先天性耐药结核病一例并文献复习  

Congenital drug-resistant tuberculosis:a case report and literature review

作　　者：岳英 黄婷婷 任斐 马进宝 漆沄 YUE Ying;HUANG Ting-ting;REN Fei;MA Jin-bao;QI Yun(Department of Gynaecology and Pediatric Tuberculosis,Xi’an Chest Hospital,Xi’an 710100,China;Department of Drug-Resistant Tuberculosis,Xi’an Chest Hospital,Xi’an 710100,China)

机构地区：[1]西安市胸科医院妇儿结核科,西安710100 [2]西安市胸科医院耐药结核科,西安710100

出　　处：《中国防痨杂志》2022年第3期252-257,共6页Chinese Journal of Antituberculosis

摘　　要：目的:结合文献复习先天性结核病的临床特点以及诊治过程,旨在积累临床医师的诊疗经验。方法:回顾性分析西安市胸科医院2020年10月31日收治的1例先天性耐药结核病患儿及患儿母亲的临床资料,通过查阅中国知网、万方数据库、中华期刊全文数据库及PubMed数据库,以“先天性结核病”为中文关键词,以“Congenital tuberculosis”为英文关键词进行文献检索,共搜索到国内外相关文献24篇,其中2例为耐药结核病。本研究主要选取母亲行体外受精-胚胎移植(IVF-ET)后新生儿发现先天性结核病的11篇文献共17例患儿,结合本例患儿对其临床特征、诊断及治疗情况进行分析。结果:文献报道加上本例共18例患儿,其中2对双胞胎。本研究中患儿母亲有结核病病史或结核病密切接触史的共12例,无结核病病史以及密切接触史的4例;母亲在助孕前行结核感染筛查的5例,未进行筛查的11例。18例中16例患儿前期按“新生儿肺炎、脓毒血症、发热待查等”抗感染治疗无效后才进行结核病的筛查,发病到诊断时间范围为3~44 d。先天性结核病的临床主要表现为:发热、咳嗽、呼吸困难、肝脾肿大、黄疸、呼吸暂停、腹泻、耳部流脓。胸部CT扫描结果多提示:弥漫分布的粟粒状结节影,纵隔、肺门淋巴结肿大,少量胸腔积液。本研究中15例患儿按一线抗结核方案治疗后,11例预后良好,4例因发现结核病时病情危重,死亡。3例为先天性耐药结核病,1例胃液标本行药物敏感性试验(简称“药敏试验”),结果显示“利福平”耐药,1例胃液标本药敏试验提示“异烟肼”耐药,本例药敏试验提示“异烟肼、利福平、利福喷丁、帕司烟肼”耐药。3例均给予二线抗结核治疗,未见明显药物不良反应,患儿预后良好。结论:先天性耐药结核病临床表现缺乏特异性,但临床症状却较为严重。二线抗结核治疗药物不良反应Objective:To review the clinical characteristics,diagnosis and treatment of congenital tuberculosis combined with the literature,in order to accumulate clinical experience for clinicians.Methods:The clinical data of a child with congenital drug-resistant tuberculosis and its mother admitted to Xi’an Chest Hospital in October 2020 were retrospectively analyzed.Taking“congenital tuberculosis”as the keyword,the literature was searched through the CNKI,Wanfang,PubMed and CJFD,and a total of 24 related literatures were searched out,and 2 cases of them were drug-resistant tuberculosis.Combined with this case,the clinical characteristics,diagnosis and treatment of 17 congenital tuberculosis children whose mothers underwent in vitro fertilization-embryo transfer were analyzed,and the 17 children were selected from 11 literatures.Results:In this study,there were 18 children,including 2 pairs of twins;12 children’mothers had a history of tuberculosis or close contact to tuberculosis,4 cases had no history of tuberculosis or close contact to tuberculosis;5 cases were screened for tuberculosis infection before pregnancy,and 11 cases without screening.Sixteen cases were screened for tuberculosis after ineffective anti-infective treatment of“neonatal pneumonia,sepsis,fever”,and the time from onset to diagnosis was 3-44 days.The clinical manifestation is fever,cough,dyspnea,hepatomegaly,jaundice,apnea,diarrhea,and ear pus.Chest CT showed diffuse miliary nodular shadow,mediastinal and hilar lymph node enlargement,and a small amount of pleural effusion.In this study,of the 15 cases treated with the first-line anti-tuberculosis regimen,11 had good prognosis,and 4 cases were found to be critically ill and died.Three cases were congenital drug-resistant tuberculosis,one was found“rifampicin”drug resistance and one showed“isoniazid”drug resistance through gastric juice test,and the case in our hospital was founde“isoniazid,rifampicin,rifampicin,and Isoniazid Aminosalicylate”drug resistance.Three cases were giv

关 键 词：结核 妊娠并发症 抗药性 综述文献(主题) 

分 类 号：R52[医药卫生—内科学] R81[医药卫生—临床医学]