發(fā)布時(shí)間：2018-05-05 08:24

  本文選題：慢性阻塞性肺疾病急性加重 + 活動(dòng)性肺結(jié)核　； 參考：《石河子大學(xué)》2017年碩士論文

【摘要】：目的:通過對(duì)慢阻肺急性加重(AECOPD)合并活動(dòng)性肺結(jié)核(PTB)患者的臨床癥狀、感染學(xué)指標(biāo)、痰涂片抗酸染色和痰培養(yǎng)檢出結(jié)核菌陽性率、肺CT結(jié)核病灶累及部位及范圍、營養(yǎng)指標(biāo)、合并癥這6個(gè)方面的回顧性分析,總結(jié)此類患者的臨床特點(diǎn),以探討早期診斷線索。方法:收集2006年1月至2016年10期間入住我院的AECOPD合并PTB患者80例,列為A組,同期住院的單純AECOPD患者166例,列為B組,單純PTB患者152例,列為C組。分別對(duì)比分析A組與B組之間、A組與C組之間的臨床癥狀(咳嗽、咳痰、咯血/痰血、胸悶/氣促、胸痛、發(fā)熱、乏力、盜汗)、感染學(xué)指標(biāo)[白細(xì)胞計(jì)數(shù)(WBC)、中性粒細(xì)胞百分比(N%)、C反應(yīng)蛋白(CRP)、紅細(xì)胞沉降率(ESR)、淋巴細(xì)胞百分比(L%)]、營養(yǎng)學(xué)指標(biāo)[體質(zhì)指數(shù)(BMI)、淋巴細(xì)胞計(jì)數(shù)(TLC)、血清白蛋白(ALB)、血紅蛋白(Hb)]、合并癥(心力衰竭、心房顫動(dòng)、高血壓病、肺癌、2型糖尿病)的差異,同時(shí)對(duì)比分析A組與C組之間痰涂片抗酸染色和痰培養(yǎng)檢出結(jié)核菌陽性率及肺CT結(jié)核病灶累及部位及范圍(雙肺、兩葉及兩葉以上、上葉尖后段及下葉背段、后基底段、前部肺葉)的差異。結(jié)果:臨床癥狀上,A組發(fā)熱及盜汗的發(fā)生率較B組高(45%vs21.68%;10%vs2.4%),咳嗽、咳痰、胸悶/氣促發(fā)生率較C組高(95%vs74.34%;90%vs61.18%;82.5%vs22.37%),痰血/咯血發(fā)生率較C組低(6.25%vs27.63%),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。感染指標(biāo)中,A組C反應(yīng)蛋白計(jì)數(shù)及紅細(xì)胞沉降率較B組高[28.8(8.8,63.97)vs 11.6(2.6,36.7);37(21.5,53.5)vs 11(5,25)],淋巴細(xì)胞計(jì)數(shù)百分比較C組低[18.5(10.02,25.2)vs 21.24(13.05,27.67)],差異有統(tǒng)計(jì)學(xué)意義(P0.05)。A組痰涂片抗酸染色和痰培養(yǎng)陽性率較C組低(16.25%vs34.87%),病灶累及雙肺、累及兩葉及兩葉以上的發(fā)生率較C組高(67.5%vs49.34%;75%vs55.26%),累及典型結(jié)核好發(fā)部位的發(fā)生率較C組低(48.75%vs63.8%;27.5%vs48.68%),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。營養(yǎng)指標(biāo)中,A組體質(zhì)指數(shù)、血清白蛋白、血紅蛋白較B組低[22.44(20.41,24.8)vs 24.33(22.29,26.19);36.4(31.4,41.1)vs 39.2(37,43.1);134(121.2,144)vs 141(129,154)],淋巴細(xì)胞計(jì)數(shù)較C組低[1.1(0.8,1.4)vs 1.4(0.9,1.8)],血紅蛋白較C組高[134(121.2,144)vs 127(116,141)],差異有統(tǒng)計(jì)學(xué)意義(P0.05)。合并癥方面,A組2型糖尿病的發(fā)生率較B組高(27.5%vs15.06%),高血壓的發(fā)病率較B組低(30%vs 48.8),心力衰竭、肺癌、2型糖尿病的發(fā)生率均較C組高(21.25 vs 1.32;10%vs 0.6%;27.5 vs 9.87),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:慢阻肺急性加重合并活動(dòng)性肺結(jié)核患者臨床以慢阻肺的呼吸道癥狀為主,結(jié)核中毒癥狀僅發(fā)熱和盜汗稍多見,感染指標(biāo)中C反應(yīng)蛋白及紅細(xì)胞沉降率較高,但痰涂片陽性率低,病灶以累及雙肺、多肺葉浸潤為主,典型結(jié)核感染灶少見,合并癥以2型糖尿病較多見,且營養(yǎng)狀態(tài)較差,故臨床應(yīng)對(duì)各項(xiàng)資料進(jìn)行綜合評(píng)估,必要時(shí)完善其他檢查協(xié)助早期診斷。
[Abstract]:Objective: to detect the positive rate of tuberculosis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with active pulmonary tuberculosis (PTB) by means of clinical symptom, infection index, acid-fast staining of sputum smear and sputum culture. In order to explore the early diagnosis clue, the clinical features of these patients were summarized by retrospective analysis of these 6 aspects. Methods: from January 2006 to October 2016, 80 patients with AECOPD combined with PTB in our hospital were divided into group A, group B, group B and group C, respectively. The clinical symptoms (cough, expectoration, hemoptysis / sputum, chest tightness / shortness of breath, chest pain, fever, fatigue) between group A and group B were analyzed. Nocturnal sweating, Infectious Index [WBC count, neutrophil percentage, erythrocyte sedimentation rate, lymphocyte percentage], nutritional index [BMI BMIA, lymphocyte count TLCN, serum albumin ALB, blood red)] Hb], complicated (heart failure, heart failure, heart failure, heart failure, heart failure, heart failure, heart failure, The difference of atrial fibrillation, hypertension and