[1]鄭賢義,許艷麗,張紀勛.社區獲得性肺炎初診為肺結核復發的臨床特點及誤診原因分析[J].醫學信息,2020,(04):97-100.[doi:10.3969/j.issn.1006-1959.2020.04.029]
 ZHENG Xian-yi,XU Yan-li,ZHANG Ji-xun.Clinical Characteristics and Misdiagnosis of Community-acquired Pneumonia at the First Diagnosis of Tuberculosis Recurrence[J].Medical Information,2020,(04):97-100.[doi:10.3969/j.issn.1006-1959.2020.04.029]
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社區獲得性肺炎初診為肺結核復發的臨床特點及誤診原因分析()
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醫學信息[ISSN:1006-1959/CN:61-1278/R]

卷:
期數:
2020年04期
頁碼:
97-100
欄目:
論著
出版日期:
2020-02-15

文章信息/Info

Title:
Clinical Characteristics and Misdiagnosis of Community-acquired Pneumonia at the First Diagnosis of Tuberculosis Recurrence
文章編號:
1006-1959(2020)04-0097-04
作者:
鄭賢義許艷麗張紀勛
(白河縣人民醫院內一科,陜西 白河 725899)
Author(s):
ZHENG Xian-yiXU Yan-liZHANG Ji-xun
(Department of Internal Medicine,Subject One,People’s Hospital of Baihe County,Baihe 725899,Shaanxi,China)
關鍵詞:
肺結核復發社區獲得性肺炎免疫指標
Keywords:
Recurrence of tuberculosisCommunity-acquired pneumoniaImmune indicators
分類號:
R563.1
DOI:
10.3969/j.issn.1006-1959.2020.04.029
文獻標志碼:
A
摘要:
目的 分析社區獲得性肺炎初診為肺結核復發的臨床特點及誤診原因,以期為基層臨床醫師診斷及鑒別診斷活動性肺結核、非活動性肺結核及社區獲得性肺炎提供參考。方法 回顧性分析2017年1月~2018年7月白河縣人民醫院收治的51例初診為肺結核復發且最終診斷為社區獲得性肺炎的患者作為研究組,另收集同期51例既往無肺結核病史的社區獲得性肺炎患者作為對照組,比較兩組病程、影像學、實驗室檢查及治療效果。結果 研究組病程≥2周、院外抗感染治療占比高于對照組比較,差異有統計學意義(P<0.05)。研究組結節影、樹芽征、纖維條索影、鈣化檢出率高于對照組比較,差異均有統計學意義(P<0.05);兩組實變影、毛玻璃影、空洞征、支氣管擴張、胸腔積液、淋巴腫大檢出率比較,差異無統計學意義(P>0.05)。研究組C反應蛋白、超敏C反蛋白、血沉陽性率低于對照組,PPD及結核抗體的陽性率高于對照組,差異均有統計學意義(P<0.05);兩組白細胞計數、中性粒細胞陽性率比較,差異無統計學意義(P>0.05)。治療后,研究組不適癥狀緩解時間長于對照組,肺部病變吸收率低于對照組,差異有統計學意義(P<0.05)。結論 病程較長、急性感染指標不高、肺部影像多樣化、結核感染相關免疫指標呈陽性及肺部病變吸收延時等原因可能是非活動性肺結核并發社區獲得性肺炎易誤診為肺結核復發的原因,應當引起臨床醫師重視。
Abstract:
Objective To analyze the clinical characteristics and misdiagnosis reasons of community-acquired pneumonia at the initial diagnosis of tuberculosis recurrence, in order to provide reference for primary clinicians to diagnose and differentially diagnose active tuberculosis, inactive tuberculosis and community-acquired pneumonia. Methods A retrospective analysis was performed on 51 patients who were newly diagnosed with tuberculosis and eventually diagnosed as community-acquired pneumonia from Baihe County People’s Hospital from January 2017 to July 2018 as a study group. Another 51 patients with community-acquired pneumonia who had no previous history of tuberculosis were collected as the control group, the course of disease, imaging, laboratory examination, and treatment effects were compared between the two groups. Results The duration of disease in the study group was ≥2 weeks, and the proportion of out-of-hospital anti-infective treatment was higher than that of the control group,the difference was statistically significant(P<0.05). The detection rates of nodular shadow, tree bud sign, fiber strand shadow, and calcification were higher in the study group than in the control group,the differences were statistically significant (P<0.05); the two groups were consolidation shadows, ground glass shadows, cavitation signs, and bronchi,there was no significant difference in the detection rates of dilatation, pleural effusion, and lymphadenopathy (P>0.05). The positive rates of C-reactive protein, high-sensitivity C-reactive protein, and ESR in the study group were lower than those in the control group, and the positive rates of PPD and tuberculosis antibodies were higher than those in the control group,the differences were statistically significant (P<0.05).There was no significant difference in white blood cell count and neutrophil positive rate between the two groups (P> 0.05). After treatment, the relief time of discomfort was longer in the study group than in the control group, and the lung lesion absorption rate was lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion Longer course, low acute infection index, diversified pulmonary imaging, positive immune index related to tuberculosis infection, and delayed absorption of pulmonary lesions may be the reasons for inactive tuberculosis complicated with community-acquired pneumonia which is easily misdiagnosed as recurrence of tuberculosis Should attract the attention of clinicians.

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