先天性结核病四例报告并文献复习  

Congenital tuberculosis:report of four cases and literature review

作　　者：王俊平[1] 王艳丽[1] 郑璇儿[1] 林颖仪 叶秀桢[1] Wang Junping;Wang Yanli;Zheng Xuaner;Lin Yingyi;Ye Xiuzhen(Department of Neonatology,Guangdong Women and Children Hospital,Guangzhou 510010,China)

机构地区：[1]广东省妇幼保健院新生儿科,广州510010

出　　处：《中华围产医学杂志》2020年第9期615-622,共8页Chinese Journal of Perinatal Medicine

摘　　要：目的总结先天性结核病的临床特点、诊断和治疗经验。方法回顾性分析广东省妇幼保健院2010年1月至2020年1月收治的4例先天性结核病患儿的临床资料,并收集在万方数据库、中国知网和PubMed检索到的自1994年1月至2019年12月发表的来自国内医疗机构的先天性结核病患儿的临床资料。采用描述性统计分析。结果本研究4例患儿均为早产儿,发病年龄为生后14~30 d,发病至诊断时间1~34 d,均经过抗结核治疗,1例治愈,1例好转,2例死亡。本研究(4例)及文献报道(52例)共56例患儿的中位发病年龄为14.5 d(7.0~20.7 d);发病至诊断的中位时间为10.5 d(7.5~22.0 d);54例母亲中(双胎妊娠2例),围产期有结核病史48例(88.9%),其中产前确诊16例;患儿主要临床表现:发热82.1%(46/56)、呼吸窘迫69.6%(39/56)、嗜睡和/或易激惹57.1%(32/56)、发绀53.6%(30/56)、喂养困难53.6%(30/56)、肝脏肿大48.2%(27/56)、脾脏肿大41.1%(23/56)。实验室检查及影像学检查:痰液或胃液中抗酸杆菌涂片、培养及聚合酶链反应检测结核分枝杆菌DNA阳性率最高33.3%,结核分枝杆菌感染T淋巴细胞斑点试验阳性率达7/12;胸部X射线:粟粒性结节占37.0%(20/54),广泛结节-斑片影占25.9%(14/54)。肝脾超声检查:肝肿大和/或脾肿大占52.4%(11/21),肝脏和脾脏内多发低密度结节病灶占47.6%(10/21)。误诊率达28.6%(16/56)。总体病死率为51.8%(29/56),经抗结核治疗后病死率为28.9%(11/38),未经过抗结核治疗者病死率为18/18。结论先天性结核病的临床表现无特异性,实验室检测阳性率低,误诊率、病死率高。需要对可疑先天性结核病婴儿的母亲进行全面评估。及时诊断和有效的抗结核治疗对于改善预后至关重要。Objective To summarize the clinical characteristics and experiences in the diagnosis and treatment of congenital tuberculosis.Methods This study involved four infants with congenital tuberculosis diagnosed in Guangdong Women and Children Hospital from January 2010 to January 2020.Moreover,publications of 52 congenital tuberculosis cases from Chinese hospitals between January 1994 and January 2019 were retrieved from Wanfang Database,China National Knowledge Infrastructure and PubMed.Clinical data of all patients were retrospectively analyzed.Results All four cases we reported here were preterm infants with the onset of the disease at 14-30 d after birth and received anti-tuberculosis treatment.The interval between disease onset and diagnosis was 1-34 d.One baby was cured,one was improved,while the other two died.The median age at the onset of the disease in these 56 cases(including the four we reported and 52 from literature)was 14.5 d(7.0-20.7 d)and the median interval between the onset and diagnosis was 10.5 d(7.5~22.0 d).Forty-eight(88.9%)out of the 54 mothers were suffered from active tuberculosis during the perinatal period,including 16 diagnosed before delivery.The main clinical symptoms in these neonates were fever(82.1%,46/56),respiratory distress(69.6%,39/56),drowsiness and/or irritation(57.1%,32/56),cyanosis(53.6%,30/56),feeding difficulties(53.6%,30/56),hepatomegaly(48.2%,27/56)and splenomegaly(41.1%,23/56).The positive rates of acid-fast staining,culture and polymerase chain reaction detection of Mycobacterium tuberculosis in sputum smears or gastric juice were all less than 33.3%,and the positive rate of spot test for Mycobacterium tuberculosis infection was 7/12.Chest X-ray showed miliary nodules and diffused nodules-patchy in 37.0%(20/54)and 25.9%(14/54)of the patients,respectively.Abdominal ultrasonography found 52.4%(11/21)with hepatomegaly and/or splenomegaly and 47.6%(10/21)with multiple low-density nodules in liver and spleen.The misdiagnosis rate was 28.6%(16/56).The overall mortality rate wa

关 键 词：结核 婴儿 早产 疾病 回顾性研究 

分 类 号：R529.9[医药卫生—内科学]