type 2 diabetes mellitus of lung cancer was also analyzed. The positive rate of tuberculous bacilli in sputum smear and sputum culture was compared between group A and group C. The difference between the two lobes and more than two lobes, the posterior segment of the upper apex and the dorsal segment of the lower lobe, the posterior basal segment, and the anterior lobe of the lung. Results: the incidence of fever and night sweating in group A was higher than that in group B (45 vs 21.68). The incidence of cough, expectoration, chest tightness / shortness of breath was 95vs74.3490 vs 61.180.The incidence of sputum / hemoptysis was lower than that of group C (6.25vs27.6345). The count of C-reactive protein and erythrocyte sedimentation rate in group A were higher than those in group B [28.8M8.8C 63.97 vs 11.62.6N 36.6N 36.7U 36.7N 36.7U 321.5fU 53.5 vs 1155.25], and the percentage of lymphocyte in group A was lower than that in group C [18.510.0225.2vs 21.2413.0527.67], and the difference was statistically significant (P 0.05A vs group C) in acid-fast staining and positive rate of sputum culture in group A (P < 0.05), and the positive rate of sputum culture in group A was significantly higher than that in group C (P < 0.05), and the positive rate of anti-acid staining and sputum culture in group A was significantly higher than that in group C (P < 0.05). The lesion involves both lungs. The incidence of more than two lobes involved in group C was higher than that in group C (67.5 vs 49.34 and 75 vs 55.265.265.75), and the incidence of typical tuberculosis was lower than that in group C (48.75 vs 63.8%, 27.5V / s 48.68). The difference was statistically significant (P 0.05). Body mass index (BMI), serum albumin and hemoglobin in group A were lower than those in group B [22.44A 20.41n 24.8 vs 24.3322.292.292.296.431.41.1m vs 39.2n 33.4121.2144vs 141121291544], lymphocyte counts were lower than those in group C [1.110.8nb 1.4 vs 1.40.91.8m], and the hemoglobin levels were higher than those in group C [134(121.2144)vs 127116141]. The difference was statistically significant (P 0.05). The incidence of type 2 diabetes in group A was higher than that in group B (27.5V vs 15.06g). The incidence of hypertension was 30% lower than that of group B (48.8%). The incidence of heart failure and type 2 diabetes with lung cancer was higher than that of group C (21.25 vs 1.321010 vs 0.6.5 vs 9.875.The difference was significant (P 0.05). Conclusion: the main clinical symptoms of COPD patients with active pulmonary tuberculosis are chronic obstructive pulmonary disease (COPD). The symptoms of tuberculosis poisoning are only fever and night sweating. The C-reactive protein (CRP) and erythrocyte sedimentation rate are higher in the infection index. But the positive rate of sputum smear was low, the focus was involved in both lungs, multiple lobar infiltration was the main focus, typical tuberculosis infection was rare, the complication was type 2 diabetes mellitus, and the nutritional status was poor, so the clinical data should be comprehensively evaluated. Improve other examinations as necessary to assist in early diagnosis.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.9;R521

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本文編號(hào)：1846953