结核病与肺部健康杂志 ›› 2017, Vol. 6 ›› Issue (3): 270-274.doi: 10.3969/j.issn.2095-3755.2017.03.000

• 综述 • 上一篇    下一篇

结核相关阻塞性肺疾病稳定期的诊治研究

徐伟,武丽娟,沈宁,曹文利   

  1. 100095北京老年医院结核病诊治管理中心(徐伟、曹文利);山西医科大学第二临床医学院(武丽娟);北京大学第三医院呼吸科(沈宁)
  • 收稿日期:2017-03-30 出版日期:2017-09-30 发布日期:2017-09-30
  • 作者简介:曹文利

Progress in diagnosis and treatment in tuberculosis patients associated chronic obstructive pulmonary disease

XU Wei*, WU Li-juan, SHEN ning, CAO Wen-li   

  1. Tuberculosis Diagnosis and Treatment Management Center of Beijing Geriatric Hospital, Beijing 100095,China
  • Received:2017-03-30 Online:2017-09-30 Published:2017-09-30

摘要: 结核相关阻塞性肺疾病(tuberculosis associated obstructive pulmonary disease,TOPD)是一种常见的慢性气道炎症反应,以老年结核病患者多见。主要表现为早期可以预防和治疗,后期则以不完全可逆的持续性气流受限并伴有进行性加重。作者通过对TOPD相关危险因素、发病机制、误漏诊原因、诊断和治疗方法的文献复习与分析,认为TOPD发病患者男性居多,52%为非吸烟人群,以老年患者多见;该病本身具有结核病与慢性阻塞性肺疾病(COPD)两种疾病的发病特征,其患者较COPD患者更易发生咯血,且其用力肺活量(FVC)和一秒用力呼气容积(FEV1)/FVC值更低;且TOPD患者对于支气管扩张剂的反应较差,气道受限的不可逆性增加;伴有气流受限的TOPD患者较不伴有气流受限的患者更易发展为急性加重期。诊断应根据有结核病患者密切接触史、临床症状及体征、实验室检查等资料综合分析,重点应是对病因的确定;积极进行基于综合治疗的原则的患者呼吸康复训练。

Abstract: The tuberculosis associated COPD(TOPD) () as a common chronic airway inflammation is mostly found in elderly patients . TOPD may be prevented and treated in early stage , but in late stage,it presents as irreversible persistent airflow limitation followed by progressive exacerbation . Through literature review and analyses of TOPD risk factor, pathogenesis, missed diagnoses and misdiagnoses, and methods of diagnosis and treatment , We draw the following conclusions:TOPD patients were mostly male, 52% in nonsmokers, and the majority was elderly patients. TOPD had the clinical characteristics of tuberculosis and COPD, and hemoptysis was more common symptom in TOPD patients than in COPD patients, and its FVC and FEV1/FEV values were lower in TOPD patients than in COPD patients; TOPD had poor response to bronchodilators, and irreversible airway resistance was serious; TOPD patients with airflow limitation were more prone to acute exacerbation than those without airflow limitation . TOPD diagnosis should be made comprehensively based on the history of tuberculosis contacts, clinical symptoms and signs, and laboratory tests .It’s important to identify the etiologies. pulmonary rehabilitation should be done actively according to combined modality therapy.