慢性阻塞性肺疾病急性加重合并活动性肺结核的临床特点分析及早期诊断探讨

发布时间：2018-05-05 08:24

本文选题：慢性阻塞性肺疾病急性加重 + 活动性肺结核　；参考：《石河子大学》2017年硕士论文

【摘要】：目的:通过对慢阻肺急性加重(AECOPD)合并活动性肺结核(PTB)患者的临床症状、感染学指标、痰涂片抗酸染色和痰培养检出结核菌阳性率、肺CT结核病灶累及部位及范围、营养指标、合并症这6个方面的回顾性分析,总结此类患者的临床特点,以探讨早期诊断线索。方法:收集2006年1月至2016年10期间入住我院的AECOPD合并PTB患者80例,列为A组,同期住院的单纯AECOPD患者166例,列为B组,单纯PTB患者152例,列为C组。分别对比分析A组与B组之间、A组与C组之间的临床症状(咳嗽、咳痰、咯血/痰血、胸闷/气促、胸痛、发热、乏力、盗汗)、感染学指标[白细胞计数(WBC)、中性粒细胞百分比(N%)、C反应蛋白(CRP)、红细胞沉降率(ESR)、淋巴细胞百分比(L%)]、营养学指标[体质指数(BMI)、淋巴细胞计数(TLC)、血清白蛋白(ALB)、血红蛋白(Hb)]、合并症(心力衰竭、心房颤动、高血压病、肺癌、2型糖尿病)的差异,同时对比分析A组与C组之间痰涂片抗酸染色和痰培养检出结核菌阳性率及肺CT结核病灶累及部位及范围(双肺、两叶及两叶以上、上叶尖后段及下叶背段、后基底段、前部肺叶)的差异。结果:临床症状上,A组发热及盗汗的发生率较B组高(45%vs21.68%;10%vs2.4%),咳嗽、咳痰、胸闷/气促发生率较C组高(95%vs74.34%;90%vs61.18%;82.5%vs22.37%),痰血/咯血发生率较C组低(6.25%vs27.63%),差异有统计学意义(P0.05)。感染指标中,A组C反应蛋白计数及红细胞沉降率较B组高[28.8(8.8,63.97)vs 11.6(2.6,36.7);37(21.5,53.5)vs 11(5,25)],淋巴细胞计数百分比较C组低[18.5(10.02,25.2)vs 21.24(13.05,27.67)],差异有统计学意义(P0.05)。A组痰涂片抗酸染色和痰培养阳性率较C组低(16.25%vs34.87%),病灶累及双肺、累及两叶及两叶以上的发生率较C组高(67.5%vs49.34%;75%vs55.26%),累及典型结核好发部位的发生率较C组低(48.75%vs63.8%;27.5%vs48.68%),差异有统计学意义(P0.05)。营养指标中,A组体质指数、血清白蛋白、血红蛋白较B组低[22.44(20.41,24.8)vs 24.33(22.29,26.19);36.4(31.4,41.1)vs 39.2(37,43.1);134(121.2,144)vs 141(129,154)],淋巴细胞计数较C组低[1.1(0.8,1.4)vs 1.4(0.9,1.8)],血红蛋白较C组高[134(121.2,144)vs 127(116,141)],差异有统计学意义(P0.05)。合并症方面,A组2型糖尿病的发生率较B组高(27.5%vs15.06%),高血压的发病率较B组低(30%vs 48.8),心力衰竭、肺癌、2型糖尿病的发生率均较C组高(21.25 vs 1.32;10%vs 0.6%;27.5 vs 9.87),差异有统计学意义(P0.05)。结论:慢阻肺急性加重合并活动性肺结核患者临床以慢阻肺的呼吸道症状为主,结核中毒症状仅发热和盗汗稍多见,感染指标中C反应蛋白及红细胞沉降率较高,但痰涂片阳性率低,病灶以累及双肺、多肺叶浸润为主,典型结核感染灶少见,合并症以2型糖尿病较多见,且营养状态较差,故临床应对各项资料进行综合评估,必要时完善其他检查协助早期诊断。
[Abstract]:Objective: to detect the positive rate of tuberculosis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with active pulmonary tuberculosis (PTB) by means of clinical symptom, infection index, acid-fast staining of sputum smear and sputum culture. In order to explore the early diagnosis clue, the clinical features of these patients were summarized by retrospective analysis of these 6 aspects. Methods: from January 2006 to October 2016, 80 patients with AECOPD combined with PTB in our hospital were divided into group A, group B, group B and group C, respectively. The clinical symptoms (cough, expectoration, hemoptysis / sputum, chest tightness / shortness of breath, chest pain, fever, fatigue) between group A and group B were analyzed. Nocturnal sweating, Infectious Index [WBC count, neutrophil percentage, erythrocyte sedimentation rate, lymphocyte percentage], nutritional index [BMI BMIA, lymphocyte count TLCN, serum albumin ALB, blood red)] Hb], complicated (heart failure, heart failure, heart failure, heart failure, heart failure, heart failure, heart failure, The difference of atrial fibrillation, hypertension and type 2 diabetes mellitus of lung cancer was also analyzed. The positive rate of tuberculous bacilli in sputum smear and sputum culture was compared between group A and group C. The difference between the two lobes and more than two lobes, the posterior segment