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目的探讨骨髓结核的危险因素、临床特点、诊断、治疗反应及预后,以提高对本病的认识。方法回顾性分析2004年1月至2014年12月四川大学华西医院收治的62例通过骨髓活检诊断骨髓结核的患者资料,包括临床表现、实验室资料、辅助检查、病理检查、治疗及预后随访等。结果本组患者中,男34例,女28例,发病年龄15~80岁,平均年龄(45.3±35.7)岁。21例(33.9%)伴有慢性疾病及脏器功能不全,包括晚期肾病、肝病、慢性呼吸疾病、风湿免疫系统疾病、糖尿病等。主要临床表现为发热61例(98.4%),症状缺乏特征性。实验室检查中,血常规提示白细胞减少、贫血或者血小板减少者有59例(95.2%),两系或三系同时减少38例(61.3%)。胸部影像学提示典型血行播散型肺结核22例(36.1%),继发性肺结核6例(9.8%),26例(42.6%)无典型结核征象。腹部影像学发现脾脏长大32例(55.2%),肝脏长大16例(27.6%),肝脾同时长大13例(22.4%)。62例患者均行骨髓相关检查,其中53例(85.5%)患者骨髓活检标本中查见肉芽肿病变,57例骨髓活检标本行抗酸染色,28例(49.1%)阳性。25例完成电话随访,因结核及并发症死亡8例。结论骨髓结核是播散性结核的组成部分之一,是肺外结核的少见类型,发热是常见的症状,临床表现及实验室检查缺乏特异性,血常规提示白细胞减少、贫血或者血小板减少,可作为重要线索,骨髓组织活检是确诊本病的主要手段。不明原因发热患者应警惕此病,并尽早完善骨髓活检。由于骨髓结核感染部位的特殊性,常常引起白细胞减少,导致患者合并其他病原体感染,更容易造成不良结局,因此,提高对本病的认识,及早地明确诊断,进行针对性的治疗,有助于改善预后。
Objective To explore the risk factors, clinical features, diagnosis, treatment response and prognosis of bone marrow tuberculosis in order to improve the understanding of this disease. Methods A retrospective analysis of 62 cases of bone marrow tuberculosis diagnosed by bone marrow biopsy from January 2004 to December 2014 in West China Hospital of Sichuan University was performed, including clinical manifestations, laboratory data, laboratory examinations, pathological examination, treatment and follow-up of prognosis . Results In this group of patients, 34 males and 28 females, the age of onset was 15 to 80 years, mean age (45.3 ± 35.7) years. Twenty-one patients (33.9%) had chronic diseases and organ dysfunction, including advanced kidney disease, liver disease, chronic respiratory disease, rheumatic immune system disease and diabetes. The main clinical manifestations of fever in 61 cases (98.4%), the lack of symptoms characterized. In the laboratory tests, 59 patients (95.2%) showed leukopenia, anemia or thrombocytopenia in their blood tests, and 38 (61.3%) reduced them in both systems. Thoracic imaging revealed typical hematogenous disseminated tuberculosis in 22 cases (36.1%), secondary tuberculosis in 6 cases (9.8%) and 26 cases (42.6%) without typical signs of tuberculosis. Abdominal imaging revealed 32 cases of spleen enlargement (55.2%), 16 cases of liver enlargement (27.6%) and 13 cases (22.4%) of growth of liver and spleen at the same time. Sixty-two patients underwent bone marrow-related examination. Granuloma lesions were seen in 53 (85.5%) bone marrow biopsy specimens. Fifty-seven bone marrow biopsy specimens were stained with acid-fast staining and 28 (49.1%) were positive. 25 cases completed telephone follow-up, due to tuberculosis and complications of death in 8 cases. Conclusions Bone marrow tuberculosis is one of the components of disseminated tuberculosis. It is a rare type of extrapulmonary tuberculosis. Fever is a common symptom. Clinical manifestations and laboratory tests lack specificity. Blood tests suggest leukopenia, anemia or thrombocytopenia. As an important clue, bone marrow biopsy is the main means of diagnosis of the disease. Patients with unexplained fever should be wary of the disease and improve bone marrow biopsy as soon as possible. Due to the specificity of the site of bone marrow tuberculosis infection, often lead to leukopenia, leading to other patients with pathogen infection, more likely to cause adverse outcomes, therefore, to improve understanding of the disease, early diagnosis and targeted treatment, contribute to Improve the prognosis.