以不明原因发热为首发表现的肺外结核23例临床分析

摘要

目的 总结以不明原因发热(FUO)为首发表现的肺外结核(EPTB)的临床特征及诊断策略.方法 回顾性分析2013年3月—2017年4月首都医科大学附属北京友谊医院诊治的FUO患者23例临床资料,均以FUO为首发临床表现,且出院时均确诊为肺外结核,总结临床特征及诊断策略.结果入院后查红细胞沉降率升高17例,结核感染T细胞斑点试验检测18例中阳性13例,抗结核抗体检测16例中阳性5例、结核菌素试验14例中强阳性8例、影像学检查16例患者中病灶部位结核相关改变6例、病理学检查8例中阳性5例.23例患者中,泌尿系结核3例(13.0%),淋巴结结核3例(13.0%),结核性心包积液3例(13.0%),腰椎结核2例(8.7%),肠结核、腹膜结核、结核性脑膜脑炎、髋关节结核、女性盆腔结核、肾结核、胸壁结核各1例(各4.3%),肺外结核(感染部位不明)5例(21.7%).23例患者中,经抗结核药物治疗21例,其中二联抗结核治疗(HE或HZ方案)7例,三联抗结核治疗(HRE方案)9例,四联抗结核方案(HRSE、HRZE或HRZS方案)5例;未予抗结核治疗2例,直接转入专科医院治疗.结论以FUO为首发表现的肺外结核具有发病隐匿、病因多样、病程长、确诊困难等特点.对FUO患者给予经验性抗感染疗效欠佳时应考虑肺外结核的可能.%Objective To summarize the clinical characteristics and diagnostic strategy of extra-pulmonary tuberculo-sis (EPTB) whose initial manifestation is fever of unknown origin (FUO). Methods Retrospectively analyzed the clinical data of 23 patients of FUO who were hospitalized in Beijing Friendship Hospital during March 2013 to April 2017 and diag-nosed as EPTB. Results After admission,17 cases of erythrocyte sedimentation rate were increased. T cell spot test for tu-berculosis infection was detected in 13 of 18 cases. Positive 5 cases of 16 cases of anti-tuberculosis antibody test, tuberculin test in 14 cases of strong positive 8 cases,6 cases of tuberculosis related change of the lesion site in 16 patients with imaging examination, pathological examination of 8 cases of positive 5 cases. In 23 patients, 3 cases of urinary tuberculosis (13.0%),tuberculous lymphadenopathy in 3 cases(13.0%),3 cases of tuberculous pericardial effusion(13.0%),2 ca-ses of lumbar tuberculosis (8.7%), intestinal tuberculosis, peritoneal tuberculosis, tuberculous meningitis, tuberculosis of the hip joint,pelvic tuberculosis,renal tuberculosis,chest wall tuberculosis with 1 case respectively (4.3%), tuberculosis (infection unknown) of 5 cases(21.7%).In 23 patients,21 cases were treated with anti-tuberculosis drugs,including 7 ca-ses of HE or HZ,9 cases of HRE plan,5 cases of HRSE, HRZE or HRZS,2 cases were not treated with anti-tuberculosis treatment,and transferred directly to specialist hospitals. Conclusion EPTB With FUO as the first manifestation has the characteristics of incidence hidden,long duration and the diagnosis difficult. When Experiential anti-infection treatment is less effective,EPTB should be considered.