Diagnosis and treatment of extrapulmonary tuberculosis.
Diagnosis and treatment of extrapulmonary tuberculosis.
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DOI：
10.4046/trd.2015.78.2.47
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发表时间：
2015-04
影响因子：
2.9
通讯作者：
Lee JY
中科院分区：
文献类型：
--
作者：
Lee JY
肺外结核（EPTB）约占韩国所有结核病（TB）病例的20%。诊断EPTB仍然具有挑战性，因为从相对难以接近的部位获得的临床样本可能是少菌的，从而降低了诊断测试的灵敏度。只要可行，应尽一切努力获得适当的标本进行分枝杆菌学和组织病理学检查。结核病血清生化标志物（腺苷脱氨酶或γ干扰素）和分子生物学技术，如聚合酶链反应的测量可能是有用的EPTB的诊断方法。虽然这种疾病通常对标准抗结核药物治疗有反应，但理想的治疗方案和治疗持续时间尚未确定。在抗结核治疗过程中经常发生矛盾反应。它应该与其他临床恶化的原因区分开来。手术主要是为了获得有效的诊断标本和管理并发症。由于涂片镜检或培养无法用于监测EPTB患者，临床监测是评估治疗反应的常用方法。
Extrapulmonary tuberculosis (EPTB) constitutes about 20% of all cases of tuberculosis (TB) in Korea. Diagnosing EPTB remains challenging because clinical samples obtained from relatively inaccessible sites may be paucibacillary, thus decreasing the sensitivity of diagnostic tests. Whenever practical, every effort should be made to obtain appropriate specimens for both mycobacteriologic and histopathologic examinations. The measurement of biochemical markers in TB-affected serosal fluids (adenosine deaminase or gamma interferon) and molecular biology techniques such as polymerase chain reaction may be useful adjuncts in the diagnosis of EPTB. Although the disease usually responds to standard anti-TB drug therapy, the ideal regimen and duration of treatment have not yet been established. A paradoxical response frequently occurs during anti-TB therapy. It should be distinguished from other causes of clinical deterioration. Surgery is required mainly to obtain valid diagnostic specimens and to manage complications. Because smear microscopy or culture is not available to monitor patients with EPTB, clinical monitoring is the usual way to assess the response to treatment.