Objective To explore the clinical, imaging and electronic bronchoscopy manifestations of diabetes mellitus complicated with tracheobronchial tuberculosis, so as to provide clues for the early diagnosis of diabetic TBTB. Method From January 2020 to December 2021, 824 patients with diabetes and first-treat pulmonary tuberculosis were hospitalized in Nanjing Second Hospital, among which 57 were diagnosed with TBTB after electronic bronchoscopy. Demographic characteristics,clinical symptoms, glycosylated hemoglobin, chest CT scan, TBTB pathological typing and etiological examination results were analyzed. Result Among the patients with diabetes and first-treated pulmonary tuberculosis hospitalized during the same period, the detection rate of TBTB was 6.92%（57/824）. The average age of the 57 diabetic patients with TBTB was（57.5±14.6） years old, more men than women（2.8:1）, and the age of onset in men was lower than that of women [（54.9±14.5）years vs（64.7±12.3）years], and there was a statistically significant difference in age between genders（P＜0.05）. Cough（46cases, 80.7%） was the main symptom of diabetic patients with TBTB, and the average glycated hemoglobin level was（9.18±2.03）%. All patients showed direct or indirect signs of TBTB in chest CT images.The direct signs were mainly wall thickening（18 cases, 31.6%） and lumen stenosis（20 cases, 35.1%）,and the indirect signs were mainly multiple nodular shadows（40 cases, 70.2%） and cavity shadows（27cases, 47.4%）.The main lesions of diabetes mellitus complicated with TBTB were the left upper bronchus（22 cases, 38.6%）, right upper bronchus（23 cases, 40.4%） and right lower bronchus（18 cases, 31.6%）,and 28 cases had ≥2 lobe segmental bronchial invasion sites, accounted for 49.1%. The pathological type was mainly type Ⅳ（40 cases, 70.2%） and mixed type（38 cases, 66.7%）. Sputum tuberculosis was positive in 26 cases, lavage fluid tuberculosis was positive in 45 cases. The positive rate of lavage fluid was significantly higher than that of sputum（78.9%: 45.6%）. Conclusion For diabetic patients with poor blood glucose control, repeated cough and direct or indirect signs of TBTB on chest CT,bronchoscopy should be performed early, and the diagnosis should be confirmed by combined etiological and pathological examination.

目的 探讨影响耐多药肺结核(multidrug-resistant pulmonary tuberculosis,MDR-PTB)早期疗效的危险因素,为MDR-PTB患者的早期疗效评估及精准治疗提供依据.方法 选取2020年11月至2022年1月南京中医药大学附属南京医院(南京市第二医院)结核科诊治的经痰培养及药物敏感试验证实的MDR-PTB患者作为研究对象,根据抗结核治疗3个月末的治疗效果纳入疗效欠佳组(n=35)和疗效良好组(n=117),比较两组患者的临床资料,分析影响早期疗效的危险因素.结果 单因素方差分析显示:性别、年龄、职业、复治、合并2型糖尿病、合并其他病原体感染、对氟喹诺酮耐药、病灶累及范围≥3个肺野、肺部空洞性病变、空洞直径、血红蛋白水平、白蛋白、体质指数与MDR-TB治疗3个月末疗效欠佳相关(均P＜0.05).多因素Logistic回归分析显示:复治肺结核(OR=4.138,95%CI 1.063～16.110)、对氟喹诺酮耐药(OR=6.677,95%CI 1.526～29.211)、肺部有空洞性病变(OR=18.879,95%CI 3.585～99.411)是影响MDR-PTB患者疗效的独立危险因素.结论 影响耐多药肺结核早期疗效的因素是多元的.复治肺结核、肺部空洞性病变、对氟喹诺酮耐药是早期疗效欠佳的独立危险因素.对合并以上危险因素的患者应尽早发现并进行精准抗结核治疗,以期改善预后.

