CAJ | 학술논문

目的：提高对以肺间质性改变为主要表现的肺结核的认识。方法报道1例2011年确诊的以肺间质改变为主要表现的肺结核患者的临床资料、诊治经过及随访情况，并进行相关文献复习。以“间质，肺结核”为检索词通过万方医学数据库对中文文献检索，以“interstitial，pulmonary tuberculosis”为检索词通过PubMed数据库进行检索，检索时间截至2014年5月。结果患者女，31岁，因“咳嗽6个月，加剧伴气促20余天”为主诉入院。入院前曾误诊为“慢性咽炎、慢性支气管炎、支气管哮喘”。入院查胸部CT显示双肺可见广泛性肺间质改变，并出现散在斑片影，边界模糊，部分病灶呈磨玻璃样。经纤维支气管镜于右肺下叶基底段肺活检（TBLB）：肉芽肿炎伴小灶性坏死，考虑结核。异烟肼、利福平、吡嗪酰胺、乙胺丁醇（HRZE）规则抗结核治疗后，咳嗽、气促渐缓解，病灶渐吸收，随访至今29个月，未见复发。在万方医学数据库上检索到相关文献13篇，1例为个案报道，其余多为误诊分析或影像表现研究；在PubMed数据库检索，国外未见相关报道。结论以间质性改变为主要表现的肺结核好发于中青年男性，亚急性病程，临床症状不典型，以咳嗽、呼吸困难、发热最为常见，胸部CT是早期诊断的关键，网格样改变、小叶间隔增厚、小叶中心性结节、胸膜受累、树芽状是活动性间质性肺结核主要影像学表现。当与肺部弥漫性疾病难以鉴别时，经纤维支气管镜及CT引导下肺穿刺术取得组织病理学是诊断的关键，必要时可考虑行外科开胸活检术。
목적：제고대이폐간질성개변위주요표현적폐결핵적인식。방법보도1례2011년학진적이폐간질개변위주요표현적폐결핵환자적림상자료、진치경과급수방정황，병진행상관문헌복습。이“간질，폐결핵”위검색사통과만방의학수거고대중문문헌검색，이“interstitial，pulmonary tuberculosis”위검색사통과PubMed수거고진행검색，검색시간절지2014년5월。결과환자녀，31세，인“해수6개월，가극반기촉20여천”위주소입원。입원전증오진위“만성인염、만성지기관염、지기관효천”。입원사흉부CT현시쌍폐가견엄범성폐간질개변，병출현산재반편영，변계모호，부분병조정마파리양。경섬유지기관경우우폐하협기저단폐활검（TBLB）：육아종염반소조성배사，고필결핵。이연정、리복평、필진선알、을알정순（HRZE）규칙항결핵치료후，해수、기촉점완해，병조점흡수，수방지금29개월，미견복발。재만방의학수거고상검색도상관문헌13편，1례위개안보도，기여다위오진분석혹영상표현연구；재PubMed수거고검색，국외미견상관보도。결론이간질성개변위주요표현적폐결핵호발우중청년남성，아급성병정，림상증상불전형，이해수、호흡곤난、발열최위상견，흉부CT시조기진단적관건，망격양개변、소협간격증후、소협중심성결절、흉막수루、수아상시활동성간질성폐결핵주요영상학표현。당여폐부미만성질병난이감별시，경섬유지기관경급CT인도하폐천자술취득조직병이학시진단적관건，필요시가고필행외과개흉활검술。
Objective This paper aims at deepening the understanding of the secondary pulmonary tuberculosis mainly with pulmonary interstitial changes. Methods A case of secondary pulmonary tuberculosis mainly with pulmonary interstitial changes diagnosed in 2011 was reported and the related literatures were reviewed. The literature review was carried out respectively with “interstitial”,“pulmonary tuberculosis”as the search terms in Wanfang med online and PubMed database by May 2014. Results A case of 31 year-old female patient, who had been misdiagnosed as having chronic pharyngitis, chronic bronchitis and bronchial asthma, was admitted to the hospital because of cough production for 6 months, and aggravating with anhelation for 20 days. After admission, the chest computerized tomography showed extensive pulmonary interstitial changes, and blurred patchy shadow, part of ground-glass opacity. TBLB: granulomatous inflammation with focal necrosis, consider tuberculosis. The symptoms of cough and anhelation were disappeared after anti-tuberculosis treatment (HRZE), and the interstitial changes would also be absorbed. So far, there was no recurrence within 29 months follow-up. Thirteen related literatures were received in Wanfang Med Online, including one of case report, and the others were misdiagnosis analysis or computed tomography study;but no related literatures were received in Pubmed,which means there were no relevant reports overseas. Conclusion It is a special kind of secondary tuberculosis which mainly manifested interstitial changes tend to happen to young and middle-aged males, and has a subacute onset. The clinical symptoms were not typical, often manifested with cough, dyspnea and fever. The key to early diagnosis is chest CT. And 0n chest CT scan, interlobular thin reticulation、centrilobular lesions, pleural adhesions, tree-in-bud are the mainly manifested of the active interstitial TB. In the case of difficult diagnosis of diffuse lung disease, the key is to get the pathological tissues by fiber bronchoscope or percutaneous lung puncture biopsy. When necessary, it is proposed to do a video assisted thoracic surgery.