结核与肺部疾病杂志 ›› 2022, Vol. 3 ›› Issue (2): 110-117.doi: 10.19983/j.issn.2096-8493.20210152

• 论著 • 上一篇    下一篇

北京市某综合医院呼吸科病房肺结核患者特征及转诊情况分析

郭华征1(), 邢振川2   

  1. 1首都医科大学附属北京潞河医院感染性疾病科,北京 101100
    2首都医科大学附属北京潞河医院呼吸与危重症医学科,北京 101100
  • 收稿日期:2021-12-07 出版日期:2022-06-30 发布日期:2022-04-18
  • 通信作者: 郭华征 E-mail:15901103355@163.com

Analysis of characteristics, diagnosis and referral of pulmonary tuberculosis in respiratory wards of a general hospital in Beijing

GUO Hua-zheng1(), XING Zhen-chuan2   

  1. 1Department of Infectious Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China
    2Pulmonary and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China
  • Received:2021-12-07 Online:2022-06-30 Published:2022-04-18
  • Contact: GUO Hua-zheng E-mail:15901103355@163.com

摘要:

目的: 分析综合医院呼吸科病房肺结核患者特征和诊断转诊情况,为早期发现肺结核患者并转诊至结核病防治机构提供帮助。方法: 收集2018年5月至2020年1月首都医科大学附属北京潞河医院呼吸科病房诊断为肺结核(包括疑似患者、临床诊断患者和确诊患者)的68例患者,出院后进行随访,其中57例于结核病定点医院或结核病防治所诊断为肺结核(包括临床诊断和确诊患者)。采用描述性方法对57例肺结核患者(观察组)资料进行统计分析,并与同期收治的114例非肺结核患者(对照组)进行对比。结果: 57例肺结核患者中,男性33例,女性24例;年龄范围为20~93岁,≥60岁的患者占比较高,达到61.4%(35/57)。临床症状以咳嗽最常见(51例,89.5%),其次为咳痰(44例,77.2%)、胸闷气短(32例,56.1%)和乏力(30例,52.6%)等。入院诊断以胸腔积液待查(17例,29.8%)、肺炎(16例,28.1%)和肺内阴影待查(15例,26.3%)为主,最常见的合并疾病为低蛋白血症(20例,35.1%)。肺结核的诊断依据主要依靠特殊细菌抗酸杆菌染色(26例,45.6%)和结核分枝杆菌核酸检测(24例,42.1%);支气管肺泡灌洗液样本检测阳性率(91.3%,21/23)高于痰液(19.6%,9/46)、支气管镜刷片(17.1%,7/41)和胸腔积液(10.0%,2/20)标本;胸部CT扫描报告肺结核3例,报阳率为5.3%。肺结核患者就诊延迟率为24.6%(14/57),诊断延迟率为43.9%(25/57)。出院诊断为肺结核的68例患者中,54例通过转诊至结核病定点医院确诊,3例通过转诊至结核病防治所确诊,6例通过转诊至结核病定点医院排除肺结核;2例临床诊断患者因症状轻未按要求转诊至结核病防治机构诊治;3例为临时来京人员,联系失败,具体转诊及确诊情况不详。观察组与对照组患者对比结果显示,观察组患者消瘦[33.3%(19/57)]、胸痛[31.6%(18/57)]、单侧胸腔积液[45.6%(26/57)]、肺内实变影[33.3%(19/57)]、气管狭窄[14.0%(8/57)]等症状明显高于对照组[分别为14.9%(17/114)、16.7%(19/114)、12.3%(14/114)、14.0%(16/114)、2.6%(3/114)],差异均有统计学意义(χ2=12.108,P=0.001;χ2=3.958,P=0.047;χ2=23.561,P=0.000;χ2=8.694,P=0.003;χ2=23.561,P=0.008)。结论: 综合医院呼吸科病房肺结核患者以老年人为主,通过胸部CT影像筛查肺结核阳性率低,消瘦、胸痛、单侧胸腔积液、肺内实变影及气管狭窄等特征对临床鉴别具有一定参考价值。

关键词: 医院, 综合, 结核, 肺, 疾病特征, 对比研究

Abstract: Objective: To analyze the characteristics of pulmonary tuberculosis (PTB) patients and diagnosis and referral in respiratory wards of general hospital, in order to provide help for early detection of PTB patients and referral to tuberculosis (TB) prevention and control institutions. Methods: A total of 68 PTB patients (including presumptive cases, clinically diagnosed cases and confirmed cases) diagnosed in the respiratory wards of Beijing Luhe Hospital from May 2018 to January 2020 were collected. After discharge, 57 cases were diagnosed as PTB (including clinical diagnosis and confirmed cases) in TB designated hospitals or TB control dispensaries. We descriptively analyzed data of 57 PTB patients, and compared them with the data of 114 cases with PTB related symptoms and excluding PTB diagnosis in the same period. Results: Among the 57 PTB patients, 33 were males and 24 were females, aged from 20 to 93 years old, and the proportion of patients ≥60 years old was the highest, accounting for 61.4% (35/57). The most common clinical symptoms were cough (51 cases, 89.5%), followed by expectoration (44 cases, 77.2%), chest tightness and shortness of breath (32 cases, 56.1%) and fatigue (30 cases, 52.6%). The main diagnosis on admission was pleural effusion (17 cases, 29.8%), pneumonia (16 cases, 28.1%) and lung shadow of unknown origin (15 cases, 26.3%), and the most common complication was hypoproteinemia (20 cases, 35.1%). The diagnosis of PTB mainly depended on acid-fast staining of specific bacteria (26 cases, 45.6%) and nucleic acid detection of Mycobacterium tuberculosis (24 cases, 42.1%). The positive rate of bronchoalveolar lavage fluid samples (91.3% (21/23)) was higher than that of sputum (19.6% (9/46)), tracheoscope brushes (17.1% (7/41)) and pleural effusion (10.0% (2/20)); Chest CT examination reported 3 cases of pulmonary tuberculosis, and the positive rate was 5.3%. The proportion of patient delay rate among PTB patients was 24.6% (14/57), while the proportion of diagnosis delay was 43.9% (25/57). Among the 68 patients discharged with PTB, 54 cases were referred to TB designated hospitals and finally confirmed, 3 cases were referred to TB control dispensaries and finally confirmed, 6 cases were referred to TB designated hospitals and excluded, 2 cases with mild symptoms were not referred to TB control dispensaries as required, 3 cases temporary visitors to Beijing were lost to follow up with unknown referral and diagnosis details. The comparison of two groups showed that patients with PTB had higher proportions of emaciation (33.3% (19/57)), chest pain (31.6% (18/57)), unilateral pleural effusion (45.6% (26/57)), pulmonary consolidation (33.3% (19/57)), tracheal stenosis (14.0% (8/57)) than those of control group (14.9% (17/114), 16.7% (19/114), 12.3% (14/114), 14.0% (16/114), 2.6% (3/114)), the differences were statistically significant (χ 2=12.108, P=0.001; χ 2=3.958, P=0.047; χ 2=23.561, P=0.000; χ 2=8.694, P=0.003; χ 2=23.561, P=0.008). Conclusion: PTB patients in respiratory wards of general hospital are mainly elderly people, the positive rate of PTB screened through chest CT images is low. Emaciation, chest pain, unilateral pleural effusion, intrapulmonary consolidation and tracheal stenosis etc. have certain reference value for clinical diagnosis.

Key words: Hospitals, general, Tuberculosis, pulmonary, Disease attributes, Comparative study

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