Heffner J E, Strange C, Sahn S A
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston 29425.
Arch Intern Med. 1988 May;148(5):1103-8.
Six patients with hypoxic respiratory failure (arterial PO2/alveolar PO2 less than 0.50) resulting from active tuberculosis were evaluated to assess the impact of respiratory failure on the diagnosis of the underlying tuberculosis. All patients demonstrated anemia (hematocrit [mean +/- SEM], 0.29 +/- 0.01 [29.0% +/- 1.0%]) and hypoalbuminemia (serum albumin, 22 +/- 2 g/L [2.2 +/- 0.2 g/dL]) and noted an illness longer than one week. Findings on chest roentgenograms varied from a miliary pattern, misinterpreted as congestive heart failure, to cavitary and noncavitary alveolar infiltrates, misdiagnosed as bacterial pneumonia. Tuberculosis was not considered as a diagnostic possibility on admission in any patient. The mean time from admission until consideration of tuberculosis was 4.7 +/- 1.0 days and the time to diagnosis was 7.2 +/- 1.7 days. In contrast, tuberculosis was considered on admission in 12 patients presenting with undiagnosed active tuberculosis without respiratory failure. We conclude that respiratory failure delays the diagnosis of active tuberculosis by suggesting nontuberculous pneumonia.
对6例因活动性肺结核导致低氧性呼吸衰竭（动脉血氧分压/肺泡血氧分压低于0.50）的患者进行评估，以确定呼吸衰竭对潜在肺结核诊断的影响。所有患者均表现为贫血（血细胞比容[均值±标准误]，0.29±0.01[29.0%±1.0%]）和低白蛋白血症（血清白蛋白，22±2 g/L[2.2±0.2 g/dL]），且病程超过1周。胸部X线片表现多样，从被误诊为充血性心力衰竭的粟粒样改变到被误诊为细菌性肺炎的空洞性和非空洞性肺泡浸润。所有患者入院时均未将肺结核列为诊断可能性。从入院到考虑肺结核诊断的平均时间为4.7±1.0天，确诊时间为7.2±1.7天。相比之下，12例未合并呼吸衰竭的未确诊活动性肺结核患者入院时即考虑到肺结核诊断。我们得出结论，呼吸衰竭通过提示非结核性肺炎而延迟了活动性肺结核的诊断。
