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慢性阻塞性肺疾病合并肺结核51 例临床分析

目的 探讨慢性阻塞性肺疾病( COPD) 合并肺结核的临床特点, 避免临床误诊、漏诊。方法 对岐山县医院呼吸内科从2010 年6 月至2012 年3 月收治的51 例COPD 合并肺结核患者进行回顾性分析。结果 COPD 合并肺结核占同期住院COPD 患者的28%。该病多见于老年人( 80. 4% ) 。结核中毒症状出现率低( 23. 5% ) , 临床症状及影像学表现无特异性。易合并支气管结核( 49% ) , PPD阳性率低( 31. 4% ) 。30 例( 58. 8% ) 曾被误诊为其他疾病。结论 随着COPD 患者的逐年增多, COPD合并肺结核的患者也在逐渐增多, 应引起重视。对COPD 急性加重( AECOPD) 、出现原因不明发热及AECOPD 治疗效果不佳患者应加强COPD 患者的结核病筛查, 及时诊断并注意个体化治疗。绝大部分患者预后良好。

胸腔镜下空洞清除术治疗空洞型肺结核

目的　探讨采用胸腔镜下空洞清除术治疗空洞型肺结核的临床效果。　方法　对 72例空洞型肺结核患者行胸腔镜下结核空洞清除术。　结果　 72例中失访 1例 ,治愈 6 9例 ,治愈率 97.2 %。6 0～ 78岁的 5 2例老年患者全部治愈 ;4 2例痰涂片阳性患者随访 1年以上 ,有 4 1例阴转 ,痰菌仍为阳性 1例 ,阴转率 97.6 %。　结论　胸腔镜下空洞清除术治疗空洞型肺结核为一种较好的治疗方法。从流行病学角度看 ,对消除老龄患者这部分传染源 ,该手术方法更有价值。

Video-assisted thoracoscopic lung resection in tuberculosis treatment: A retrospective cohort study

ObjectiveTo investigate the feasibility of video-assisted thoracoscopic surgery (VATS) lung resection in the treatment of tuberculosis.MethodsWe retrospectively analyzed the clinical data of 164 tuberculosis patients who underwent lung resection in Xi'an Chest Hospital from 2013 to 2017. Patients were divided into two groups according to the surgical procedure: a VATS group (85 patients, 56 males and29 females) and a thoracotomy group (79 patients, 52 males and 27 females). The clinical effect of the two groups was compared.Results Compared to the thoracotomy group, the VATS group had less operation time (151.59±76.75 min vs. 233.48±93.89 min, P<0.001), amount of intraoperative blood loss (200.00 ml vs. 600.00 ml, P<0.001), the postoperative drainage (575.00 ml vs. 1 110.00 ml, P=0.001), extubation time (4 d vs. 6 d, P<0.001) and hospital stay (13.00 d vs. 17.00 d, P<0.001). There was no statistical difference in postoperative complications (10 patients vs.17 patients, P=0.092) between the two groups. A total of 97 patients underwent lobectomy, including 36 of the VATS group and 61 of the thoracotomy group. The operation time (211.39±70.88 min vs. 258.20±87.16 min, P=0.008), the intraoperative blood loss (400.00 ml vs. 700 ml, P<0.010), the postoperative drainage (800.00 ml vs. 1 250.00 ml, P=0.001), extubation time (5.00 d vs. 8.00 d, P=0.002) and hospital stay (13.11±4.45 d vs. 19.46±7.74 d, P<0.010) in the VATS group were significantly better than those in the thoracotomy group. There was no statistical difference in postoperative complication rate (4 patients vs. 14 patients, P=0.147) between the two[1], groups.ConclusionCompared with conventional thoracotomy, VATS lung resection has obvious advantages in treatment of tuberculosis, which may be the preferred technique.

Analysis of clinical characteristics between patients with non-tuberculosis mycobacterial pulmonary disease and pulmonary tuberculosis

ObjectiveTo investigate the clinical characteristics of non-tuberculous mycobacterium (NTM) pulmonary disease and pulmonary tuberculosis, as well as the bacterial distribution of NTM pulmonary disease. Methods The bacterial distribution and clinical characteristics of 104 patients with NTM lung disease hospitalized in Jiangxi Provincial People’s Hospital from May 2017 to May 2020 were retrospectively analyzed, as well as the clinicplal characteristics of 155 patients with tuberculosis hospitalized during the same period. Results The age of NTM lung disease group [(60±15) years] was higher than that of tuberculosis group [(55±19) years]. There were statistically significant differences in basic diseases (such as malignant tumor, type 2 diabetes, old tuberculosis, bronchiectasis), laboratory examination (such as blood routine examination, albumin) and chest imaging characteristics between the two groups (P<0.05). There was no significant difference in clinical symptoms (such as cough, sputum or fever) (P>0.05). The common underlying diseases of NTM lung disease were malignant tumor (29%), bronchiectasis (21%), chronic obstructive pulmonary disease (19%), etc. The common clinical symptoms of NTM lung disease included cough, sputum, fever, hemoptysis, chest tightness and shortness of breath, and other non-specific respiratory symptoms. The common manifestations of NTM lung disease on chest high-resolution CT (HRCT) included patchy images (82%), mediastinal lymph node enalargement (35%), pleural thickening (31%), pleural effusion (26%) and other signs. The isolates of NTM included Mycobacterium avium (50%), Mycobacterium intracellulare (21%), Mycobacterium chelonae/abscessus (14%), Mycobacterium fortuitum (5%), Mycobacterium gordonae (4%), Mycobacterium gilvum (3%), and Mycobacterium smegmatis (3%). Multivariate Logistic regression analysis showed that advanced age (OR=1.027) was a risk factor for NTM lung disease. Conclusions The clinical manifestations of NTM lung disease and tuberculosis are similar and difficult to distinguish. For male patients over 60 years old with malignant tumor, old tuberculosis, bronchiectasis and other basic diseases, and the chest HRCT findings are mainly bronchiectasis, NTM lung disease should be actively excluded. There is little difference in clinical manifestations between different strains of NTM lung disease, and the treatment cycle of NTM lung disease is long and easy to be interrupted, requiring enhanced follow-up.