目的 总结胸膜结核瘤(pleural tuberculoma,PTM)的临床特征,分析发病高危因素.方法 回顾性分析2017年4月至2021年4月在南京市第二医院收治的56例PTM患者(病例组)资料,首先总结该56例患者的临床特征,其次与60例结核性胸膜炎(tuberculous pleurisy,TPE)(对照组)未合并PTM的病例对比,分析罹患PTM的高危因素.结果 PTM的平均年龄为(29.04±6.95)岁,男女性别无差异.从诊断TPE起,PTM的平均发病时间为(4.29±2.34)个月.42例(75％)PTM位于下肺叶.病例组和对照组临床症状、基础疾病差异无显著性,在合并影像学比较中,病例组胸膜增厚更常见(44.64％vs 23.33％,P=0.02),同时胸水ADA(adenosine deaminase)水平高于对照组[(48.32±19.19)U/L vs(44.79±24.57)U/L,P=0.03].在细胞免疫功能检测中,CD4+、CD8+T淋巴细胞绝对计数和CD4+/CD8+T比值2组差异无显著性(P>0.05),而病例组CD4+和CD8+T细胞的活化标志物Ki-67+的表达明显高于对照组(36.64±16.50 vs 7.19±5.23,P<0.001;33.31±15.94 vs 5.02±7.13,P<0.001).结论 PTM的发病年龄较轻,多见于TPE治疗半年内出现.罹患PTM的高危因素较复杂,胸膜增厚、ADA水平升高以及T淋巴细胞的免疫活化失调可能是PTM发病的高危因素.

目的 探索宏基因组二代测序(metagenomic next-generation sequencing,mNGS)在肺结核诊断中的实际临床应用价值.方法 对91 例疑似肺结核患者支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)样本行mNGS、涂片、培养、Xpert比较.结果 mNGS与涂片、培养的诊断敏感度存在显著性差异(P 均<0.01);与Xpert之间无显著性差异(38.36%vs 41.10%,P =0.84);Xpert和mNGS联合诊断敏感度明显提高(56.16%);同时在筛查肺结核是否复发时诊断效率更高(P<0.01).结论 mNGS检测手段明显提高肺结核的诊断效能,值得推广应用.

胸内结节病与结核病在临床特征、病理学表现、影像学征象上存在一定的相似性,尤其是在结核病高流行区域,建立规范的鉴别诊断流程以避免误诊误治,显得尤为重要.因此,中国防痨协会多学科诊疗分会、《中国防痨杂志》编辑委员会和中华医学会放射学分会临床多学科合作工作组联合组织全国结核病科、呼吸科、病理科、影像科及关联学科专家,编制了《结核病流行背景下胸内结节病与结核病临床鉴别与处置专家共识》.笔者作为本共识编制的参与者,就两病鉴别诊断的难点和推荐意见进行解读,以供广大临床工作者参考与借鉴.

目的 回顾性分析江苏省新冠Delta病毒突变株患者的临床特征,为疫情防控提供依据.方法 以江苏省2021年7月20日至2021年8月5日于南京市第二医院收治的392名Delta病毒突变株的COV-ID-19患者资料为研究对象,根据年龄(<60岁和≥60岁)分为A、B组,总结分析2组的临床特征.结果 共纳入392名Delta病毒突变株患者,男性207例,女性185例,平均年龄为52.13±15.80(14～84)岁.359名(91.58％)患者有明确的流行病学接触史,患者的平均潜伏期为(4.56±2.23)d,疾病分型的人数及百分比分别为:轻型119例(30.36％)、普通型261例(66.58％)、重型10例(2.55％)和危重型2例(0.05％).A组轻型所占比例明显高于B组(37.92％vs 13.82％,P=0.0001),而B组普通型和重型比例均高于A组(78.05％vs 61.34％,6.50％vs 0.74％,P<0.001).最常见的临床表现是发热(82.40％)、干咳(66.58％).<60岁269例,≥60岁123例.疫苗总接种率为61.99％,其中A组接种率为81.78％,B组为18.70％.2组患者入院时外周血淋巴细胞计数均在正常范围内,但B组外周血淋巴细胞计数在治疗7 d后低于A组(P=0.00).影像学表现中,B组在疾病进展期和恢复期肺炎病灶/总肺体积均高于A组(P<0.05).患者的总体核酸检测转阴天数为:(21.25±5.32)d,而B组核酸检测转阴后天数明显高于A组,分别是(20.00±5.00)和(24.00±4.98)d(P<0.001).目前,390患者经治疗后痊愈出院隔离并随访,2例危重患者病情趋于好转已转为普通型,继续住院接受治疗.结论 Delta突变株病毒传播速度快,老年患者病灶范围更广、病情更重、免疫功能恢复更慢、病毒核酸持续时间更长,对疫情的防控提出更大的挑战,在缺乏确切有效的治疗药物出现之前,我国疫苗及中药可能是有效的预防及治疗措施.

