摘要：
目的 了解肝脏结核的临床特征.方法 对1例肝结核患者的临床表现、实验室检查结果、治疗及预后进行分析, 并以"Liver/Hepatology/Hepatic Tuberculosis"为关键词, 检索2013-2017年Pubmed数据库关于肝结核的文献, 筛选并总结分析肝结核患者的临床资料.结果 该例16岁男性患者以咳嗽、腹胀为主要表现, 痰查抗酸杆菌阳性, CT提示肝脏低密度占位性病变, 经抗结核治疗后病变消失, 最终考虑血行播散性结核所致肝结核.通过文献复习并结合本例患者, 共64例患者, 其中男38例, 女26例, 年龄11月龄～77岁, 合并其他部位结核或存在基础疾病者39例, 主要临床表现有:发热33例(51.6％)、腹痛32例(50.0％)、体重下降20例(31.2％)、食欲减退16例(25.0％)、疲乏无力14例(21.9％)和恶心/呕吐13例(20.3％), CT表现主要为肝脏局部低密度占位性病变, 59例患者经病理/细菌学诊断, 5例患者经诊断性抗结核治疗有效后诊断.治愈36例, 好转19例, 死亡3例.结论 肝结核临床症状不典型, 影像学结合肝脏病理组织学检查是诊断肝结核的主要方法, 抗结核治疗及适时手术治疗为有效治疗手段, 预后大多良好.%Objective To understand the clinical features of hepatic tuberculosis. Methods The clinical manifestations, laboratory findings, treatment, and prognosis of a case of hepatic tuberculosis were analyzed. Similar cases were identified from PubMed database during the period from 2013 to 2017 using search terms "Liver/Hepatology/Hepatic Tuberculosis". The clinical data of the identified patients with hepatic tuberculosis were reviewed and analyzed. Results The 16-year-old male patient presented with cough and abdominal distension. His sputum was positive for acid-fast bacillus. CT showed low-density spaceoccupying lesions. After anti-tuberculosis treatment, the lesion disappeared. Hepatic tuberculosis was finally considered, which was caused by disseminated tuberculosis. Literature search identified 63 similar cases. In summary, the 64 cases(containing this one)included 38 males and 26 females with age from 11 months to 77 years. Tuberculosis in other site or underlying disease was found in 39 cases. The main clinical manifestations were fever(51.6％), abdominal pain(50.0％), weight loss(31.2％), loss of appetite(25.0％), tiredness/weakness(21.9％), and nausea/vomiting(20.3％). Low-density space-occupying lesions were the main features on CT image. The diagnosis was confirmed by histopathological and/or bacteriological testing in 59 patients. Five patients were diagnosed after diagnostic anti-tuberculosis treatment was effective. Overall, 36 patients were cured, 19 improved, and 3 died.Conclusions The clinical symptoms of hepatic tuberculosis are atypical. Imaging combined with histopathological examination of the liver is the preferred method for diagnosis of hepatic tuberculosis. Anti-tuberculosis treatment and timely surgical treatment is usually effective with good outcomes.
