【摘要】 目的 探讨和分析气管支气管结核(TBTB)患者的临床特点。方法 回顾性分析2015年1—12月首次在广州市胸科医院住院治疗并行支气管镜检查、资料完整的727例TBTB患者的临床特征、影像学表现、分型特点和细菌学检查情况,并对不同性别之间TBTB分型的差异及不同性别累及支气管数量的差异进行比较。结果 并发TBTB的肺结核患者占同期住院治疗并行支气管镜检查肺结核患者的14.3%(727/5071)。727例患者中,累及3个及以上肺野者545例(75.0%,545/727),出现空洞者397例(54.6%,397/727),并发肺不张者194例(26.7%,194/727)。TBTB主要累及右上支气管者230例(31.6%,230/727)、左上支气管者203例(27.9%,203/727)、左主支气管者105例(14.4%,105/727);女性累及2个及以上支气管者130例(37.6%,130/346),高于男性的86例(22.6%,86/381),差异有统计学意义(x~2=19.54,P<0.01)。TBTB分型中,所占比率较高的类型为Ⅰ型(50.2%,365/727)、Ⅳ型(39.9%,290/727)和Ⅱ型(34.4%,250/727),其中男性患者Ⅰ型比率(61.9%,236/381)高于女性(37.3%,129/346),差异有统计学意义(x~2=44.11,P<0.01);Ⅱ型(26.5%,101/381)及Ⅳ型(33.3%,127/381)的比率均低于女性[分别为43.1%(149/346)和47.1%(163/346)],差异均有统计学意义(x~2值分别为22.02、14.35,P值均<0.01)。727例患者中,痰涂片抗酸染色或结核分枝杆菌培养阳性455例,占62.6%(455/727)。结论 肺结核患者并发TBTB较常见,患者肺部病灶广泛,常伴空洞形成,痰菌阳性率高,主要累及双上支气管及左主支气管,Ⅰ型、Ⅳ型、Ⅱ型发生率较高。更多还原

【Abstract】 Objective To explore clinical characteristics of tracheobronchial tuberculosis(TBTB).Methods A total of 727 hospitalized TBTB patients checked by bronchoscopy in Guangzhou Chest Hospital from January 2015 to December 2015 were retrospectively analyzed.The clinical characteristics,image features,subtypes,bacteriological test,and differences of subtypes and number of involved bronchi were compared.Results There were 727 cases with tracheobronchial tuberculosis,accounted for 14.3%(727/5071) of the total number of tuberculosis at the same period.Tuberculosis focus involved 3 or more lung fields in 545 cases(75.0%,545/727),cavity in 397 cases(54.6%,397/727),and 194 patients(26.7%,194/727) were combined with atelectasis.TBTB involved upper right bronchial in 230 cases(31.6%,230/727),upper left bronchus in 203 cases(27.9%,203/727) and the left main bronchus in 105 cases(14.4%,105/727).Among female patients,the tuberculosis lesions involved 2 or more bronchus in 130 cases(37.6%,130/346),which was significantly higher than the male cases(22.6%,86/381;x~2 = 19.54,P<0.01).As to subtype,365 cases were of TBTB type Ⅰ(50.2%,365/727),290 cases(39.9%,290/727) were of type Ⅳ,and 250 cases(34.4%,250/727) were of type Ⅱ.The rate of type Ⅰ was 61.9%(236/381) in male cases,which was significantly higher than that in female patients(37.3%(129/346);x~2=44.11,P<0.01);and rates of typesⅡU and Ⅳin male were significantly lower than those in female(26.5%(101/381) vs.43.1%(149/346),x~2=22.02,F<0.01)(33.3%(127/381) vs.47.1%(163/346),x~2 = 14.35,P<0.01).There were 455 cases(62.6%,455/727) with smear positive or Mycobacterium tuberculosis culture positive.Conclusion TBTB is common in patients with pulmonary tuberculosis,the lung fields involved were more in most of them,and accompanied with cavity formation,positive sputum bacteria.Bilateral upper bronchus and the left main bronchus were usually involved in patients with TBTB.The type Ⅰ,type Ⅳ,and type Ⅱ were often usually.更多还原