CAJ | 학술논문

目的：研究肺结核抗痨过程中发生类赫反应（ PR）的频率、临床特点及其危险因素。方法采用病历资料的回顾性列队研究。结果符合条件的1310例肺结核患者抗痨后76例发生PR（5.8％），发生PR的时间是抗痨后（40±28）d。发热和咳嗽是PR的最常见症状。76例PR患者中误诊为耐药结核24例，肺炎32例和肺癌6例。发生PR的危险因素是：体重指数低、低白蛋白血症、初始血淋巴细胞数低和发生PR时淋巴细胞数较大增加（ P均＜0.05）。结论在肺结核患者抗痨中出现PR是常见现象，且易误诊；低蛋白血症、低体重指数、初始淋巴细胞数量较低以及初始与抗痨后淋巴细胞数的变化量较大的肺结核患者更易发生PR，这有助于区别是PR发生，或是肺炎或耐药而导致抗痨治疗失败。
목적：연구폐결핵항로과정중발생류혁반응（ PR）적빈솔、림상특점급기위험인소。방법채용병력자료적회고성렬대연구。결과부합조건적1310례폐결핵환자항로후76례발생PR（5.8％），발생PR적시간시항로후（40±28）d。발열화해수시PR적최상견증상。76례PR환자중오진위내약결핵24례，폐염32례화폐암6례。발생PR적위험인소시：체중지수저、저백단백혈증、초시혈림파세포수저화발생PR시림파세포수교대증가（ P균＜0.05）。결론재폐결핵환자항로중출현PR시상견현상，차역오진；저단백혈증、저체중지수、초시림파세포수량교저이급초시여항로후림파세포수적변화량교대적폐결핵환자경역발생PR，저유조우구별시PR발생，혹시폐염혹내약이도치항로치료실패。
Objective To evaluate the incidence , clinical characteristics and predicting factors for the development of paradoxical response ( PR) in patients with pulmonary tuberculosis ( TB) .Methods A retrospective cohort study was executed including 1 310 patients who were diagnosed and treated with pulmonary TB .Results PR was present in 76(5.8%) of 1 310 patients after 40±28 days following ini-tiation of treatment.Fever and cough were the most common symptoms associated with PR .24(31.6%) patients had been initially misdiag-nosed of drug-resistant TB,32(42.1%) patients had been misdiagnosed of pneumonia and 6(7.9%) patients had been misdiagnosed of lung cancer.The risk factors for PR were low body mass index (BMI), low serum albumin level, low baseline lymphocyte counts and lymphocyte count greater increase during PR development (all P<0.05).Conclusions PR is not an uncommon problem in pulmonany TB and is com-mon misdiagnosed.Low BMI, baseline hypoalbuminaemia, lymphopaenia and a greater change in lymphocyte count during PR development are associated with the development of PR .This is useful for clinical practice , especially for helping to distinguish PR from pneumonia or drug resistance .PR during the management of pulmonary TB must be paid more attention in the expected patients to develop PR .