目的:评价在国家结核病防治规划实施中,省市级结核病定点医院推广使用抗结核药品固定剂量复合剂(FDC)使用的可行性.方法:按照典型抽样的方法,在全国选择5个省,每省一个省级和一个地市级结核病定点医院作为研究现场,采取观察性研究方法,对新诊断的利福平敏感或无耐药检测结果的肺结核患者,根据FDC的纳入标准和排除标准进行治疗观察,分析使用抗结核FDC患者的纳入和退组情况.结果:2021年4月1日至7月31日,10个机构登记新诊断的利福平敏感或无耐药检测结果的肺结核患者3558例,抗结核FDC使用率为71.9％(2559/3558),其中最高为 94.5％(346/366),最低为 45.6％(215/472);12.1％(431/3558)的患者因禁忌证未使用抗结核FDC,有禁忌证的患者占登记患者数的比例最高为43.9％(207/472),最低为2.3％(5/215).使用抗结核FDC的患者中22.3％(571/2562)在疗程中途停止使用抗结核FDC,各机构中最高为44.8％(155/346),最低为3.6％(13/365);退组患者中54.5％(311/571)由于发生不良反应调整方案;各机构中发生不良反应退组的患者占使用抗结核FDC患者的比例,最高为27.2％(94/346),最低为0.3％(1/300);治疗第1个月的退组率为7.9％(203/2559),治疗第6个月的退组率为0.4％(8/1996),退组率随疗程呈明显下降趋势(x趋势2=14.277,P＜0.05).结论:抗结核FDC适宜在省市级结核病定点医院使用,加大对医务人员的培训是进一步提高抗结核FDC使用率和降低FDC中断治疗率的关键.

Pleural tuberculoma (PTM) is a tumor-like lesion secondary to tuberculous pleurisy that involves in the parietal or visceral pleura, the imaging manifestations are oval and round lesions.Although PTM is a benign proliferative lesion, the lung can be extensively involved.Without active treatment, some lesions continue to grow and increase in number, which will seriously affect the prognosis of the disease.The incidence of PTM has increased significantly for great attention from domestic and foreign counterparts and the improvement of auxiliary examination technology, but the pathogenesis of PTM is still in the exploration stages.This commentary aimed to explore the pathogenesis and treatment in PTM with literature in recent years.

机化性肺炎(organizing pneumonia,OP)指以肺泡腔、肺泡管、呼吸性细支气管及终末细支气管腔被疏松的纤维结缔组织充填为病理学特征的疾病[1].继发性机化性肺炎(secondary organizing pneumonia SOP)属于病因明确的机化性肺炎,有别于隐源性机化性肺炎(cryptogenic organizing pneumonia COP),常见的致病因素有感染(细菌、病毒、支原体等)、结缔组织疾病、药物(胺碘酮、博来霉素等)、放射线、器官移植等[2].感染继发SOP临床确诊比较困难.结核分枝杆菌(Mycobacterium tuberculosis MTB)感染引起的SOP更鲜有报道.现将南京市第二医院结核科收治的一例与MTB感染相关的SOP报道如下.

Objective:To explore the clinical value of the lesion volume measurement software based on lung CT image in the curative effect evaluation of patients with COVID-19, and provide accurate data for the application of hormones in COVID-19 patients.Methods:The clinical data of 102 patients with COVID-19 were analyzed retrospectively from January 2020 to April 2020.The patients were divided into two groups according to whether they used hormones during the treatment, 39 cases in hydroxy corticosteroids-treated group and 63 cases in hydroxy corticosteroids-untreated.The lesion volume measurement software was used to analyze the percentage of lesions in the whole lung volume (PV), and the clinical characteristics and viral clearance time were compared in two groups.Results:After one day of treatment, PV in hydroxy corticosteroids-treated group accounted for (7.03±1.20)%, which was higher than that in hydroxy corticosteroids-untreated group (4.10±0.84)%.After three days of treatment, PV in hydroxy corticosteroids-treated group was (9.45±1.32)%, which was higher than that in hydroxy corticosteroids-untreated group (4.15±0.87)%, the difference was statistically significant ( P<0.05). Follow-up of 60 days showed that the reduction of lung lesions in two groups tended to be the same after 28 to 60 days of treatment.Taking PV increase 1.50% as the boundary value, the corresponding area under the ROC curve was 89.70%.The sensitivity of screening patients with corticosteroids application was 87.18%, specificity 95.14%, positive predictive value 91.89%, and negative predictive value 92.31%.Image evaluation based on the lesion volume measurement software had high consistency with nucleic acid detection results (Kappa=0.786, P<0.001). The median nucleic acid turnaround time was 18 days in hydroxy corticosteroids group and 16 days in hydroxy corticosteroids-untreated group, with no statistically significant difference between two groups ( P=0.077). Using nucleic acid testing as the golden standard to evaluate the diagnosis and efficacy evaluation of COVID-19 by artificial intelligence, the sensitivity was 97.14%, accuracy 91.18%, positive predictive value 90.67%, and negative predictive value 92.59%. Conclusions:The lung volume measurement software based on artificial intelligence provides clear quantitative indication for the diagnosis, the indication and timing of hydroxy corticosteroids use, and the judgement of prognosis of patients with COVID-19.It is worth of clinical application.

