Yoshida E, Yoneda T, Morikawa S, Ako H, Yoshikawa M, Tsukaguchi K, Narita N
2nd Department of Internal Medicine, Nara Medical University, Japan.
Kekkaku. 1992 Nov;67(11):729-33.
We reported a case who had suffered from severe pulmonary tuberculosis in association with severe malnutrition. A 19-year-old man was admitted complaining of high fever, productive cough and body weight loss. Before admission, he worked as a cook for long hours a day and had meals irregularly. On admission, he was cachexic. Coarse crackles were auscultated on the both lung field, and the liver was enlarged. Chest X-ray revealed multiple ringed and mottled shadows mainly in bilateral upper and middle lung field. Laboratory examination revealed inflammatory reaction defined by an increase of white blood cells, accelerated erythrocyte sedimentation rate and positive CRP, impairment of liver function and cell-mediated immunity, hypoxemia and restrictive lung dysfunction. Ziehl-Neelsen stain of sputum showed a large number of acid fast bacilli. The assessment of his nutritional status showed decrease in anthropometric measurements, visceral proteins and the Fischer ratio, which suggested that he was in the status of protein-calorie malnutrition in association with amino acid imbalance. He was treated with nutritional therapy in addition to antituberculous drugs, which improved his clinical symptoms, laboratory data and nutritional assessment. These results suggested the importance of nutritional assessment and nutritional therapy based on it.
我们报告了一例患有严重肺结核并伴有严重营养不良的病例。一名19岁男性因高热、咳痰和体重减轻入院。入院前，他每天长时间担任厨师，饮食不规律。入院时，他极度消瘦。双肺野可闻及粗湿啰音，肝脏肿大。胸部X线显示双上肺野及中肺野主要为多发环形及斑片状阴影。实验室检查显示白细胞增多、血沉加快、C反应蛋白阳性提示炎症反应，肝功能及细胞介导免疫受损，低氧血症及限制性肺功能障碍。痰涂片萋-尼染色显示大量抗酸杆菌。对其营养状况的评估显示人体测量指标、内脏蛋白及费舍尔比值降低，提示他处于蛋白质-热量营养不良伴氨基酸失衡状态。除抗结核药物治疗外，他还接受了营养治疗，这改善了他的临床症状、实验室数据及营养评估。这些结果提示了营养评估及基于此的营养治疗的重要性。