Clinical Analysis of Acquired Immune Deficiency Syndrome with Pulmonary Diseases in Comprehensive Hospitals

【摘要】　目的　探讨综合性医院内获得性免疫缺陷综合征（acquired immune deficiency syndrome，AIDS）患者的肺部表现及其特征。　方法　回顾性分析2006年2月－2009年12月收治的58例AIDS患者肺部病变的临床资料。　结果　58例患者中男47例，女11例，男女比例为4.27∶1；年龄6~78岁，平均43岁，其中lt;50岁者36例，占62.1%，gt;50岁22例，占37.9%。肺部表现是AIDS患者入住综合性医院的常见临床表现，居各种临床表现的首位（占55.2%）。主要有弥漫性肺部疾病和肺结核，分别是21例（36.2%）和23例（39.7%），收治的主要科室是呼吸内科38例（65.5%）和传染科12例（20.7%）；常见的临床症状有发热、咳嗽、活动后气促或呼吸困难；其肺部影像学表现多样，有毛玻璃样变、弥漫性结节影、斑片影、肺内块影或肺内空洞、纤维条索影或伴胸水；其常见伴随症状有口腔溃疡真菌、腹泻或其他消化道症状，及其皮疹、贫血、神经系统症状等；同时也有部分患者合并乙型肝炎病毒/丙型肝炎病毒/梅毒等混合感染。　结论　AIDS的肺部病变是综合性医院住院AIDS患者的主要表现，提高呼吸科医师对AIDS患者肺部表现的认识将有利于AIDS的临床防治。【Abstract】　Objective　To investigate the clinical characteristics of acquired immune deficiency syndrome (AIDS) with pulmonary diseases in comprehensive hospitals.　Methods　The clinical data of 58 cases of AIDS with pulmonary diseases admitted in our hospital from 2006 to 2009 were analysed retrospectively.　Results　Among the patients, there were 47 males and 11 females, and the proportion of the number of males to females was 4.27∶1. Their age ranged from 6 to 78 years old, averaging at 43. Thirty-six patients (62.07%) were under 50 years old; and there were 22 patients (37.93%) aged 50 or above. The pulmonary expression was common in AIDS patients admitted into comprehensive hospitals, occupying the first place in various clinical manifestatiosn (55.24%). Pulmonary expressions of AIDS were mainly diffuse pulmonary diseases and pulmonary tuberculosis, which had 21 (36.21%) and 23 (39.66%) cases respectively. Chief treating departments were Department of Respiratory Medicine (65.52%) and Department of Infective Diseases (20.69%). Its common symptoms included fever, cough, shortness of breath after activities or dyspnea; Its pulmonary image had various manifestations including ground-glass opacity (GGO), diffuse nodal shadow, spot and thin piece shadow, pulmonary chunk shadow or cavity, fibre twigs shadow or/and hydrothorax; Its common combined symptoms included oral cavity ulcer fungus infection, diarrhoea or other digestive tract symptoms, and erythra, anemia, and nervus system symptoms, etc. There were still some other cases of combined viral hepatitis type B, type C, or syphilis.　Conclusion　Pulmonary diseases of AIDS are the main expressions of patients with AIDS in comprehensive hospitals. It will be beneficial to clinical prophylaxis and treatment of AIDS to heighten the knowledge of respiratory physicians on pulmonary expressions of patients with AIDS.

