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目的探讨胸片正常支气管内膜结核(EBTB)的临床特点及确诊手段。方法分析12例经纤支镜(FB)确诊的胸片正常的支气管内膜结核患者的临床表现、胸部CT、纤支镜检查结果。结果全部病例均有咳嗽,发热4例,咯血或血丝痰3例,胸闷2例,消瘦2例,喘鸣1例,伴乏力、午后潮热、盗汗6例。血沉正常5例。结核菌素纯蛋白衍化物(PPD)试验仅1例呈阳性。CT检查:3例未见明显异常,肺内结节2例,支气管不同程度受累6例。FB镜下异常者11例,均经活检或刷检涂片抗酸染色细菌学确诊。结论EBTB缺乏特异性临床表现,痰检、CT、血沉、PPD试验已不能作为主要诊断手段,胸片正常的不明原因长期呼吸道症状存在者应及时行FB检查,以早期确诊。
Objective To investigate the clinical features and diagnostic methods of normal chest wall endobronchial tuberculosis (EBTB). Methods The clinical manifestations, chest CT, and bronchoscopy were analyzed in 12 patients with bronchial endometrial tuberculosis diagnosed by fiberoptic bronchoscopy (FB). Results All cases had cough, fever in 4 cases, hemoptysis or bloody sputum in 3 cases, chest tightness in 2 cases, wasting in 2 cases, wheezing in 1 case, with fatigue, afternoon hot flashes, night sweats in 6 cases. 5 cases of normal erythrocyte sedimentation rate. Only one case of tuberculin pure protein derivative (PPD) test was positive. CT examination: no obvious abnormalities in 3 cases, 2 cases of pulmonary nodules, bronchial involvement in varying degrees in 6 cases. FB abnormalities in 11 cases, were biopsy or brush smear acid-fast bacteriological diagnosis. Conclusion EBTB lack of specific clinical manifestations, sputum examination, CT, ESR, PPD test can not be used as the main diagnostic tool, chest X-ray of unknown unexplained long-term respiratory symptoms should be timely FB examination to early diagnosis.