先天性结核病12例临床分析  

Clinical analysis of 12 cases of congenital tuberculosis

作　　者：胡海霞 王晓霞 黄绍梅[1] 李晓琪 郭慧莲 李翠萍[1] HU Haixia;WANG Xiaoxia;HUANG Shaomei;LI Xiaoqi;GUO Huilian;LI Cuiping(Department of Pediatrics,Guangzhou Chest Hospital,Guangzhou,Guangdong 510095,China)

机构地区：[1]广州市胸科医院儿科,广东广州510095

出　　处：《临床肺科杂志》2025年第4期531-537,共7页Journal of Clinical Pulmonary Medicine

基　　金：广州市卫生健康科技项目(20221A011048)。

摘　　要：目的探究先天性结核病(congenital tuberculosis,CTB)的临床特征,提高对CTB的认识。方法收集2015年8月至2022年11月广州市胸科医院儿科收治的CTB患儿共12例,分析总结其临床资料、临床特点、诊疗情况和疾病预后。结果12例CTB患儿的母亲在分娩后诊断为血行播散型肺结核2例(16.7%)、结核性腹膜炎1例(8.3%)、结核性胸膜炎2例(16.7%)、继发性肺结核7例(58.3%)。12例患儿:发病中位数日龄(19.42±7.48)天,临床主要表现有发热12例(100%)、肝肿大8例(66.7%)、呼吸困难3例(25%)、咳嗽3例(25%)、脾肿大3例(25%)、面色苍白2例(16.7%);11例患儿行血结核感染T细胞斑点试验(T-Spot.TB),11例阳性(100%,11/11),3例(50%,3/6)胃液结核分枝杆菌(Mycobacterium tuberculosis MTB)DNA或RNA阳性,3例(42.9%,3/7)胃液利福平耐药实时荧光定量核酸扩增检测阳性,5例(45.5%,5/11)胃液MTB培养阳性,2例(16.7%,2/12)痰/胃液涂片找抗酸杆菌,3例(100%,3/3)肺泡灌洗液宏基因组测序(metagenomic next-genera-tion sequencing,mNGS)找到结核分枝杆菌复合群序列数;肺部影像学检查提示斑片状渗出影8例(66.7%),粟粒影并渗出影4例(33.3%)。12例患儿全部接受个体化抗结核治疗方案,并已完成疗程,达临床治愈标准,均顺利停药。随访显示,所有患儿生长发育基本可达到正常儿童水平。结论CTB临床表现无特异性,生后1月内发热的患儿需警惕CTB,血T-SPOT.TB、胃液MTB检测、mNGS及可疑CTB患儿母亲全面筛查结核菌感染均有助于患儿诊断,早期及个体化抗结核治疗预后良好。Objective To explore the clinical characteristics of congenital tuberculosis(CTB)and enhance understanding of CTB.Methods A total of 12 cases of CTB children treated in the Department of Pediatrics,Guangzhou Chest Hospital from August 2015 to November 2022 were collected.Their clinical data,characteristics,treatment,and disease prognosis were analyzed and summarized.Results The mothers of the 12 children with CTB were diagnosed as 2 cases(16.7%)of hematogenous disseminated pulmonary tuberculosis,1 case(8.3%)of tuberculous peritonitis,2 cases(16.7%)of tuberculous pleurisy,and 7 cases 58.3%)of secondary pulmonary tuberculosis during pregnancy or after delivery.For 12 cases of CTB,children,the median age of onset was 19.42±7.48 days.The main clinical manifestations were fever in 12 cases(100%),hepatomegaly in 8 cases(66.7%),dyspnea in 3 cases(25%),splenomegaly in 3 cases(25%),lymphadenopathy in 3 cases(25%),and pale complexion in 2 cases(16.7%).T-SPOT.TB in blood was positive in 11 cases(100%,11/11),and Mycobacterium tuberculosis DNA or RNA in gastric juice was positive in 3 cases(50%,3/6).3 cases(42.9%,3/7)were positive for rifampicin resistance by real-time fluorescence quantitative nucleic acid amplification in gastric juice,5 cases(45.5%,5/11)were positive for MTB culture in gastric juice,and 2 cases(16.7%,2/12)were positive for acid-fast bacilli by sputum/gastric juice smear.3 cases(100%,3/3)of bronchoalveolar lavage fluid metagenomic next-generation sequencing(mNGS)found the sequence number of Mycobacterium tuberculosis complex.Pulmonary imaging showed patchy exudation in 8 cases(66.7%),and military shadow with exudation in 4 cases(33%).All the 12 children received individualized anti-tuberculosis treatment and completed the course of treatment,reaching the clinical cure standard,and all the children successfully discontinued the drug.Follow-up showed that the growth and development of all children could basically reach the normal level of children.Conclusion The clinical manifestations of CTB are nonspecific

关 键 词：先天性结核病 婴儿 结核分枝杆菌 回顾性研究 

分 类 号：R529.9[医药卫生—内科学]