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肺结核的临床表现和评估

Author
Anton Pozniak, MD, FRCP
Section Editor
C Fordham von Reyn, MD
Deputy Editor
Elinor L Baron, MD, DTMH
Translators
黄怡, 主任医师，教授

引言

肺是结核分枝杆菌感染最常见的部位。结核病(tuberculosis, TB)的临床表现包括：原发性结核、再活动性结核、喉结核、支气管内结核、下肺野结核和结核球。结核病的肺部并发症包括：咯血、气胸、支气管扩张、广泛性肺损伤、恶性肿瘤及慢性肺曲霉菌病。

肺结核的临床表现和评估将总在在此。儿童及人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染患者中肺结核的临床表现将单独讨论，肺结核的流行病学、发病机制、实验室诊断和治疗将单独讨论。肺外结核和粟粒型结核也将单独讨论。(见相关专题。)

临床表现

原发性结核 — 在20世纪50年代采用有效化疗药物异烟肼之前，原发性结核一直被认为主要为儿童中的疾病。此后，很多研究显示，青少年和成人患结核病的频率有所增加[1,2]。

症状和体征 — 一项前瞻性研究很好地描述了原发性结核的自然病程，该研究纳入了1932-1946年间居住在挪威法罗群岛沿海的517例新结核菌素试验转阳者[3]。包括331例成人和186例儿童，所有病例均随访5年以上。该人群中，原发性结核的临床表现有极大差异，约1/3的患者出现了肺部相关的症状和体征。发热为最常见的症状，232例入组时无发热的患者中有70%出现发热。发热通常以低热起病且进展缓慢，但也可高达39℃，平均持续14-21日。到第10周时，有98%的患者体温恢复正常。

发热通常不伴随其他症状，但约25%的患者会发生胸膜炎性痛或胸骨后痛。一半的胸膜炎性胸痛患者具有胸腔积液的证据。胸骨后痛和肩胛间钝痛是由支气管淋巴结肿大引起的，有时随吞咽加重。罕见的症状包括乏力、咳嗽、关节痛和咽炎。 (参见“Tuberculous pleural effusion”)

                             

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Literature review current through: 2017-07 . | This topic last updated: 2016-01-12.
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