第十二届西南胸部结核外科及胸外科新进展学术研讨会亮点

肺切除术联合化疗治疗耐多药肺结核51例

摘要： 目的 探讨肺切除联合化疗治疗耐多药肺结核的临床应用价值，总结治疗经验。 方法 1999年1月至2007年1月，我科共收治51例主病灶局限于肺叶或单侧全肺的耐多药肺结核患者，男38例，女13例；年龄18～56岁，平均年龄36.5岁。施行肺叶切除术30例，肺叶加同侧肺段切除术或同侧双肺叶切除术11例，全肺切除术10例；分析术后继续抗结核化疗18~24个月的疗效。 结果 51例患者均手术成功，46例完成化疗（18~24个月）后治愈；治疗失败5例，其中3例在疗程最后6个月痰菌仍为阳性，2例于围手术期内死于术后并发症。术后发生并发症12例，其中术后1个月内发生9例：呼吸功能衰竭3例，均经呼吸机辅助呼吸治愈；脓胸3例，2例经胸腔闭式引流治愈，1例术后3周死于多器官功能衰竭；支气管胸膜瘘1例，经留置胸腔引流管3个月后瘘口逐渐闭合治愈；暂时性视力障碍1例，未作特殊处理，1个月后视力恢复正常，急性肺水肿1例，治疗无效死亡。1个月后发生并发症3例：切口感染2例，经开放引流每日换药，行二期缝合伤口Ⅲ/丙愈合；支气管胸膜瘘1例，行胸部肌瓣填塞+胸廓成形术后支气管胸膜瘘再度复发，给予胸壁开放式引流，长期未愈，72个月后因大咯血窒息死亡。 结论 对主病灶局限的耐多药肺结核患者施行肺切除联合抗结核化疗，治愈率高，并发症发生率及病死率均在可接受范围内。

Epidemic Factors and Preventing and Management Countermeasure of Pulmonary Tuberculosis in Zhushan County

Objective　To investigate and analyze the epidemic characteristics and factors of pulmonary tuberculosis (PTB) to provide foundation and make prevention and treatment policy. Methods　Statistical analysis was conducted to analyze the current existing PTB prevention and control data in the Center for Disease Control and Prevention of Zhushan County and corresponding prevention and treatment policy was proposed. Results　Since 1997 when PTB was included into B infectious diseases in Zhushan County, 4 431 cases of PTB had been reported by the end of 2009. Annual reported incidence rate was 74.73 per 100 000 and the disease was found in 17 towns. All seasons witnessed the incidence but winter and summer had more sufferer. The youngest patient was 4 months whereas the oldest was 86 years old. The majority of the patients were from 20 to 59 years old, peasants were the main patients, and the incidence of male was higher than that of female. The use of chemotherapy resulted in a significant decline of PTB death rate. Poor immunity of elder group, population flow caused by poverty, low detection rate of patients and AIDS were the major causes to PTB epidemic. A lack of prevention and treatment in the grassroots hospital and difficulty to fully implement the Directly Observed Treatment, Short-course (DOTS) strategy in remote areas were also bottlenecks to PTB control process. Conclusion　The followings should be performed to improve the quality of DOTS strategy implementation: strengthen the government’s commitment, provide policy and funding safeguard, conduct health education and health promotion widely, reinforce management according to the law, fully implement the DOTS strategy, and fortify the prevention and control construction.

血清降钙素原及C 反应蛋白在社区获得性肺炎和肺结核中的诊断价值

目的 探讨血清降钙素原( PCT) 及C 反应蛋白( CRP) 在社区获得性肺炎( CAP) 和肺结核中的临床应用价值。方法 分析2011 年4 月至2011 年12 月新疆医科大学第一附属医院呼吸内科收住的明确诊断的CAP患者134 例, 同期收住的明确诊断为肺结核患者86 例。收集患者入院24 h 内的血常规、PCT、CRP、红细胞沉降率( ESR) 、病原学等指标。结果 PCT 及CRP在CAP 患者中的水平高于肺结核患者[ PCT: M( Q) 0. 30( 1. 54) 比0. 05( 0. 11) ng/mL, P lt; 0. 01; CRP: M( Q) 57. 85( 87. 43) 比21. 15( 55. 75) mg/L, P lt;0. 01] 。通过ROC 曲线分析, 与CRP 相比, PCT 能较好的区别CAP和肺结核[ PCT 的ROC 曲线下面积0. 736( 95% CI 0. 668 ～0. 803) , CRP 的ROC 曲线下面积为0. 652( 95% CI 0. 576 ～0. 727) ] 。PCT 在肺结核患者痰涂阳与痰涂阴两组中无显著性差异。结论 CAP患者的PCT 及CRP水平较肺结核患者高; 肺结核患者的PCT 水平不高, 对于肺结核痰涂阳及涂阴患者无诊断价值, 但对于结核高发地区有助于区别CAP 与肺结核。

Safety of rifapentine vs. rifampicin for pulmonary tuberculosis: a meta-analysis

Objective To systematically review the safety of rifapentine vs. rifampicin for pulmonary tuberculosis. Methods PubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of rifapentine vs. rifampicin for pulmonary tuberculosis up to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 26 RCTs involving 3 624 cases were included. The results of meta-analysis showed that the rifapentine group was superior to the rifampicin group on the incidence of abnormal liver function (RR=0.31, 95%CI 0.32 to 0.47, P<0.000 01), skin rash occurrence rate (RR=0.24, 95%CI 0.16 to 0.37,P<0.000 01), the incidence of leukopenia (RR=0.41, 95%CI 0.31 to 0.54,P<0.000 01), and the incidence of gastrointestinal reaction (RR=0.46, 95%CI 0.37 to 0.57,P<0.000 01) with statistical significance. Conclusions Current evidence shows that compared with rifampicin, rifapentine can effectively reduce the adverse reactions of patients. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.