先天性结核病7例临床分析  

Clinical analysis of congenital tuberculosis in 7 infants

作　　者：王成虎[1] 杨光[2] 张新华[1] Wang Chenghu;Yang Guang;Zhang Xinhua(Department of Neonatal Medicine,Shanxi Provincial Children's Hospital,Taiyuan 030013,China;Department of Pediatrics,Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西省儿童医院新生儿内科,太原030013 [2]山西医科大学儿科系,太原030001

出　　处：《中华新生儿科杂志（中英文）》2022年第2期157-161,共5页Chinese Journal of Neonatology

摘　　要：目的探讨先天性结核病(congenital tuberculosis,CTB)的临床特点,提高对该病的认识。方法回顾性分析2016年6月至2021年2月山西省儿童医院新生儿内科收治的CTB患儿临床资料,分析其临床特点、诊疗情况及预后。结果共纳入7例CTB患儿,其中4例母亲因输卵管阻塞经体外受精胚胎移植术受孕,2例母亲确诊为输卵管结核。7例患儿中男1例,女6例;早产儿6例,足月儿1例;发病日龄中位数18 d(7~30 d)。发热7例,呼吸急促、反应差6例,呼吸暂停5例,咳嗽3例,面色苍白、双肺湿啰音各1例,肝肿大6例,脾肿大3例,淋巴结肿大1例。胸部X线检查有斑片状渗出影3例,粟粒影并渗出影2例,斑片影、双肺纹理增多模糊各1例。痰抗酸杆菌涂片声门部和深部痰标本阳性率高于口咽部标本;7例痰结核分枝杆菌DNA测定均阳性。1例经有创呼吸支持治疗1 d自动出院后死亡;2例治疗后明显好转,携氧出院后抗结核治疗1~2个月,因肺部病变重呼吸衰竭死亡;存活4例中1例治愈,3例明显好转。结论输卵管结核不孕症妇女经体外受精胚胎移植术受孕可能是新生儿患CTB的主要原因;特异性检查首选痰抗酸杆菌涂片、痰聚合酶链反应结核分枝杆菌DNA测定;痰结核分枝杆菌及耐药基因检查可指导临床用药;声门部或深部痰标本可提高检查阳性率。Objective To study the clinical characteristics of congenital tuberculosis(CTB).Methods From June 2016 to February 2021,the clinical data of infants with CTB admitted to the neonatal department of our hospital were retrospectively analyzed,including their clinical characteristics,diagnosis,treatment and prognosis.Results A total of 7 infants with CTB were enrolled into the study.4 mothers had in vitro fertilization embryo transfer(IVF-ET)due to tubal obstruction and 2 mothers who were diagnosed of tubal tuberculosis.The 7 infants included 1 male and 6 female,6 preterm and 1 full-term.The median age of onset was 18 d(7~30 d).All of the 7 infants had fever,6 had shortness of breath and poor response,5 had apnea,3 were coughing,1 showed pale skin colour,1 had bilateral rales in the lung,6 had hepatomegaly,3 splenomegaly and 1 lymphadenopathy.Chest X-ray showed patchy exudation in 3 infants,miliary pattern of opacification in 2 infants,patchy opacification in 1 infant,bilateral increased lung markings in 1 infant.The positive rate of acid-fast bacilli(AFB)was 50%in all sputum samples.Specimens from glottic and subglottic area showed higher positive rate than oropharyngeal specimen.PCR MTB-DNA tests of sputum samples were positive in all 7 cases.1 infant received invasive respiratory support for 1 d and died after discharge.2 infants improved significantly after initial treatment,received 1~2 months of anti-TB therapy outside the hospital and died of severe respiratory failure.Of the 4 infants survived,1 was cured and 3 significantly improved.Conclusions Mothers with tubal tuberculosis receiving IVF-ET may cause high risk of CTB.Sputum AFB test and sputum PCR MTB-DNA test are preferred diagnostic tests.Genetic test of drug-resistant TB may guide clinical drug use.Glottic or deeper throat specimens can increase the positive rate.

关 键 词：先天性结核病 输卵管结核 体外受精 婴儿 新生 

分 类 号：R529.9[医药卫生—内科学]