Smear-positive Pulmonary Tuberculosis Clinical Analysis On60Cases

Objective To study the clinical features of smear-positive pulmonary tuberculosis,improving its clinical manifestations diagnosis, develop individualized, standardized,effective and reasonable treatment options, lessons learned, provide a reference for futurework in clinical practice.Methods From May2012to October2013at the Department of RespiratoryMedicine, Affiliated Hospital of Yan’an University,two wards in hospital60patients withsmear-positive pulmonary tuberculosis as the observation group, and select the sameperiod60cases of hospitalized patients with smear-negative pulmonary tuberculosis as acontrol group,from two basic data of patients, clinical man if estations, imagingcharacteristics and laboratory test results were compared,summarized the clinical man ifestations smear positive characteristics.Results1.Basic data:smear-positive tuberculosis and smear-negative TB patients,the overall male patients than women, mainly aged19to39years age group, the agefactor is the prevalence of infectious diseases diseases of the most important factors.Incidence ratio compared to other young people ages high, there may be people in thisage group with way more exposure to infected TB are directly related.In clinical work inthis part of treatment to patients ages should be given more attention in order to reach thesource of infection, the objective of reducing the prevalence of tuberculosis.2.Clinical manifestations:Smear positive pulmonary tuberculosis cough (93.3%), cough (88.3%),hemoptysis (31.7%), fever (43.3%), weight loss (63.3%), fatigue (75%), night sweats(82%), chest pain (82%) and cough and sputum negative pulmonary tuberculosis (75%),cough (36.7%), hemoptysis (1.6%), fever (3.33%), weight loss (21.7%), fatigue (23.3%),night sweats (15%), chest pain (31.7%) was statistically significant differences.Statisticsfound that clinical symptoms in patients with smear-negative pulmonary tuberculosisthan most patients with smear-positive TB disease to light, some of smear-negative TBpatients with cough, sputum, fatigue, chest pain, weight loss and other symptoms,hemoptysis, night sweats, fever and other symptoms are not obviously, some evenwithout any symptoms.3.Imaging features: according to the lesions in1lung field,2lung,3lung field, more than4and lung field and whether complicated cavity, smear positivepulmonary tuberculosis and smear negative pulmonary tuberculosis with significantdifferences,Statistics found smear-positive group mainly involved in multi-leaf,smear-negative pulmonary tuberculosis lesions involving mainly single leaf; other studiessuggest that the nodule smear positive pulmonary tuberculosis patients amongsmear-negative tuberculosis patients and the difference was not statistically significant,but the nodules the size and extent of positive sputum positive correlation. Smearnegative pulmonary smear positive pulmonary tuberculosis patients is no reason why thetypical clinical and chest radiographic manifestations, may be associated withsmear-negative tuberculosis patients bacterial load of smaller reasons, this differencereflects the Mycobacterium tuberculosis and the human immune system interactions theoutcome is different, can be used to help in early diagnosis of smear-positive tuberculosis.4.Laboratory examination: smear positive pulmonary tuberculosis ESR value (98.53±58.86) and smear negative pulmonary tuberculosis ESR value (75.21±54.95) hadsignificant difference, C-reactive protein smear positive pulmonary tuberculosis value(108.67±68.94) and C-reactive protein smear negative pulmonary tuberculosis value(77.83±75.91) there was significant difference.5.Smear positive pulmonarytuberculosis, sputum acid fast bacilli overcast conditions: about78.34%of patients at theend of2sputum smear negative conversion. Conclusion:1.Smear-positive and smear-negative TB patients in TB patients, theoverall male patients have more than women, the proportion of young adults comparedwith people of other ages is high, people in this age group have more exposure routes ofinfection have TB direct relationship.2. Smear-negative TB patients than most of the clinical symptoms of patients withsmear-positive TB disease to light. Therefore, clinicians in the diagnosis ofsmear-negative tuberculosis diagnosis must be combined with a variety of symptoms, thesymptoms are not typical of the individual can not be ignored, the only way to reduce therate of missed diagnosis and misdiagnosis rate.3.Statistics found smear-positive group mainly involved in multi-leaf,smear-negative pulmonary tuberculosis lesions involving mainly single leaf; varioussigns detection rate of smear-negative group were significantly lower than smear-positivegroup. Because patients with smear-negative bacterial load of small reasons, thisdifference reflects the different outcomes of Mycobacterium tuberculosis and the humanimmune system interactions can be used to aid in the diagnosis of smear negativepulmonary tuberculosis.4. Smear positive pulmonary tuberculosis and smear-negative tuberculosis patientsvalue erythrocyte sedimentation rate and C-reactive protein were high, relative term,smear-positive tuberculosis ESR and C-reactive protein values are higher than thesmear-negative TB patients, because patients with different severity of inflammation inthe body caused.5.Smear positive pulmonary tuberculosis, sputum acid fast bacilli overcastconditions: about78.34%of patients at the end of2sputum smear negative conversion.