诊肺结核病例进行回顾性分析。结果误诊患者临床表现发热10例，其中高热3例，中度发热4例，低热3例；盗汗2例；查痰结核菌均阴性；血常规检查白细胞总数在4.0~10.0×10⁹／L之间12例；结核菌素纯蛋白衍生物（PPD）皮试阳性7例；X线胸片病变位于上叶尖后段、下叶背段16例；有肺结核病史2例。结论误诊的主要原因：吸收延迟的肺炎临床症状不典型，X线胸片、血常规检查与肺结核相似，对PPD的诊断价值估计过高。对临床资料综合分析，抗炎治疗动态观察，是防止吸收延迟的肺炎误诊肺结核的重要措施。

关键词: 肺炎;结核, 肺;误诊

Abstract: Objective To investigate the causes for delayed absorption pneumonia patients misdiagnosed as pulmonary tuberculosis and to improve the clinical differential diagnosis ability on these two pulmonary diseases.  Methods Retrospective analysis of 16 cases with delayed absorption pneumonia who were misdiagnosed as pulmonary tuberculosis.  Results The clinical symptoms ofthese patients included10 caseswithfever, amongwhom 3 caseshad high grade fever, 4 cases had medial grade fever and 3 cases had low grade fever;2 cases with night sweat. All patientshadnegative acid fast bacteria; Of 16 cases 12cases showed that WBC were 4.0~10.0×10⁹／L, 7 cases were positive on TST result used PPD 5IU, 16 cases’ lesionlocated in the apical and rear segments of the upper lobes or the superior segments of the lower lobes, 2 cases had the history of pulmonary tuberculosis.  Conclusion The main causes of misdiagnosis are as follows:the clinical symptoms of delayed absorption pneumonia are atypical, Chest X-ray appearance and routine blood test Results are similar to that of pulmonary tuberculosis and the diagnostic value of PPD test is over-estimated.Comprehensive analysis of the clinical data and observing the focus dynamically after anti-inflammatory treatment should be important measures to avoid delayed absorption pneumonia misdiagnosed as pulmonary tuberculosis in clinical practice.

Key words: pneumonia, tuberculosis,pulmonary, diagnostic errors

刘昕, 武文清. 吸收延迟肺炎误诊肺结核16例分析及误诊原因探讨[J]. 中国防痨杂志, 2010, 32(9): 101-103.

Liu Xin,Wu Wenqing. Analysis on 16 delayed absorption pneumonia cases misdiagnosed as pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2010, 32(9): 101-103.