目的:探讨非结核分枝杆菌肺病(nontuberculous mycobacterial pulmonary disease,NTM-PD)的临床特征.方法:回顾性分析南京中医药大学附属南京医院2018年1月—2019年12月确诊的170例NTM-PD患者的临床特征、实验室检查、胸部CT、NTM的菌种鉴定、药敏特征、治疗转归,并与同时期确诊的300例肺结核(pulmonary tuberculosis,PTB)患者临床资料进行比较.结果:NTM-PD组咯血、有结核病史、有合并症、血T-SPOT、淋巴细胞亚群、肺部空洞、支气管扩张与PTB组比较差异有统计学意义(P＜0.05).NTM-PD组对抗结核药物耐药率均高达90％以上,对乙胺丁醇耐药率为40.6％.NTM-PD组131例患者标本进行菌种鉴定,109例检测出NTM,检出率为83.2％(109/130).共检测出6种NTM,其中胞内分支杆菌最多,占69.8％(76/109).NTM-PD组接受治疗后,短期(＜1个月)内症状缓解,痰涂片转阴率为42.35％.强化治疗2个月后肺部病灶显著吸收率为23.00％,半年内大多数患者复发.结论:咯血、结核史、合并症、血T-SPOT、免疫紊乱、肺部结节、空洞、支气管扩张对NTM-PD诊断有一定参考价值.本地区胞内分枝杆菌比例最高,患者治疗困难、易复发、预后差.

目的 总结和分析动脉栓塞介入治疗肺结核相关肺动脉假性动脉瘤(pulmonary artery pseudoaneu-rysms,PAP)伴大咯血的临床特征.方法 对南京市第二医院行动脉介入栓塞治疗的3例肺结核并发PAP伴大咯血患者的临床表现、治疗及预后进行报道.并以"pulmonary tuberculosis"和"pulmonary artery pseudoaneurysms"或"Rasmussen's aneurysm"为检索词检索PubMed数据库,检索时间为2011年1月至2020年12月,剔除综述类文献、重复发表及资料不全等文献,纳入肺结核并发PAP患者临床资料完整的文章,收集患者的临床特征、影像学表现、PAP分型、诊治方法及预后,并进行文献复习.结果 病例1～3均确诊为肺结核并发大咯血,影像学提示肺结核空洞性病灶,且经胸部CT血管造影(CTA)及肺动脉造影均发现PAP继发于结核空洞壁上的肺动脉血管.其中,病例1,男,24岁,以"痰中带血7 d,加重3 d(咯血量＞500 ml/d,意识不清)"为主要表现,行支气管动脉栓塞术后再次大咯血,再行左胸廓内动脉和左胸外侧动脉、左侧肺动脉栓塞术后咯血停止;病例2,女,65岁,以"咯血5 d(100 ml/次,2次/d)伴胸闷"为主要表现,行支气管动脉栓塞术后再次大咯血,再行右侧肺动脉栓塞术后咯血停止;病例3,男,58岁,以"咳嗽、胸闷、盗汗4个月,咯血3 d(300 ml)"为主要表现,行双侧支气管动脉栓塞术后仍有咯血,再行左右支气管动脉、右上肺动脉栓塞术后咯血停止.通过筛选共获得21篇文献,42例肺结核并发PAP患者,与本文3例患者共计45例,其中男性36例,女9例,中位年龄为52.0(35.0,63.0)岁.45例患者均进行了CTA,PAP的检出率为100.0％;41例进行了肺动脉造影,PAP的检出率为75.6％(31例).41例患者接受了血管介入治疗,其中26例行肺动脉栓塞治疗,7例行支气管动脉栓塞治疗,8例接受了支气管动脉栓塞+肺动脉栓塞治疗,术后有效止血40例,1例患者因大咯血窒息死亡.术后40例获得随访,2例复发,分别经外科切除术和再次行支气管动脉栓塞而治愈.结论 PAP是导致肺结核大咯血的主要原因之一,肺动脉介入栓塞治疗仍是PAP并发大咯血的首选干预措施.当支气管动脉栓塞效果不佳或咯血近期复发时,应及时进行胸部CTA检查,以排除PAP可能.

