试验性抗结核治疗之冷思考

发布时间：2018-05-31 15:59

本文选题：试验 + 治疗　；参考：《医学争鸣》2014年06期

【摘要】：试验性抗结核治疗的本质是菌阴肺结核及肺外结核的诊断问题。试验性抗结核治疗是一种行之有效但有潜在风险的鉴别诊断方法,缺乏相应的标准、指南、专家共识等规范性文件的指导,临床上仍以专家的个人经验为主,极不规范,误诊、漏诊时有发生。我们根据临床体会,对诊断性抗结核治疗适应证的初步建议如下:1肺结核疑似病例,诊断性抗感染治疗方案治疗10天无效者;2肺结核疑似病例,T.SPOT.TB阳性者;3临床诊断病例;4不明原因发热(FUO),T.SPOT.TB阳性者;5多发性浆膜腔积液,初步排除结缔组织病和肿瘤或T.SPOT.TB阳性者;6出现意识障碍和/或神经、精神症状,高度怀疑结核性脑膜炎者。在临床实践中,一定要严格遵照诊疗程序,对确诊的病例要果断地采取针对性的抗结核治疗;对疑似病例和临床诊断病例要慎重地采取试验性的抗结核治疗,并继续积极地寻找细菌学、病理学依据,严密观察病情变化,严格地定期监测肝功能。
[Abstract]:The essence of experimental anti-tuberculosis therapy is the diagnosis of bacterial-negative pulmonary tuberculosis and extrapulmonary tuberculosis. Experimental anti-tuberculosis therapy is an effective but potentially risky method for differential diagnosis, lacking the guidance of normative documents, such as standards, guidelines, expert consensus, etc. The clinical practice is still dominated by the individual experience of experts, which is extremely irregular and misdiagnosed. Missed diagnosis occurs from time to time. According to our clinical experience, the preliminary suggestions for the indication of diagnostic anti-tuberculosis treatment are as follows: 1 suspected case of tuberculosis, Diagnostic anti-infective therapy regimen was used to treat 10 days of ineffective pulmonary tuberculosis suspected cases with T. SPOT.TB positive. 3 Clinical diagnosis of FUOOTTB / TSPOT.TB positive patients with multiple serous cavity effusion, FUOOTTB / TSPOT.TB positive cases, and the clinical diagnosis of FUOOTTB / TSPOT.TB positive cases. Primary exclusion of connective tissue disease and tumor or T.SPOT.TB positive patients with consciousness disorders and / or neurological symptoms, highly suspected tuberculous meningitis. In clinical practice, we must strictly follow the procedures for diagnosis and treatment, and resolutely take targeted anti-tuberculosis treatment for confirmed cases; and carefully take experimental anti-tuberculosis treatment for suspected cases and clinically diagnosed cases. And continue to actively search for bacteriological, pathological basis, closely observe the changes of the disease, strictly regular monitoring of liver function.
【作者单位】：新疆医科大学研究生院;新疆医科大学第一附属医院呼吸科;
【基金】：新疆重大疾病医学重点实验室开放课题项目(SKLIB-XJMDR-2012-2)
【分类号】：R521

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