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目的:对以高热为主要表现的痰菌阴性肺结核43例患者临床特点、实验室检查、影像学特征及治疗进行分析。方法:对2006年1月至2013年3月在我院住院的232例确诊为肺结核患者病例进行回顾性分析。结果:(1)发病年龄较轻:患者平均年龄为(45.8±19.5)岁,其中21~49岁22例,男性多见,男女比例为2.5∶1。(2)临床表现不典型:无明显午后低热、盗汗、消瘦等结核中毒症状。(3)影像学表现不典型:胸部CT示磨玻璃样改变、大叶性实变、空气支气管征等,病变部位不在典型的肺结核常见部位如上叶尖后段或下叶背段。(4)误诊情况:误诊为肺炎35例,支气管肺癌5例,肺脓肿1例,韦格纳肉芽肿1例,间质性肺疾病1例。(5)治疗情况:所有患者入院前不同程度给予常规抗感染治疗,确诊后给予正规抗结核治疗后病变大部分吸收好转。结论:对以高热、咳痰、痰找抗酸杆菌阴性及淋巴结肿大、胸部CT表现呈不典型肺结核的患者应排除菌阴肺结核,使用多种有效检查方式明确诊治,治疗上应慎用喹诺酮类及利奈唑胺类抗生素。
OBJECTIVE: To analyze the clinical features, laboratory tests, imaging features and treatment of 43 sputum negative pulmonary tuberculosis cases characterized by high fever. Methods: A retrospective analysis of 232 cases diagnosed as pulmonary tuberculosis in our hospital from January 2006 to March 2013 was performed. Results: (1) The younger age of onset: The average age of the patients was (45.8 ± 19.5) years old, of which 22 cases were 21 to 49 years old. The male common was 2.5: 1. (2) Clinical manifestations atypical: no obvious afternoon low fever, night sweats, weight loss and other symptoms of tuberculosis. (3) imaging findings are not typical: chest CT showed ground glass-like changes, lobar consolidation, bronchial air sign, the lesion is not typical of the common parts of the pulmonary tuberculosis such as the posterior segment of the posterior segment or lower back. (4) Misdiagnosis: 35 cases were misdiagnosed as pneumonia, 5 bronchogenic carcinoma, 1 lung abscess, 1 Wegener’s granulomatosis and 1 interstitial lung disease. (5) Treatment: All patients were given conventional anti-infective treatment before admission, and most of the lesions were recovered after the diagnosis of regular anti-TB treatment. Conclusion: For patients with high fever, expectoration, sputum looking negative for acid-fast bacillus and lymph nodes, patients with atypical pulmonary tuberculosis manifesting in chest CT should exclude bacteria of the genitourinary pulmonary tuberculosis. The patients should be diagnosed and treated with many effective examinations. Quinolone should be used with caution And linezolid antibiotics.