摘要目的 研究"支气管结核的几点专家共识"(简称专家共识)对支气管结核分型的价值,以及对诊断治疗的指导意义.方法 按照专家共识的分型方法,对天津市海河医院2005年5月至2010年4月确诊的支气管结核288例进行回顾性分析.采用x2检验进行统计学分析.结果支气管结核288例中Ⅰ型(炎症浸润型)138例,占47.9%;Ⅱ型(溃疡坏死型)96例,占33.3%;Ⅲ型(肉芽增殖型)15例,占5.2%;Ⅳ型(瘢痕狭窄型)21例,占7.3%;Ⅴ型(管壁软化型)1例,占0.4%;兼有2种以上(Ⅳ型或Ⅴ型合并其他类型)的混合型17例,占5.9%.288例中青年女性108例,占37.5%;中青年Ⅰ、Ⅱ型患者215例,占74.7%;老年患者19例,占 6.6%.合并继发性肺结核280例,占97.2%;左侧病变107例,右侧病变162例,右上叶支气管受累109例(包括累及右主支气管36例),单纯左上叶固有段支气骨受累58例,左上叶舌段受累10例,左上叶固有段和舌段同时受累3例.胸部CT示气管、支气管局部黏膜增厚116例(40.3%),锯齿状或棘状突起89例(30.9%),支气管闭塞32例(11.1%),支气管局部狭窄253例(87.9%).经支气管镜介入治疗后第1个月痰菌阴转率为60.2%(56/93例),明显高于未经支气管镜介入治疗患者[23.1%(18/78例)].结论 专家共识较准确地反映了支气管结核的病程及描述各型支气骨结核的表现,对治疗支气管结核有一定的指导价值.

abstractsObjective To study the clinical application and significance of the recently published expert consensus on endobronchial tuberculosis (EBTB).Methods A retrospective analysis of 288 cases of EBTB hospitalized in Tianjin Haihe Hospital from May 2005 to April 2010 was carried out.The classification and typing of the disease were based on a consensus report recently published by Chinese Journal of Tuberculosis and Respiratory Diseases.Chi-square test was performed to analyze the differences between groups.Results Of the 288 cases of EBTB,47.9% (138/288) was classified as Type Ⅰ (Inflammatory infiltrative),33.3% (96/288) as Type Ⅱ (ulcerous necrotic),5.2% (15/288) as Type Ⅲ(granulomatous hyperplastic),7.3% (21/288) as Type Ⅳ (scar stricture)and 0.4% (1/288) as Type Ⅴ (Bronchomalacia),respectively.There were 17 cases (5.9%) classified as a mixed type with a combination of Type Ⅳ or Type Ⅴ disease with 1 or more of the other types.37.5% (108/288)of the patients were young females,while young and middle-aged patients with type Ⅰ and type Ⅱ diseases accounted for 74.7% (215/288)of the cases,much more than old aged patients (6.6%,19/288).97.2% (n =280) of the cases suffered from secondary pulmonary tuberculosis.In 107 cases,the disease was located in the left,162 cases in the right,while in 109 cases the right upper lobe bronchus was involved,and right main bronchus in 36 cases,3 cases and 58 cases in left upper lobe with and without lingular segment,10 cases in lingnlar segment only.Chest CT showed that local mucosal thickening of the trachea or bronchus was evident in 40.3% (116/288); toothed or spike protuberance in 30.9% (89/288),bronchial obstruction in 11.1% (32/288),and bronchial stenosis in 87.9% (253/288).The negative rate of sputum in the first month after interventional therapy was 60.2% (56/93),significantly higher than that in non-interventional therapy group (23.1%,18/78).Conclusion The new consensus report on EBTB was clinically useful for classification and typing of the disease,and for the selection of treatment modalities.