目的 分析2012-2017年间南京市肺结核病流行病学特征,为制定结核病防治策略及医疗服务资源的分布与优化提供科学依据.方法 利用2012到2017年间全国结核病管理信息系统报告的南京市肺结核发病信息,采用描述性流行病学、季节指数法对肺结核时空流行病学特征进行分析.结果 时间分布上,南京市肺结核报告发病率季节性变化不明显,年报告发病率及病例数总体呈下降趋势,年均下降率为1.05/10万.地区分布上,根据充计,肺结核病例报告多集中在经济发达的中心城区,但年报告肺结核发病率最高为经济发展较为落后的高淳区,约为67.44/10万人.人群分布上,流动人口的报告发病率(59.72/10万人)明显高于本地人口(25.72/10万人);各年龄段均有疫情报告,60岁以上老年组报告发病率最高,约为69.34/10万人;农民和离退休人员位居肺结核病患者职业分布的前两位,分别占总报告发病数的24.09％和16.53％;男性患者报告发病率约为女性患者的2.19倍.结论 南京市肺结核疫情无明显的季节性变化,年报告发病率整体呈下降趋势,患者男性为多,农民和老年人是结核病防治工作的重点,经济发达的中心城区为结核病高负担聚集区,经济相对落后的高淳区为结核病高风险传播聚集区.

目的:分析南京地区11例严重急性呼吸综合征冠状病毒2 (severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)感染儿童的临床特征,为临床防治工作提供参考.方法:将南京地区(南京市第二医院汤山院区)2020年1-3月收治的11例SARS-CoV-2感染儿童纳为研究对象,按照年龄分为3～9岁年龄组和10～18岁年龄组,收集患者的一般情况、流行病学特点、临床症状、实验室检查、胸部CT、治疗及预后等资料进行比较分析.结果:3～9岁年龄组淋巴细胞绝对计数、CD3+总T细胞、CD4+T细胞、CD19+B细胞数高于10～18岁年龄组,核酸转阴时间短于后组,且组间比较差异有统计学意义(P＜0.05).结论:不同年龄段SARS-CoV-2感染儿童淋巴细胞反应不同,核酸转阴时间不同,故应当依据年龄制定合理的抗病毒方案,必要时予免疫干预.

Exogenous lipoid pneumonia (ExLP) is a rare disease in clinical practice.Because of the lack of typical and specific clinical manifestations and auxiliary examination,further understanding and detailed history collection are very important for the diagnosis of ExLP.ExLP combined pulmonary tuberculosis is even more rare and can be easily misdiagnosed.This article reports a typical case of ExLP complicated with pulmonary tuberculosis confirmed by etiology and pathology,and literatures are reviewed in order to improve the further understanding of the disease.

目的 回顾性观察银翘散联合三仁汤加减治疗新型冠状病毒肺炎普通型湿毒郁肺证患者的临床疗效.方法 采用回顾性临床研究方法,收集36例新型冠状病毒肺炎普通型湿毒郁肺证患者的临床资料,将其分为治疗组和对照组.治疗组20例采用常规治疗联合银翘散和三仁汤加减,对照组16例采用常规治疗.以中医证候积分、中医证候疗效、体温复常时间、病毒核酸转阴率、肺部病灶吸收情况作为结局指标评价治疗效果.结果 两组患者治疗后中医证候评分均较治疗前显著下降(P<0.05),治疗组中医证候积分下降程度明显大于对照组(P<0.05).治疗组中医证候疗效明显优于对照组(P<0.05).与对照组比较,治疗组患者体温复常时间明显缩短(P<0.05),治疗10 d后病毒核酸转阴率明显升高(P<0.05).两组患者肺部病灶吸收情况比较,差异无统计学意义(P>0.05).结论 在西医常规治疗基础上,采用银翘散联合三仁汤加减治疗能够改善新型冠状病毒肺炎普通型湿毒郁肺证患者临床症状,缩短体温复常时间,提高病毒核酸转阴率.

