儿童继发性肺结核的临床特征分析  

Clinical features of children with post-primary tuberculosis

作　　者：徐慧[1] 杨海明[1] 刘金荣[1] 刘辉[1] 申月琳[1] 赵顺英[1] 李惠民[1] Xu Hui;Yang Haiming;Liu Jinrong;Liu Hui;Shen Yuelin;Zhao Shunying;Li Huimin(Department No.2 of Respiratory Medicine,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院呼吸二科,北京100045

出　　处：《中华儿科杂志》2022年第4期307-310,共4页Chinese Journal of Pediatrics

摘　　要：目的总结儿童继发性肺结核的临床及影像学特点,提高对其早期识别及诊断水平。方法回顾性分析2015年1月至2021年12月首都医科大学附属北京儿童医院呼吸二科确诊的30例继发性肺结核患儿临床资料,分析临床特点及影像学表现。结果30例患儿中男10例、女20例,就诊年龄13.0(12.0,13.3)岁,常见的症状为咳嗽26例(87%)和发热23例(77%),除发热外仅4例(13%)伴有其他结核中毒症状(盗汗、乏力、体重下降)。白细胞计数(10±3)×10^(9)/L,中性粒细胞比例为0.69±0.11,血C反应蛋白水平31(15,81)mg/L。胸部CT主要表现为结节影伴空洞19例(63%)、肺实变13例(43%)、支气管播散12例(40%)、肺门或纵隔淋巴结肿大5例(17%)。好发部位依次为右上肺21例(70%)、左下肺17例(57%)及右下肺15例(50%)。30例患儿均进行痰抗酸染色涂片和痰结核杆菌培养,检出率分别为33%(10/30)和50%(15/30)。结论儿童继发性肺结核临床表现无特异性,胸部CT的影像学主要表现为结节影伴空洞、实变和支气管播散,准确识别继发性肺结核对限制结核病的传播和早期治疗至关重要。Objective The aim of this study was to summarize the clinical and imaging characteristics of post-primary tuberculosis in children,so as to improve the early identification and diagnosis of post-primary tuberculosis.Methods This was a retrospective study which enrolled children who were admitted to the Department No.2 of Respiratory Medicine,Beijing Children′s Hospital Affiliated to Capital Medical University between January 2015 to December 2020 and with a diagnosis of post-primary tuberculosis.Results A total of 30 patients were enrolled,including 10 males and 20 females.The age on admission were 13.0(12.0,13.3)years.Their common symptoms were cough and fever,there were 26 cases(87%)with cough and 23 cases(77%)with fever,but only 4 cases(13%)had other toxic symptoms(night sweat,weakness or weight loss)of tuberculosis other than fever.Blood examination showed that the white blood cell count was(10±3)×10^(9)/L,accompanied by elevated proportion of neutrophils(0.69±0.11)and increased level of C-reactive protein(31(15,81)mg/L).The common radiographic findings of CT were nodular or mass shadow with cavitation(19 cases(63%)),consolidation(13 cases(43%)),bronchogenic spread(12 cases(40%)),hilar or mediastinal lymphadenopathy(5 cases(17%))in this cohort.The affected locations included the right upper lobe(21 cases(70%)),the left lower lobe(17 cases(57%))and the right lower lobe(15 cases(50%)).Acid-fast bacillus smears and mycobacterial cultures were attempted for all cases,resulting in 33%(10/30)with smear positivity and 50%(15/30)with culture positivity.Conclusions Post-primary tuberculosis in children has no specific clinical manifestations.Imaging of chest CT is mainly manifested as nodular shadow with cavitation,consolidation or bronchogenic spread.Accurate identification of post-primary tuberculosis is crucial for preventing the spread and early treatment of tuberculosis.

关 键 词：儿童 结核 肺 诊断 

分 类 号：R521[医药卫生—内科学]