儿童肺结核59例临床分析  

Clinical Analysis of 59 Children with Pulmonary Tuberculosis

作　　者：陈琼华[1] 郑敬阳[1] 苏丽端 林印涛 曾丽娥[1] 刘琳琳[1] CHEN Qionghua;ZHENG Jingyang;SU Liduan;LIN Yintao;ZENG Li‘e;LIU Linlin(Department of Respiratory Medicine,The Third Clinical Medical College,Fujian Medical University,Quanzhou Women s and Children s Hospital,Quanzhou 362000,China)

机构地区：[1]福建医科大学第三临床医学院,泉州市妇幼保健院·儿童医院呼吸科,泉州362000

出　　处：《福建医科大学学报》2022年第5期425-430,共6页Journal of Fujian Medical University

摘　　要：目的总结儿童肺部结核感染的临床特征。方法回顾性分析2007年1月—2022年7月收治的59例肺结核患儿的资料,对患儿的临床特征、实验室检查、影像学和支气管镜下表现进行分析,并随诊患者的预后和转归情况。结果59例中,男童31例,女童28例,主要以发热(74.58%)和咳嗽(66.10%)为主诉就诊。未接种卡介苗3例(5.08%);有明确结核接触史24例(40.68%)。胸部CT检查59例,其中高度怀疑结核18例(30.51%);主要表现为肺实质病变30例(50.85%),胸腔积液19例(32.20%),淋巴结肿大及钙化14例(23.73%),气管支气管狭窄阻塞12例(20.34%),粟粒样改变9例(15.25%)。支气管镜检查20例,镜下均可见炎症改变;11例见支气管开口赘生物,1例见支气管结石,3例见支气管外压性狭窄。痰找结核分枝杆菌阳性率29.17%(14/48),结核菌素试验阳性率85.29%(29/34),γ-干扰素释放试验阳性率84.21%(16/19)。37例(62.71%)患儿最初误诊为肺炎。根据年龄将患儿分为婴幼儿组、学龄前期组和学龄期组,3组患儿的结核接触史、中性粒细胞比例和胸腔积液比例差别均有统计学意义(P<0.05)。根据诊断时期将患儿分为2007—2011年组、2012—2016年组和2017—2022年组,3组患儿的诊断年龄、发热人数比例、中性粒细胞比例、C反应蛋白、合并结核性脑膜炎比例差别均有统计学意义(P<0.05)。所有患儿诊断出结核后均转诊结核定点医院进一步治疗,大部分治疗好转,4例预后差。结论儿科医师应充分认识儿童肺结核的特点,联合多种诊断方法,提高儿童结核病的早期诊断水平,及时干预,改善预后。Objective To summarize the clinical characteristics of pulmonary tuberculosis infection in children.Methods This was a retrospective study which enrolled children admitted to our hospital between January 2007 to July 2022 with a diagnosis of pulmonary tuberculosis.The clinical features,laboratory examination,imaging and bronchoscopic findings of the children were analyzed,and the prognosis and outcome of the patients were followed up.Results A total of 59 children were enrolled,including 31 males and 28 females.The main complaints were fever(74.58%)and cough(66.10%).Three cases(5.08%)were not inoculated with BCG vaccine,while 24 cases(40.68%)with definite tuberculosis contact history.Fifty-nine cases were examined by chest CT,among which 18 cases(30.51%)were highly suspected of tuberculosis.The main manifestations of chest images were pulmonary parenchymal lesions(30 cases,50.85%),pleural effusion(19 cases,32.20%),lymphadenopathy and calcification(14 cases,23.73%),tracheobronchial stenosis and obstruction(12 cases,20.34%),and miliary changes(9 cases,15.25%).Twenty children underwent bronchoscopy,and inflammatory changes were observed.Bronchial ostium neoplasm was seen in 11 cases,broncholith in 1 case,and extrabronchial compression stenosis in 3 cases.The positive rate of mycobacterium tuberculosis detected in sputum was 29.17%(14/48),tuberculin skin test positive rate was 85.29%(29/34),and interferon-gamma release assays positive rate was 84.21%(16/19).Thirty-seven(62.71%)children were initially misdiagnosed as pneumonia.They were divided into infant group,preschool group and school-age group according to their age.There were differences in tuberculosis contact history,neutrophil ratio and pleural effusion ratio among the three groups(P<0.05).They were divided into three groups,namely,the group from 2007 to 2011,the group from 2012 to 2016,and the group from 2017 to 2022 according to diagnosis period.There were statistically significant differences in age at diagnosis,the proportion of children with fever,the pr

关 键 词：肺结核 儿童 临床特征 早期诊断 

分 类 号：R521[医药卫生—内科学]