老年慢性阻塞性肺疾病合并肺结核的临床特点及诊治体会

摘要

目的 探讨老年慢性阻塞性肺疾病(COPD)合并肺结核的临床特点,总结诊治体会.方法 回顾性分析70例老年COPD合并肺结核患者的合并症、个人史、既往史、主要临床表现、辅助检查结果、临床诊断情况、治疗与预后等临床资料.结果 70例患者中,有吸烟史者占72.9%,既往有肺结核接触史或肺结核病史者占47.2%,有糖皮质激素用药史者占40.0%;合并症较常见,以合并贫血、蛋白质营养不良及糖尿病为主;结核菌素纯化蛋白衍生物皮试强阳性率仅为2.9%;痰结核分枝杆菌涂片及培养阳性率较低(分别为7.1%、14.3%);影像学检查提示病灶位于双肺者占94.3%,位于好发部位者仅占25.7%;误诊及漏诊率达49.6%;抗结核药物不良反应发生率为38.6%,肺结核治愈率为67.1%.结论 老年COPD合并肺结核的临床症状不典型,合并症多,误诊、漏诊率高,预后不良,应引起临床医师的重视.%Objective To investigate the clinical characteristics of elderly patients with chronic obstructive pulmonary disease(COPD) complicated with pulmonary tuberculosis,and to summarize the experience in diagnosis and treatment.Methods The clinical data of 70 elderly patients with COPD complicated with pulmonary tuberculosis were retrospectively analyzed,including complications,personal history,past history,main clinical manifestation,accessory examination results,clinical diagnosis,therapy and prognosis,etc.Results Of 70 patients,72.9%,47.2% and 40.0% of patients had smoking history,history of contact with tuberculosis or history of tuberculosis,and history of receiving glucocorticoid therapy,respectively.Complications were common in 70 patients,and mainly included anemia,protein malnutrition and diabetes.Strong positive rate of tuberculin purified protein derivation test was only 2.9%.The positive rates of sputum smear and culture for Mycobacterium tuberculosis were low(7.1% and 14.3% respectively).The imaging result showed that lesions located in bilateral lung and predilection sites were found in 74.3% and 25.7% of patients respectively.The misdiagnosis and missed diagnosis rate was 49.6% in total.The adverse reaction rate of antituberculosis drugs was 38.6%,and the cure rate of pulmonary tuberculosis was 67.1%.Conclusion Elderly patients with COPD complicated with pulmonary tuberculosis have atypical symptoms,more complications,high misdiagnosis and missed diagnosis rates,and poor prognosis,which should be highly emphasized by clinicians.