目的 总结耐多药结核病(MDR-TB)的临床特征.方法 回顾性总结MDR-TB患者(MDR-TB组,64例)和药敏敏感结核病患者(DS-TB组,115例)的临床特征、实验室检查和胸部CT等资料,分析基因芯片法检测MDR-TB异烟肼和利福平耐药基因灵敏度和特异度.结果 MDR-TB组发生胸闷气促、咯血、结核史、合并症比例高于DS-TB组(P＜0.05).MDR-TB组影像学上肺部病灶累积肺野≥3个、空洞和气胸发生率高于DS-TB组(P＜0.05).MDR-TB组对氧氟沙星耐药率达到64.1％.基因芯片法检测异烟肼和利福平耐药基因灵敏度分别为68.75％和62.50％,特异度分别为92.12％和84.42％.结论 胸闷气促、咯血、有结核史、有合并症、肺部病灶范围广、空洞和气胸等临床特征对MDR-TB诊断有一定参考价值.耐药基因检测MDR-TB异烟肼和利福平耐药基因灵敏度和特异度不高.

通过分析2例结核所致纵隔纤维化(mediastinal fibrosis,MF)患者的临床诊治过程,增强临床医师对MF的认识,提高对该疾病的诊断能力.经过多学科讨论后发现,该2例结核所致MF患者在临床表现、影像学特征、气管镜检查、诊治过程等方面具有一定的共性特征:(1)慢性病程,临床症状缺乏特异性,易误诊为慢性阻塞性肺疾病(COPD).(2)影像学检查可见纵隔及肺门处不规则软组织影伴钙化,气道和肺血管变形狭窄.(3)气管镜检查可见黏膜多发性色素沉着,支气管狭窄或闭塞.(4)根据患者既往病史、抗结核药品不规则治疗史、结核免疫学指标阳性等可提示MF与结核感染有关.(5)药品治疗效果欠佳,血管介入治疗对改善临床症状有一定的价值.结核感染作为MF的致病因素应加以重视,需早期发现早期治疗.

Objective:To observe the clinical features of different images progress models of the COVID-19, improve the early diagnosis of severe patients.Methods:Clinical features and radiological characteristics of the 65 imported COVID-19 patients in Nanjing Second Hospital were retrospectively analyzed.These patients were divided into two groups based on whether the disease progressed rapidly within 48 hours.Groups: rapid progress (group A)16 cases, none rapid progress (group B) 49 cases, analysed the basic information, incubation period, clinical characteristics, laboratory and radiological characteristics(include lesions distributions, morphology, borders and numbers of lung lobes involved). SPSS 22.0 statistical software was used to analyze the differences between the two groups.Results:Differences in clinical datas between the two groups: the age, chest tightness symptoms, underlying diseases and the level of LDH in group A were significantly higher than those in group B (all P<0.001), the CD4 T lymphocyte and lymphocyte counts in group A were significantly lower than group B ( Z=182.500, 259.000, both P<0.001). Imaging differences between the two groups: Most of the patients in group A showed a mixed distribution of ground-glass opacity, the boundary of the lesion was blurred, while patients in group B had a clear subpleural distribution boundary, there are significant statistical difference between the two groups ( χ2=32.705, 13.268, both P<0.001). The detection rate of " crazy paving" sign in group A was higher than that in group B ( χ2=4.201, P<0.05). The cases of " reversed halo sign" was less and there was no significant difference between the two groups ( χ2=4.201, P>0.05) except one case in group A that a critically case with merit our attentions.Vascular thickening had no statistically significant between the two groups ( χ2=1.160, P>0.05). Conclusions:Older patients with underlying disease, decreased lymphocyte count and CD4, elevated LDH, mixed distribution of lesions along the bronchial vascular bundle and periphery, blurred ground-glass opacity boundaries or " crazy paving" sign suggest that the lesion may develop rapidly.

摘要： 患者男，47岁，因全身多发肿块1个月于2018年7月12日入院。患者于1个月前发现右上臂屈侧出现一黄豆大小肿块，无红肿疼痛等不适，起初未重视，后肿块消退。1周前患者左上臂屈侧出现一大小约4 cm × 5 cm肿块，左膝及左大腿伸侧分别出现约6 cm × 7 cm、8 cm × 10 cm肿块，触之有波动感，不伴红肿及疼痛不适，于外院行左上臂屈侧肿块穿刺后抽出脓液10 ml，送病原学检查，结果显示抗酸杆菌++++，诊断为多发性皮下结核性脓肿，转至我科就诊……