98例老年性结核性腹膜炎的临床特点分析

发布时间：2018-09-14 10:07

【摘要】：目的：通过分析近9年来遵义医学院附属医院（我院）及遵义市第一人民医院60岁及以上的结核性腹膜炎患者的临床特点，探讨其诊疗方法，力求及时诊断，减少误诊、漏诊率。方法：选取遵义医学院附属医院（我院）2005年2月至2014年2月60岁及以上结核性腹膜炎病例45例，以及遵义市第一人民医院同期60岁及以上结核性腹膜炎病例53例，共计98例，集中对其临床表现、辅助检查、误诊及漏诊情况进行回顾性分析、总结。结果：老年性结核性腹膜炎患者多以腹痛、腹胀就诊，其中腹痛约占83.67%，腹胀者约占81.63%，不同程度发热者约占37.75%，纳差、乏力者约占77.55%，只有8.16%-21.43%的患者伴有腹泻、便秘、恶心、盗汗、消瘦表现。查体检出有腹部柔韧感者约占33.67%，有腹腔积液体征者约占76.53%，腹部压痛者约占83.67%，腹部包块者约占3.06%。辅助检查提示：腹水常规、生化检查提示外观均为淡黄色或无色浑浊液体，白细胞数＞500×106/L占95.58%，淋巴细胞为主占86.76%，李凡他试验阳性占91.18%，腹水ADA＞45U/L占85.29%，腹水蛋白＞30g/L占82.35%，同期腹水蛋白/血清蛋白＞0.5占82.35%，同期腹水LDH/血清LDH＞0.6占82.35%。血沉增快者约占60.20%，血红蛋白下降者约占66.32%，低蛋白血症者约占82.65%，血清CA125增高者约占81.63%，抗结核抗体阳性者约占2.04%。给予抗痨治疗后总有效率高达95.59%。98例中有误诊13例及漏诊病例2例共15例，约占15.31%。98病例中男女比例为1：1.08，60-69岁62例，70-79岁28例，80岁及以上8例，合并腹膜外结核者25例，约占25.51%。结论：（1）60岁及以上老年人群并非结核腹膜炎的好发人群，性别差异不显著，男女比例接近，男：女为1:1.08。（2）合并腹膜外结核病例约占25.51%，其中以肺结核居多。（3）老年人群罹患结核性腹膜炎者以低热、盗汗典型结核中毒症状就诊者比例很少，该类患者往往多以腹痛、腹胀为首发或主要症状就诊。超过90%患者合并不同程度腹腔积液。（4）腹腔积液细菌培养及腹膜活检对结核性腹膜炎有确诊意义，但在老年人群受检率低，腹水常规、生化检查，血沉、腹水腺苷脱氨酶（ADA）等检查仍是综合判断诊断的常用有效辅助检查。（5）老年性结核性腹膜炎误诊率、漏诊率较高，不易与其他疾病鉴别时，可进行试验性抗痨治疗，以免延误病情或导致病情恶化。（6）观察腹水、血清CA125、血沉的变化可用于判断治疗的有效性。（7）联合使用口服抗痨药治疗老年性结核性腹膜炎仍是较有效的治疗手段。
[Abstract]:Objective: to analyze the clinical characteristics of tuberculous peritonitis patients aged 60 years and above in affiliated Hospital of Zunyi Medical College and the first people's Hospital of Zunyi City in recent 9 years, and to explore the methods of diagnosis and treatment in order to make timely diagnosis and reduce misdiagnosis. Missed diagnosis rate Methods: Forty-five cases of tuberculous peritonitis aged 60 years and above and 53 cases of tuberculous peritonitis aged 60 years and above in the first people's Hospital of Zunyi Medical College from February 2005 to February 2014 were selected. The clinical manifestations, auxiliary examination, misdiagnosis and missed diagnosis were reviewed and summarized. Results: patients with senile tuberculous peritonitis were treated with abdominal pain, abdominal distension, abdominal pain accounted for 83.67, abdominal distension about 81.63, fever about 37.75, anorexia and fatigue about 77.55. Only 8.16-21.43% of the patients had diarrhea, constipation, nausea, night sweating. Wasting performance. The results showed that the abdominal flexibility was about 33.67m, the abdominal effusion was 76.53, the abdominal tenderness was 83.67, and the abdominal mass was 3.06. Auxiliary examination hint: ascites routine, biochemical examination indication appearance are all light yellow or colorless turbid liquid, The white blood cell count > 500 脳 10 ~ 6 / L accounted for 95.58%, the number of lymphocytes was 86.76, the positive rate of Li Fan test was 91.18, the ascites ADA > 45U/L was 85.29m, the ascites protein > 30g/L was 82.35, the ascites protein / serum protein > 0.5 was 82.35, and the ascites LDH/ serum LDH > 0.6 was 82.35. Erythrocyte sedimentation rate increased rapidly (60.20%), hemoglobin decreased (66.32%), hypoproteinemia (82.65%), serum CA125 increased (81.63%), anti-tuberculosis antibody positive (2.04%). The total effective rate was 95.59.98 cases misdiagnosed in 13 cases and missed diagnosis in 2 cases (15 cases). The ratio of male to female in 15.31.98 cases was 1: 1.0860-69 years old, 62 cases were 70-79 years old, 28 cases were 80 years old or above, 25 cases (25.51%) were complicated with extraperitoneal tuberculosis. Conclusion: (1) the elderly aged 60 years and above are not the most susceptible people with tuberculosis peritonitis, the sex difference is not significant, and the ratio of male and female is close. Male: female: 1: 1.08. (2) the incidence of extraperitoneal tuberculosis is about 25.51, of which tuberculosis is the most common. (3) the elderly people with tuberculous peritonitis suffer from low fever and few patients with typical symptoms of nocturnal sweating. Abdominal distension was the first or main symptom. More than 90% of the patients were complicated with different degrees of peritoneal effusion. (4) bacterial culture and peritoneal biopsy of peritoneal effusion were significant in diagnosis of tuberculous peritonitis, but in the elderly, the rate of detection was low, ascites routine, biochemical examination, erythrocyte sedimentation rate, Ascites adenosine deaminase (ADA) is still an effective assistant examination for comprehensive diagnosis. (5) the misdiagnosis rate and missed diagnosis rate of senile tuberculous peritonitis are high. (6) observation of ascites, changes of serum CA125, erythrocyte sedimentation rate can be used to judge the efficacy of treatment. (7) combined use of oral antituberculous drugs in the treatment of senile tuberculous peritonitis is still a more effective treatment.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R526

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