医药学论文：涂阴培阴肺结核523例临床分析

【摘要】 目的 探讨菌阴肺结核临床特点和诊断及治疗时限。方法 回顾分析5年间诊断菌阴肺结核523例，对其临床表现、X线特征等动态观察及治疗全程，每月痰涂检查3次，疗前、疗末痰菌培养各1次。结果 菌阴肺结核占同期初治肺结核78.1%，临床症状以咳嗽、咯血为主，但症状轻微，另2.7%无任何症状在体检时发现。常规剂量抗痨治疗全程后，疗末症状改善及X线显示吸收好转率100%。结论 菌阴肺结核临床症状轻微，以咳嗽、咯血、低热、盗汗为诊断线索，结合X线、实验室检查并排除其它疾病而综合判定。X线是诊断菌阴肺结核重要手段之一，强调集体读片作为常规。治疗这部分菌阴病人4月方案是可取的，以6～9月方案为宜。

 

　　【关键词】 结核；肺；涂阴培阴

 

　　The clinical analysis on 523 cases of sputum negative and cultivating sputum negative pulmonary tuberculosis

 

 

 

【Abstract】 Objective To discuss the clinical character of sputum negative pulmonary tuberculosis and its diagnosis as well as the time limitation of the treatment to it.Methods To recall and analyze the diagnosis on 523 cases of sputum negative pulmonary tuberculosis,dynamic observation and the whole procedure in treatment to its clinical showing and X rays feature in the past 5 years .Sputum was checked for 3 times every month.Sputum cultivating was made each once before the treatment and after it.Results Sputum negative pulmonary tuberculosis is 78.1%of the pulmonary tuberculosis treated at the same time originally.The clinical symptoms are mainly slight coughing and haemoptysis.Nothing had been found on another 2.7% in physical examination.Through the whole procedure of anti-tuberculosis treatment with common dosage, the rate of symptom improvement and assimilating function recovery shown by X rays is 100%.Conclusion Sputum negative pulmonary tuberculosis has slight clinical symptoms.It csn be determined in a comprehensive way by taking coughing,splitting blood, slight fever and profuse sweating as a diagnosis clue,through X rays and laboratory checking to eliminate other diseases.X rays is one of the important ways to diagnose sputum negative pulmonary tuberculosis.Collective reading on sputum should be a routine.4-month plan(6 to 9 months) is desirable to treat these patients.

 

 

　　【Key words】 tuberculosis;lung;sputum negative and cultivating sputum negative

 

　　据目前国内外掌握的材料表明：尚有相当数量(大约50%～70%)痰涂片阴性病例存在［1］,然而在结核病控制工作中，客观上也必然面临这一部分病人，这部分病人是否是传染源，是否需要治疗，是值得研究的问题［2］，回顾本院5年间收治住院初治涂阴培阴肺结核523例，就其临床特点、诊断和治疗分析如下。

 

　　1 临床资料

 

　　1991～1995年间收治住院的肺结核病人，男396例，女127例，男女比为3：1，平均年龄35.4岁（16～82岁），其中16～40岁322例占61.6%，41～60岁99例占18.9%，61岁以上102例占19.5%。咳嗽347例占66.3%，发热84例占16%，咯血112例占21.4%，胸痛27例占5.1%，乏力202例占38.6%，盗汗94例占17.9%，气短21例占4%，无症状体检发现14例占2.7%。X线表现结节状阴影209例占40%，片絮状阴影329例占62.9%，空洞47例占9%，团块状阴影7例占1.3%，球状阴影12例占2.3%。病变在1个肺野264例占50.5%，2个肺野227例占43.4%，3个以上肺野32例占6.1%。单侧肺318例占60.8%，双侧肺205例占39.2%。实验室检查血沉增快330例占63%，PCR仅检查49例其中12例阳性24%，PPD试验380例，强阳性47例12.4%，一般阳性321例84.4%，阴性12例3.2%。痰涂及痰培养疗前至疗末均为阴性，随访1年其中2例涂阳培阴，1例涂阴培阳。全部病例给予H、R、S、Z、E中以H、R为主的三联或四联常规剂量抗痨治疗，疗程分4月、6月、9月，疗程结束时全部病例症状改善，X线示病灶吸收好转，临床治愈率100%，随访1年复发6例。痰检每月痰涂片3次，疗前、疗中及疗末痰培养各1次均为阴性。X线片均经主任医师、主治医师及住院医师集体读片，排除其它疾病诊断活动性肺结核并作动态观察，随诊1年，观察临床症状、X线变化、痰涂片、痰培养均有完整的记载。