| 刘裔,吴志嵩,茅惠娟,等.皮肌炎合并肺结核 27例临床分析[J].安徽医药,2021,25(10):2036-2038. |
| 皮肌炎合并肺结核 27例临床分析 |
| Clinical manifestation and treatment of dermatomyositis complicated with pulmonary tuberculosis: analysis of 27 consecutive cases |
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| DOI：10.3969/j.issn.1009-6469.2021.10.029 |
| 中文关键词: 结核，肺 皮肌炎 酶联免疫斑点测定 核酸扩增技术 体征和症状 |
| 英文关键词: Tuberculosis, pulmonary Dermatomyositis Enzyme-linked immunospot assay Nucleic acid amplification techniques Signs and symptoms |
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| 中文摘要: |
| 目的探讨皮肌炎合并肺结核的临床特点，总结诊治体会。方法回顾性分析 2017年 7月至 2019年 1月南京市第二医院结核科收治的 27例皮肌炎合并肺结核病人的既往史、合并症、主要临床表现、实验室检查结果、治疗与预后等临床资料。结果 27例病人中，所有病人均有激素和(或)免疫抑制剂治疗史，合并肺外结核者占比 44.4%；所有病人以咳嗽咳痰(74.1%)、发热盗汗( 70.4%)、胸闷胸痛( 63.0%)为主要临床表现；痰利福平耐药实时荧光定量核酸扩增检测技术( Xpert Mtb/RIF)阳性率 70.4%，显著高于痰结核分枝杆菌涂片( 40.7%)及培养( 11.1%)阳性率，血液结核感染 T细胞检测( T-SPOT)阳性率 85.2%，显著高于血结核抗体阳性率( 18.5%)影像学检查提示病灶位于双肺者占 66.7%，呈斑片条索样改变者占 51.9%。抗结核药物不良 |
| 英文摘要: |
| Objective To investigate the clinical characteristics of dermatomyositis complicated with pulmonary tuberculosis, and tosummarize the experience of diagnosis and treatment.Methods Retrospective analysis of the past history, comorbidities, main clinicalmanifestations, laboratory test results, treatment and prognosis of 27 patients with dermatomyositis and tuberculosis admitted to the Tuberculosis Department of Nanjing Second Hospital from April 2017 to January 2019.Results All the 27 patients have be treated withhormones and/or immunosuppressive agents, and 44.4% of them had extrapulmonary tuberculosis. The main manifestations of all patients were cough and sputum (74.1%), fever and night sweats (70.4%), and chest tightness and pain (63.0%) ; the positive rate of rifampicin-resistant in sputum real-time fluorescent quantitative nucleic acid amplification detection technology (Xpert Mtb/RIF) was70.4%, which was significantly higher than the positive rate of sputum mycobacterium tuberculosis smear (40.7%) and culture (11.1%);the positive rate of tuberculosis T-spot infection in blood was 85.2%, which was significantly higher than the positive rate of blood tuberculosis antibody (18.5%). The imaging examination showed that 66.7% of the lesions were located in double lungs, 51.9% of the lesions showed Patch and strip like changes; the incidence of adverse reactions to anti-tuberculosis drugs was 55.6%, and the effective rate of tuberculosis treatment was 77.8%.Conclusion The incidence of pulmonary tuberculosis in patients with dermatomyositis iscorrelated with the use of hormones and/or immunosuppressive agents, which is easy to be combined with extrapulmonary tuberculosis.The clinical symptoms are typical. Reasonable use of relevant examinations can identify the diagnosis of tuberculosis in the early stage.The incidence of adverse reactions in the treatment process is high, but the treatment efficiency is higher through program adjustment. |
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