17例儿童泌尿系结核临床特征与疗效分析  

Analysis of clinical characteristics and curative effect in 17 urinary tuberculosis children

作　　者：张锋 王曼知 危松青 张小佛 周海依 ZHANG Feng;WANG Man-zhi;WEI Song-qing;ZHANG Xiao-fo;ZHOU Hai-yi(Department of Pediatric Tuberculosis,Changsha Central Hospital,University of South China,Changsha 430004,China)

机构地区：[1]南华大学附属长沙中心医院儿童结核科,430004

出　　处：《中国防痨杂志》2020年第10期1061-1067,共7页Chinese Journal of Antituberculosis

摘　　要：目的探讨儿童泌尿系结核临床特征与疗效,提高儿科医师对该病的认识。方法搜集2015年1月至2020年1月南华大学附属长沙中心医院儿童结核科收治的符合诊断标准的17例泌尿系结核患儿的临床资料进行整理及描述性统计分析。结果17例患儿均来自湖南各地,其中农村15例,男童11例,年龄中位数(四分位数)为11.0(8.5,16.5)岁。16例接种过卡介苗,6例有明确肺结核密切接触史。并发肺结核、结核性脑膜脑炎和结核性脊髓脊膜炎、腹腔结核分别为14、8、7例。12例有泌尿系症状,其中尿频、尿急、尿痛11例,夜间盗汗9例,发热8例。尿常规异常者12例,PPD试验和结核感染T淋巴细胞斑点试验(T-SPOT.TB)阳性者分别为9和12例。泌尿系CT扫描显示结核典型表现、泌尿系受累、膀胱壁增厚者分别为15、15、9例。本组患儿均延误诊断,延误时间为15 d至9个月。均以H-R-Z-E抗结核治疗方案(强化期3~6个月,巩固期12~15个月)为基础,仅1例原发性癫痫患儿将异烟肼改为帕司烟肼,并因病情或疗效原因而联用其他一、二线抗结核药品(如丙硫异烟胺、链霉素、左氧氟沙星、利奈唑胺),最终6例治愈,9例病情好转,处于继续治疗中,2例死亡。结论本省儿童泌尿系结核患儿以农村、男童、大龄多见,接种卡介苗对该年龄段患儿无保护性;有明显结核病密切接触史、泌尿系症状和其他器官结核,PPD试验和T-SPOT.TB阳性、CT扫描有疑似典型病灶改变有助于辅助诊断。积极治疗后效果良好。Objective To explore the clinical characteristics and curative effect in urinary tuberculosis children,and to improve pediatricians’awareness of this disease.Methods Clinical data of 17 urinary tuberculosis children,who were admitted to Department of Pediatric Tuberculosis,Changsha Central Hospital,University of South China from January 2015 to January 2020 and met the diagnostic criteria,were collected for descriptive statistical analysis.Results The 17 cases were from all parts of Hu’nan Province,15 were rural cases,and 11 were boys.The median age(quartile)was 11.0(8.5,16.5)years.Sixteen cases had been vaccinated with BCG,and 6 cases had a clear history of exposure to pulmonary TB.Numbers of cases who complicated with pulmonary tuberculosis,tuberculous meningoencephalitis,tuberculous spinal meningitis,or abdominal tuberculosis were 14,8,and 7,respectively.12 cases had urinary system symptoms,including 11 cases of frequent urination,urgency,and painful urination;night sweats were found in 9 cases and 8 cases suffered fever.The abnormal urine routine were found in 12 cases,the PPD test and T-SPOT.TB were positive in 9 and 12 cases,respectively.CT scans of the urinary system showed typical manifestations of tuberculosis,urinary system involvement,and bladder wall thickening in 15,15 and 9 cases,respectively.All children were delayed in diagnosis,and the delay time was15 days to 9 months;they were all treated with the H-R-Z-E anti-tuberculosis as basic plan(intensive period of 3 to6 months and consolidation period of 12 to 15 months),only 1 case who complicated with primary epilepsy changed isoniazid to pasiniazid,and used the first-and second-line anti-tuberculosis drugs(such as prothionamide,streptomycin,levofloxacin,linezolid)in combination according to the condition or effect.Finally,6 cases were cured,9 cases improved and continued treatment,2 cases died.Conclusion Children with urinary tuberculosis in this province are more common in rural areas,and mainly are boys,and elder children.BCG vaccination is no

关 键 词：结核 泌尿生殖系统 儿童 疾病特征 数据说明 统计 诊断 鉴别 治疗结果 

分 类 号：R527[医药卫生—内科学]