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目的分析南战区部队肺结核患者的临床特征,并提出肺结核早期诊断的对策。方法对2008~2012年确诊的146例肺结核患者的临床表现、实验室检查和计算机断层扫描术(compute tomography,CT)影像学等研究数据进行分析。结果肺结核以入伍兵龄在3年内者多见,临床症状以咳嗽、咳痰、胸闷等为主,而潮热、咯血、盗汗、消瘦等症状并不多见(约占30%~15%),约1/3的肺结核患者可无任何症状体征,血沉增快者占40.4%,抗结核抗体阳性占47.9%、结核菌素试验强阳性占28.1%,痰抗酸杆菌和痰结核菌阳性率分别为32.9%和35.6%;CT影像学检查病灶以双上肺多见(占63%)。肺结核分型主要为浸润型肺结核(占97.6%)。初次就诊对肺结核的误诊率为24.7%。结论南战区部队肺结核的临床特点以不典型者多见,早期诊断的关键在于重视和认识肺结核的疫情和临床特点、认真进行与结核杆菌感染相关的实验室检查与鉴别诊断,定期或执行任务之前进行常规胸片检查很有必要。
Objective To analyze the clinical features of pulmonary tuberculosis patients in Southern Theater and put forward the countermeasures of early diagnosis of pulmonary tuberculosis. Methods The clinical data, laboratory tests and computed tomography (CT) radiographs of 146 patients with pulmonary tuberculosis diagnosed from 2008 to 2012 were analyzed. Results The most common clinical symptoms were cough, phlegm and chest tightness. The symptoms of hot flashes, hemoptysis, night sweats and weight loss were uncommon (about 30% -15%), About one-third of patients with tuberculosis can have no symptoms and signs, ESR accounted for 40.4%, anti-TB antibody positive accounted for 47.9%, tuberculin test strong positive accounted for 28.1%, sputum acid-fast bacilli and sputum TB positive rate Respectively, 32.9% and 35.6%; CT imaging lesions were common in both lungs (63%). Tuberculosis type is mainly infiltrative pulmonary tuberculosis (97.6%). The initial diagnosis of tuberculosis misdiagnosis rate was 24.7%. Conclusions The clinical features of tuberculosis in the southern theater are more common in atypical cases. The key to early diagnosis is to pay attention to and recognize the epidemic and clinical features of tuberculosis, to carry out laboratory tests and differential diagnosis related to tuberculosis infection seriously, and to carry out regular or prior tasks For routine chest radiography is necessary.