Kuraoka Toshihiko
Department of Internal Medicine, Kyosai-Yoshijima Hospital, Hiroshima, Japan.
Kekkaku. 2004 Nov;79(11):645-53.
I have been engaged in the diagnosis and treatment of pulmonary tuberculosis for about 25 years. I have presented many interesting tuberculosis cases such as cavity, nodule, infiltration, miliary pattern, and bronchial tuberculosis. I summarized that the key point of the diagnosis for pulmonary tuberculosis is, 1) X-ray diagnosis shows no specific findings, so it is important to remind pulmonary tuberculosis as not unusual disease. I will make a proposal to insert pulmonary tuberculosis in the guideline for the diagnosis of pneumonia by the Japanese Respiratory Society. 2) Sputum PCR examination is very rapid and useful diagnostic method. The diagnostic evaluation of PCR is equal or over that of AFB culture. 3) CT diagnosis is useful for the detection of minimal pulmonary shadow or cavity lesion. 4) Brocho-fiberscopic examination is useful for the detection of the Mycobacterium in the bronchial brushing smear or washing samples. We should suspect bronchial tuberculosis in the cases with strongly positive sputum smear without cavity shadow. 5) The rate of complication with diabetes mellitus is significantly higher than that of 10 years ago in adult male tuberculosis patients. Recently 1 of 4 patients complicated with diabetes mellitus in adult male patients.
我从事肺结核的诊断和治疗工作约25年了。我展示过许多有趣的肺结核病例，如空洞、结节、浸润、粟粒样病变及支气管结核。我总结出肺结核诊断的要点如下：1）X线诊断无特异性表现，因此将肺结核作为一种不常见疾病来提醒很重要。我建议日本呼吸学会在肺炎诊断指南中纳入肺结核。2）痰PCR检查是非常快速且有用的诊断方法。PCR的诊断评估等同于或优于抗酸杆菌培养。3）CT诊断对检测微小肺部阴影或空洞病变很有用。4）支气管纤维镜检查对在支气管刷检涂片或冲洗样本中检测分枝杆菌很有用。对于痰涂片强阳性且无空洞阴影的病例，我们应怀疑支气管结核。5）成年男性肺结核患者中糖尿病并发症的发生率比10年前显著更高。最近成年男性患者中有四分之一合并糖尿病。
