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目的提高对以肺间质性改变为主要表现的肺结核的认识。方法报道1例2011年确诊的以肺间质改变为主要表现的肺结核患者的临床资料、诊治经过及随访情况,并进行相关文献复习。以“间质,肺结核”为检索词通过万方医学数据库对中文文献检索,以“interstitial,pulmonary tuberculosis”为检索词通过Pub Med数据库进行检索,检索时间截至2014年5月。结果患者女,31岁,因“咳嗽6个月,加剧伴气促20余天”为主诉入院。入院前曾误诊为“慢性咽炎、慢性支气管炎、支气管哮喘”。入院查胸部CT显示双肺可见广泛性肺间质改变,并出现散在斑片影,边界模糊,部分病灶呈磨玻璃样。经纤维支气管镜于右肺下叶基底段肺活检(TBLB):肉芽肿炎伴小灶性坏死,考虑结核。异烟肼、利福平、吡嗪酰胺、乙胺丁醇(HRZE)规则抗结核治疗后,咳嗽、气促渐缓解,病灶渐吸收,随访至今29个月,未见复发。在万方医学数据库上检索到相关文献13篇,1例为个案报道,其余多为误诊分析或影像表现研究;在Pub Med数据库检索,国外未见相关报道。结论以间质性改变为主要表现的肺结核好发于中青年男性,亚急性病程,临床症状不典型,以咳嗽、呼吸困难、发热最为常见,胸部CT是早期诊断的关键,网格样改变、小叶间隔增厚、小叶中心性结节、胸膜受累、树芽状是活动性间质性肺结核主要影像学表现。当与肺部弥漫性疾病难以鉴别时,经纤维支气管镜及CT引导下肺穿刺术取得组织病理学是诊断的关键,必要时可考虑行外科开胸活检术。
Objective To raise awareness of pulmonary tuberculosis, a major manifestation of pulmonary interstitial lung disease. Methods The clinical data, diagnosis, treatment and follow-up of one pulmonary tuberculosis patient whose pulmonary interstitial changes were confirmed as major manifestations in 2011 were reported and the related literatures were reviewed. We searched the Chinese documents through the Wanfang medical database using the term “interstitial and pulmonary tuberculosis” and searched the Pub Med database using the search term “interstitial, pulmonary tuberculosis”. The search time was up to May 2014. Results Female patient, 31 years old, due to “cough for 6 months, exacerbated with qi for 20 days ” as the main complaint hospitalization. Have been misdiagnosed as “chronic pharyngitis, chronic bronchitis, bronchial asthma ” before admission. Chest CT examination showed extensive lung interstitial lungs seen changes in the lungs, scattered patchy shadow appears, blurred border, some lesions were ground glass. Bronchoscopy in the right lower lobe basal segment lung biopsy (TBLB): granulomatous inflammation with focal necrosis, consider tuberculosis. Isoniazid, rifampin, pyrazinamide, ethambutol (HRZE) regular anti-TB treatment, cough, qi promote gradual relief, the lesion gradually absorbed, up to now 29 months, no recurrence. There were 13 articles retrieved from Wanfang medical database, one case was reported and the others were misdiagnosis analysis or imaging study. There were no reports in Pub Med database. Conclusions Pulmonary tuberculosis with interstitial changes mainly occurs in middle-aged and young men. Subacute course and atypical clinical symptoms are the most common. Cough, dyspnea and fever are most common. Chest CT is the key to early diagnosis. Mesh-like changes, Interlobular septal thickening, centrilobular nodules, pleura involvement, tree bud is the main imaging manifestations of active interstitial tuberculosis. When diffuse lung disease is difficult to identify, by bronchoscopy and CT-guided lung biopsy to obtain histopathology is the key to diagnosis, if necessary, can be considered underwent surgical thoracotomy.