349例儿童胸内结核病与非结核病的鉴别诊断  

Differential diagnosis of 349 pediatrics cases with intrathoracic tuberculosis and non-tuberculosis

作　　者：史祥[1] 尹洪云[1] 马俊[1] 葛燕萍[1] 

机构地区：[1]同济大学附属上海市肺科医院结核病临床研究中心上海市结核病(肺)重点实验室,200433

出　　处：《中国防痨杂志》2016年第6期513-516,共4页Chinese Journal of Antituberculosis

摘　　要：将2009年1月至2011年12月期间在上海市肺科医院住院确诊的349例16岁以下患儿分为胸内结核病组（简称“结核病组”）和胸内非结核病组（简称“非结核病组”）。其中，结核病组238例，男157例，女81例，平均年龄（12．44±3．17）岁；非结核病组111例，男64例，女47例，平均年龄（12．32±2．88）岁。回顾性分析比较两组间的年龄、体质量指数等人口学信息，病程、个人疾病史、临床表现（症状、体征）、住院后血液学检查结果、CT影像学诊断等临床信息。两组患儿鉴别诊断要点：结核病组患儿多以中短病程为主，多有结核病患者密切接触史，更多仅有发热，发热与咳嗽同时出现或黄痰、高热表现者相对少见；超过50％的结核病患儿符合结核病影像诊断，胸膜病变的发生率高；PPD试验多为硬结平均直径≥10mm，血清结核抗体阳性率高；结核病组患儿痰涂片抗酸染色阳性率较低；普通抗生素治疗效果差。对于疑似结核病患儿可先进行1～2周的普通抗生素治疗观察，如病变无明显吸收和改变，可以进行诊断性抗结核药物治疗。Pediatrics patients under 16 years old admitted in Shanghai Pulmonary Hospital during Jam 2009 to Dec. 2011 were divided into two groups： children with intrathoracic tuberculosis as TB group and non-tuberculo- sis group as non-TB group. Two hundred and thirty-eight cases of TB group included 157 males and 81 females with average age （12.44±3.17） years old; 111 cases of non-TB group included 64 males and 47 females, with average age （12.32 ± 2.88） years. Demographic data including age and Body Mass Index （BMI）, course of disease, personal disease history, clinical manifestations （symptoms and talized, imaging diagnosis in CT were retrospectively signs）, hematological examinations results after being hospi- analyzed. The points of deferential diagnosis between two groups： the disease course was mainly medium and short durations, closeiy contact history with TB patients was common in more cases, the rate of fever without any other symptoms was significantly higher some cases accompa- nied productive cough with yellow sputum, high fever was seldom, more than 50% children with TB meet the diagnostic imaging,the incidence of pleural lesions was higher, the size of induration PPD test mostly ≥10 mm in diameter, the positive rate of serum TB antibody was significantly higher, the rate of sputum smear positive among children with pulmonary TB was very iow, the therapeutic effects with general antibiotics were poor. For suspected children TB patients, general antibiotics treatment was given for 1-2 weeks. The patients with poor results were suggested to receive anti-TB treatments for diagnosis.

关 键 词：儿童 结核 胸部疾病 诊断 鉴别 

分 类 号：R442.8[医药卫生—诊断学]