of the upper apex and the dorsal segment of the lower lobe, the posterior basal segment, and the anterior lobe of the lung. Results: the incidence of fever and night sweating in group A was higher than that in group B (45 vs 21.68). The incidence of cough, expectoration, chest tightness / shortness of breath was 95vs74.3490 vs 61.180.The incidence of sputum / hemoptysis was lower than that of group C (6.25vs27.6345). The count of C-reactive protein and erythrocyte sedimentation rate in group A were higher than those in group B [28.8M8.8C 63.97 vs 11.62.6N 36.6N 36.7U 36.7N 36.7U 321.5fU 53.5 vs 1155.25], and the percentage of lymphocyte in group A was lower than that in group C [18.510.0225.2vs 21.2413.0527.67], and the difference was statistically significant (P 0.05A vs group C) in acid-fast staining and positive rate of sputum culture in group A (P < 0.05), and the positive rate of sputum culture in group A was significantly higher than that in group C (P < 0.05), and the positive rate of anti-acid staining and sputum culture in group A was significantly higher than that in group C (P < 0.05). The lesion involves both lungs. The incidence of more than two lobes involved in group C was higher than that in group C (67.5 vs 49.34 and 75 vs 55.265.265.75), and the incidence of typical tuberculosis was lower than that in group C (48.75 vs 63.8%, 27.5V / s 48.68). The difference was statistically significant (P 0.05). Body mass index (BMI), serum albumin and hemoglobin in group A were lower than those in group B [22.44A 20.41n 24.8 vs 24.3322.292.292.296.431.41.1m vs 39.2n 33.4121.2144vs 141121291544], lymphocyte counts were lower than those in group C [1.110.8nb 1.4 vs 1.40.91.8m], and the hemoglobin levels were higher than those in group C [134(121.2144)vs 127116141]. The difference was statistically significant (P 0.05). The incidence of type 2 diabetes in group A was higher than that in group B (27.5V vs 15.06g). The incidence of hypertension was 30% lower than that of group B (48.8%). The incidence of heart failure and type 2 diabetes with lung cancer was higher than that of group C (21.25 vs 1.321010 vs 0.6.5 vs 9.875.The difference was significant (P 0.05). Conclusion: the main clinical symptoms of COPD patients with active pulmonary tuberculosis are chronic obstructive pulmonary disease (COPD). The symptoms of tuberculosis poisoning are only fever and night sweating. The C-reactive protein (CRP) and erythrocyte sedimentation rate are higher in the infection index. But the positive rate of sputum smear was low, the focus was involved in both lungs, multiple lobar infiltration was the main focus, typical tuberculosis infection was rare, the complication was type 2 diabetes mellitus, and the nutritional status was poor, so the clinical data should be comprehensively evaluated. Improve other examinations as necessary to assist in early diagnosis.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9;R521

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