儿童胸内结核临床特点及诊断分析  

Clinical characteristics and diagnosis analysis of intrathoracic tuberculosis in children

作　　者：尹洪云[1] 史祥[1] 葛燕萍[1] 孙雯雯[1] 马俊[1] 张青[1] 肖和平[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)重点实验室结核科,上海200433

出　　处：《中国实用儿科杂志》2017年第12期951-955,共5页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨临床表现及常规辅助检查对16岁以下胸内结核患儿的协助诊断作用。方法收集2009年1月至2011年12月因胸内疾病于同济大学附属上海肺科医院住院治疗的16岁以下患儿的病历资料,根据最终诊断分为胸内结核和非结核病2组。胸内结核组238例(男137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2组的临床表现及常规辅助检查结果。将患儿根据年龄再分为<10岁及≥10岁2组,对其临床资料也进行比较分析。结果 (1)病理诊断明确率为72.30%,其中胸内结核组为70.73%。结核菌阳性率为21.85%。(2)胸内结核组以中病程为主(占56.30%),发病初发热病例及有结核病诱发因素者比例、结核菌素(PPD)皮试阳性反应比例及反应强度、血清结核抗体阳性率及红细胞沉降率、C反应蛋白、血小板计数、D-二聚体平均值均明显高于非结核病组。(3)约59%的非结核病组患儿经抗生素治疗治愈或显效,胸内结核组10%患儿显示有效。(4)胸内结核组的影像诊断符合率为53.36%,非结核病组影像诊断误导为结核者占11.71%。结论细致的病史询问、简便的实验室及辅助检查结果,对16岁以下儿童胸内结核病与非结核性病变有协助诊断作用。Objective To explore the value of clinical manifestations and routine examinations for the diagnosis of intrathoracie tuberculosis in children. Methods The medical records of children under 16 years of age due to intrathoracic diseases in Shanghai Pulmonary Hospital affiliated to Tongji University School of Medicine from January 2009 to De- cember 2011 were collected. According to the final diagnosis, the patients were divided into 2 groups ：intrathoracic tuberculosis and non tuberculosis. The clinieal manifestations and routine auxiliary examination results of the 2 groups were retrospectively analyzed. The children were divided according to age 〈 10 years and over 10 years old in 2 groups, and the clinical data were also compared. Results （ 1 ） Pathological diagnoses were confirmed at 72.30% of proportion at whole patients, 70.73% in TB group. The positive rate of tuberculosis bacteriology was 21.85% in TB group. （2）The middle course of history accounted for 56.30% in TB children. At the onset of illess, the proportion of fever and predisposi- tion to tuberculosis, positivity of tuberculin skin test （TST） and serumal tuberculosis antibody, and average value of ESR, CRP, PLT and D-Dier in blood were significantly higher in TB group than those in non-TB group. （3）About 59% of patients in the non-TB group were cured or were markedly improved by antibiotic treatment, which was effective in 10% of the TB group. （4）Diagnostic accordance rate by radiology was 53.36% and the rate of misdiagnosis as tuberculosis accounted for 11.71% in non-TB group. Conclusion Clinical features combined with medical history and laboratory resuhs are helpful for the identification of tuberculosis in children under 16 years old. Keywords child; tuberculosis ; intrathoracic ; clinical manifestation ; diagnosis

关 键 词：儿童 结核 胸内 临床表现 诊断 

分 类 号：R72[医药卫生—儿科]