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目的探讨老年慢性阻塞性肺病(COPD)长期应用糖皮质激素并发肺结核的临床特点及斯普林的辅助治疗作用。方法回顾性分析9例2008年COPD长期应用糖皮质激素并发肺结核的临床表现、X线、实验室及诊治情况,并与10例非COPD的老年肺结核患者对照分析。结果9例患者临床表现主要为咳嗽、咳痰,而发热、盗汗远少于非COPD组。X线表现不典型,多为双肺病变,抗酸杆菌阳性率22%,与非COPD组相近(20%),差异无统计学意义(P>0.05);PPD阳性率(22%)远低于非COPD组(50%),差异有统计学意义(P<0.005)。结论老年COPD长期应用糖皮质激素并发肺结核的临床表现不典型,抗酸杆菌阳性率高,PPD阳性率较低。因此,尽早诊断和治疗是重要的。与抗结核药联合,提高免疫辅助治疗,应用斯普林可增进抗结核药的疗效,改善患者自身细胞免疫功能。
Objective To investigate the clinical features of long-term glucocorticoid-associated pulmonary tuberculosis (COPD) in elderly patients with chronic obstructive pulmonary disease (COPD) and the adjuvant therapeutic effect of Spring. Methods The clinical manifestations, X-ray, laboratory and diagnosis and treatment of 9 chronic obstructive pulmonary disease (COPD) patients with COPD in 2008 were analyzed retrospectively. The data were compared with 10 non-COPD elderly patients with pulmonary tuberculosis. Results The clinical manifestations of 9 patients were mostly cough and sputum, while fever and night sweats were far less than those in non-COPD patients. X-ray was not typical, mostly lung disease, acid-fast bacilli positive rate of 22%, and non-COPD group (20%), the difference was not statistically significant (P> 0.05); PPD positive rate In non-COPD group (50%), the difference was statistically significant (P <0.005). Conclusion The clinical manifestations of long-term use of glucocorticoid-associated pulmonary tuberculosis in elderly COPD are not typical, the positive rate of acid-fast bacilli is high, and the positive rate of PPD is low. Therefore, early diagnosis and treatment are important. In combination with anti-TB drugs to improve immune adjuvant therapy, the application of Spring can enhance the efficacy of anti-TB drugs and improve their own cellular immune function.