目的 总结103例误诊为社区获得性肺炎(CAP)的肺结核患者临床特点,分析氟喹诺酮类抗菌药物对肺结核诊断的影响,探讨有利于提高肺结核诊断率的诊疗方案.方法 对103例误诊为CAP的肺结核患者(肺结核组)与确诊为CAP的患者(CAP组)进行1∶1对照研究.肺结核组患者根据误诊前是否使用氟喹诺酮类抗菌药物分为氟喹诺酮组和非氟喹诺酮组.结果 肺结核组农村居民比例高,临床特点中干咳、咯血、盗汗、消瘦、风湿样体征发生率高于CAP组(P＜0.05)；单核细胞计数、百分比及血小板计数高于CAP组(P＜0.05)；影像学渗出部位分布在上肺(49.5％),同时胸腔积液发生率更高(P＜0.05).氟喹诺酮组在肺结核延误诊断时间及确诊前使用抗生素时间显著高于非氟喹诺酮组(P=0.000).结论 对病变发生于肺上叶或伴有胸腔积液,按CAP治疗后病情反复的患者,需注意与肺结核的鉴别诊断,尽可能不要首选氟喹诺酮类抗菌药物进行经验性治疗.%Objective To review and analyze the clinical characteristics of 103 cases of pulmonary tuberculosis which were misdiagnosed as community acquired pneumonia (CAP) to understand the effect of fluoroquinolone treatment on the diagnosis of pulmonary tuberculosis.Methods We conducted a hospital-based,retrospective case-control study of 103 pulmonary tuberculosis patients who initially were misdiagnosed as CAP and 103 true CAP patients.The patients with pulmonary tuberculosis were further classified as fluoroquinolone group and non-fluoroquinolone group based on whether they received fluoroquinolone therapy previously.Results Tuberculosis was more prevalent in rural residents.Tussiculation,hemoptysis,night sweating,marasmus,and rheumatoid signs were significantly more prevalent in the tuberculosis patients than in CAP patients (P＜0.05),as well as the monocyte count,percentage of monocytes and platelet count (P＜0.05).The imaging examinations showed exudation in the upper lung (49.5 ％).Pleural effusion was significantly more in the patients with pulmonary tuberculosis than in CAP patients (P＜0.05).In the patients treated with fluoroquinolones,the diagnosis of tuberculosis and appropriate antimicrobial therapy was significantly delayed compared with the patients without prior fluoroquinolone therapy (P =0.000).Conclusions For patients with exudation in upper lobe of lung or pleural effusion revealed by X-Ray,pulmonary tuberculosis should be considered if the patient is refractory to CAP therapies.The first-line empirical treatment should exclude fluoroquinolones if possible.
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