【作者】 林兆原； 彭得虎； 吴碧彤； 冯永忠； 罗立全； 蔡智群；

【Author】 Lin Zhaoyuan,Peng Dehu,Feng Wu Bitong,et al. Guangzhou Chest Hospital,Guangzhou 510095,China

【机构】 广州市胸科医院；

【摘要】 目的探讨结核性胸膜炎抗结核治疗过程中出现以肺内结节影为表现的矛盾反应的临床特点,减少误诊。方法回顾分析抗结核治疗过程中出现肺内结节影6例结核性胸膜炎的部位、合并肺结核情况、出现肺内结节影的时间及影象学特点、临床表现、实验室检查等临床特点。结果 6例结核性胸膜炎右侧4例,左侧2例,有3例合并肺结核;出现肺内结节影的时间在2～4月,多数在2～3月(4/6例);影像学显示出现在同侧和单发的多见(均为4/6例),结节影均靠近外周胸膜下或叶间裂旁;临床表现均没有明显的发热、胸痛加剧,没有胸液增多;实验室检查显示白细胞正常,癌胚抗原(CEA)正常。结论结核性胸膜炎抗结核治疗2～4月中新出现肺内结节影,病灶靠近外周胸膜下或叶间裂旁,胸液基本吸收,没有肿瘤、炎症、耐药等依据,应首先考虑矛盾反应,维持原方案治疗。更多还原

【Abstract】 Objective:To investigate the clinic characteristics of pulmonary tubercle as a conflict response occurred during anti-tuberculosis treatment of tuberculous pleurisy,aim to reduce misdiagnosis. Methods:Retrospective analysis of 6 patients with pulmonary tubercle through where the pleurisy parts was,whether accompanied with pulmonary tuberculosis,when would pulmonary tubercle appear after treatment and Imageology characteristics,clinical presentation,laboratory clinical features.Results:4 patients with tuberculous pleurisy in the right side,left in 2 cases;3 cases accompanied with pulmonary tuberculosis;emergence of lung tubercle in 2 to 4 months time,most of them in 2 to 3 months(4/6 cases); image Studies showed tubercles were common in the same side and single(both 4/6 cases),tubercles are close to the peripheral subpleural or leaves of the split side;no obvious clinical manifestations are fever,chest pain increased,no increase in pleural fluid;Laboratory examination showed normal white blood cells, carcinoembryonic antigen(CEA) is normal.Conclusion:Pulmonary tubercle emerged during anti-TB treatment for 2 to 4 months to cure tuberculous pleurisy.The characteristics were lesions closed to the peripheral subpleural or interlobar fissure,fundamental absorption of pleural fluid,there was no evidences with cancer,inflammation,drug resistance.and so on,you should first consider the contradictory reactions to maintain the original regimen.更多还原