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目的通过测定肺结核患者的血清纤维化四项指标,探讨肺结核继发肺纤维化的早期诊断意义,以及与规范抗结核治疗的关系。方法根据既往病史把痰涂片阳性活动性结核患者分为初治组、复治组。根据螺旋CT肺部病变的性质分为A组,血行播散型肺结核组8例;B组,继发性肺结核组78例;C组,结核性胸膜炎组21例;D组,阴性对照组为门诊治愈或稳定的肺结核病患者33例,肺内病变以纤维条索为主。进行透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原肽(PC-Ⅲ)、Ⅳ型胶原蛋白(Ⅳ-C)的测定。结果 D组患者血清纤维化指标结果正常,活动性结核(A、B、C组)患者各项纤维化指标均升高,与D组比较,差异有统计学意义(P<0.05)。活动性结核中C组与A组、B组血清纤维化指标检测结果差异有统计学意义(P<0.05),而A组与B组之间差异无统计学意义(P>0.05)。复治涂阳患者HA、PC-Ⅲ与初治涂阳患者相比差异有统计学意义(P<0.05)。结论肺结核早期即有纤维化的发生,其程度与肺结核病程长短及炎症程度成正比;控制复发率是降低肺结核继发肺纤维化的关键因素。
Objective To determine the significance of early diagnosis of pulmonary fibrosis secondary to pulmonary tuberculosis by measuring the four indicators of serum fibrosis in patients with pulmonary tuberculosis as well as the relationship with standard anti-TB therapy. Methods According to the past history of sputum smear positive active tuberculosis patients were divided into the initial treatment group, rehabilitation group. According to the characteristics of spiral CT pulmonary lesions were divided into group A, hematogenous disseminated pulmonary tuberculosis group of 8 patients; B group, secondary pulmonary tuberculosis group of 78 patients; C group, tuberculous pleurisy group of 21 patients; D group, negative control group Outpatients cured or stable in 33 cases of pulmonary tuberculosis, pulmonary fibrosis in the main cable-based disease. Hyaluronic acid (HA), laminin (LN), type Ⅲ procollagen peptide (PC-Ⅲ) and type Ⅳ collagen (Ⅳ-C) were measured. Results The serum fibrosis indexes of patients in group D were normal, and all the fibrosis indexes of patients with active tuberculosis (group A, B and C) were higher than those in group D (P <0.05). There were significant differences in serum fibrosis markers between group C and group A and group B (P <0.05), but there was no significant difference between group A and group B (P> 0.05). There was significant difference between HA and PC-Ⅲ patients with smear-positive smear-positive smears and those with smear-positive smears (P <0.05). Conclusion The occurrence of fibrosis in early stage of pulmonary tuberculosis is proportional to the course of tuberculosis and the degree of inflammation. Controlling the recurrence rate is the key factor to reduce secondary pulmonary fibrosis in pulmonary tuberculosis.