Approach to Early Diagnosis of Chronic Obstructive Pulmonary Disease Complicated with Tuberculosis in the Elderly

Objective To analyze clinical features in the elderly who suffer chronic obstructive pulmonary disease(COPD)complicated with tuberculosis(TB),and investigate clues to earlier diagnostic.Methods The clinical features of 53 elderly patients aged≥65 years with COPD complicated with TB(group A)were analyzed retrospectively,and the risk factors,clinical symptoms,laboratory tests and imaging performance were compared with the elderly with COPD alone(group B).Results Patients of A group showed the feature of COPD symptoms principally,the positive rates of cough,expectoration and tachypnea were 94.34%,94.34% and 92.45% respectively;however,the positive rates of fatigue and night sweats were 26.42% and 15.09%,the difference was not statistically meaningful compared with patients of B group.Fever-positive rate of group A(69.81%)was higher than that of group B(22.22%)(P0.01),yet two groups were mainly characterized by moderate to high fever and low-grade fever of post meridiem was seldom.The positive rates of marasmus,anemia,low protein and erythrocyte sedimentation rate(ESR)of group A were higher than those of group B respectively(33.96% vs.7.94%,47.17% vs.9.52%,66.04% vs.39.68%and 77.36% vs.20.63%,all P0.01).Tuberculin test(PPD)-positive rate of group A was 20.75%,serum adenosine deaminase(ADA)was 24.53%,tuberculosis antibody(TB-Ab)was 28.30%,sputum smear was 56.60% and sputum culture was 62.26%.Imaging changes were primarily distributed in the atypical areas,the discrepancy between two groups on fiber cord shadows,large areas of consolidation,pleural effusions and emphysemas was not statistically significant,concerning exudate change of patches,nodules,etc.;the occurrence of cavity,calcifications and pleural lesions in group A was higher than that in group B(P0.01).Conclusion For the elderly COPD patients complicated with TB,they principally showed the feature of COPD symptoms,less typical symptoms of TB,moreover,the positive rates of PPD,ADA and TB-Ab were not high,and hence vigilance to early find tuberculosis for the elderly with COPD in the clinical diagnosis should be heightened.