根據世界衛生組織(World Health Organization; WHO)估計截至目前為止全球約有22億人 口被結核菌感染。2013年全球結核病(tuberculosis; TB)新發病數約900 萬人，150 萬結核病人 死亡。台灣2013年新增11,528名結核個案，發生率為每10萬人口49.4例，其中609 人死亡。 自2006年疾病管制署推動「結核病十年減半全民動員計劃」以來，雖然發生率與死亡率有明 顯下降趨勢，結核病至今仍是台灣與全球公共衛生重大威脅之一。 傳統結核病知識偏重於結核病的臨床表現、細菌學和影像學檢查判讀，結核伴隨的血 液學變化相當多樣化，卻常被臨床醫師忽略而延遲診斷。結核病的血液學變化以正球性貧 血(normocytic anemia)， 嗜中性球(neutrophils)為主的白血球增多(leukocytosis)和血小板增多 (thrombocytosis)較常見。少數個案可能出現較嚴重的貧血(Hb<10g/dl)，白血球減少或顆粒性白血 球缺乏，淋巴球減少(lymphopenia)，類白血病(leukemoid)反應，血小板減少(thrombocytopenia)， 全血球減少(pancytopenia)，瀰漫性血管內凝血(disseminated intravascular coagulation; DIC)及深部 靜脈血栓(deep vein thrombosis; DVT)等，嚴重的血液病變常見於散播型結核(disseminated TB)， 但也可出現在單純的肺內結核病人。其中粟粒性結核病(miliary TB)所造成的骨髓壞死、血球吞 噬現象及全血球減少，是預後不良的指標，需特別注意。 血液學病變主要經由結核病免疫發炎反應及其釋放的細胞激素(cytokines)造成。因此， 快速診斷結核病並提供有效治療，阻斷結核相關免疫發炎反應，才是最佳治療方式及影響預 後的主要因素。本文擬就結核感染相關的血液學異常變化及其致病機轉加以闡述，尤其強調 肺外結核病，應做為不明原因發燒鑑別診斷之參考。

According to the World Health Organization (WHO) report, there were an estimated 2.2 billion individuals have been infected by Mycobacterium tuberculosis. There was 9 millions new Tuberculosis(TB) cases and nearly 1.5 million people die of tuberculosis worldwide in 2013. In Taiwan, there were 11,528 new cases and around 600 people died in 2013. Although, Taiwan CDC had launched a “Halving TB in 10 years” national TB project in 2006, followed by accelerated annual decline in TB incidence and mortality also. TB continues to be one of the major threats to global public health. In contrast to the conventional TB educational programs mostly focused on the clinical presentation of TB disease, interpretation of bacteriologic and radiologic studies in clinical practice. The hematologic dyscrasias not uncommonly seen in TB patients are seldom mentioned and always overlooked. Patients with mycobacterial infection could present myriad hematological abnormalities. Although, mild normocytic anemia and leukocytosis or thrombocytosis are the most common abnormalities. Some people infected by Mycobacterium tuberculosis may cause severe anemia(Hb<10g/dl), neutropenia, lymphopenia, leukemoid reaction, thrombocytopenia, pancytopenia, disseminated intravascular coagulation(DIC), deep vein thrombosis(DVT) or coagulopathy. By incidence, these abnormalities are more common in disseminated TB than in isolated pulmonary TB cases. The major pathogenesis of hematologic changes are attributed to the immune-related inflammation and cytokines released during TB infection. Therefore, the preferred treatment is directed at the underlying disease, favorable outcome depend on rapid diagnosis and early treatment. Our review on TB-related hematological abnormalities and pathogenic mechanism intend to provide a reference in TB diagnosis and treatment, particularly for those with extrapulmonary TB.