气管支气管结核诊断和治疗指南（2025年版）
中华医学会结核病学分会组织专家采用循证方法更新2025版指南，新增证据质量评价、推荐强度、共识率和分子生物学检测方法，将「细菌学」修订为「病原学」，强调支气管镜分类和分期诊断，围绕22个临床问题给出31条推荐。
要点
- 气管支气管结核定义为累及气管和支气管黏膜、黏膜下层及外膜的结核。
- 典型临床表现为刺激性咳嗽、咳痰、咯血、喘息和呼吸困难持续超过2周。
- 胸部CT阅片需重视气道内、气道壁及气道外征象。
核心结论
- 本指南围绕22个常见临床问题给出31条推荐，旨在提高气管支气管结核的临床诊治水平。
研究设计与样本
- 由中华医学会结核病学分会组织相关领域专家，采用循证医学方法，基于原共识和试行指南制定。
主要发现
- 新增证据质量评价、推荐强度、共识率和分子生物学检测方法。
- 将原「细菌学」术语修订为「病原学」。
- 补充完善诊断方法和标准，重点将原临床分类和分期诊断修订为支气管镜分类和分期诊断。
- 全面系统介绍气管支气管结核治疗方法，推荐不同分类和分期的介入治疗原则。
关键数值与推荐
- 推荐1：气管支气管结核定义为发生于气管和支气管黏膜、黏膜下层及外膜的结核。
- 推荐2：典型临床表现为刺激性咳嗽、咳痰、咯血、喘息和不同程度呼吸困难持续超过2周，肺部可闻及哮鸣音、干湿啰音、呼吸音减弱或消失、气管偏移等。
- 推荐3：临床审阅胸部CT时除重视肺窗、纵隔窗和软组织征象外，还应关注气道内、气道壁及气道外征象。
临床怎么用
- 临床应提高对气管支气管结核的早期准确诊断和及时规范治疗意识。
- 诊断强调病原学和分子生物学检测，并采用支气管镜分类和分期指导治疗。
- 根据支气管镜分类和分期选择介入治疗原则，极重度和重度气管结核合并气管狭窄需紧急处理。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Zhonghua Jie He He Hu Xi Za Zhi. 2026 May 12;49(5):503-524. doi: 10.3760/cma.j.cn112147-20250826-00518. ABSTRACT Tracheobronchial tuberculosis (TBTB) is a special clinical type of pulmonary tuberculosis (MTB), belonging to lower respiratory tract tuberculosis. Due to its non-specific clinical manifestations, it is prone to misdiagnosis, underdiagnosis, mistreatment, and missed treatment in clinical practice. To enhance the early and accurate diagnosis and timely and standardized treatment of TBTB in clinical practice, the Tuberculosis Branch of the Chinese Medical Association organized experts in relevant fields, adopted evidence-based medical methods, basing on the original consensus and guidelines (trial), and mainly made the following updates: New evidence quality evaluation, recommendation strength, consensus rate, and molecular biological detection methods were added; the original term "bacteriology" was revised to "etiology"; the diagnostic methods and criteria were supplemented and improved, with emphasis on revising the original clinical classification and staging diagnosis to bronchoscopic classification and staging diagnosis; the treatment methods for TBTB were comprehensively and systematically introduced; the interventional treatment principles for different classifications and stages were recommended, especially emphasizing the emergency treatment methods for extremely severe and severe tracheal tuberculosis combined with tracheal stenosis in order to improve the diagnosis and treatment.This guideline specifically presents 31 recommendations around the following 22 common clinical issues, with the aim of improving the diagnosis and treatment level of TBTB in clinical practice and benefiting more patients. The recommendations are listed below: Recommendation 1: Definition of TBTB: Tuberculosis that occurs in the mucosa, submucosa and outer membrane of the tracheas and bronchi. Recommendation 2: Typical clinical manifestations of TBTB: Irritating cough, expectoration, hemoptysis, wheezing and varying degrees of breathing difficulties lasting more than 2 weeks, and wheezing sounds in the lungs, dry and wet rales, weakened or absent breathing sounds, tracheal deviation, etc. Recommendation 3: Typical imaging signs that should be paid special attention to: during clinical review of chest CT scans, not only the lung window, mediastinal window and soft tissue signs should be emphasized, but also the signs within the airway, on the airway wall and out
引用
- 指南共识 · 慢阻肺：Guidelines for the diagnosis and treatment of tracheobronchial tuberculosis (2025 Edition)
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。