婴儿肺结核临床分析

发布时间：2018-08-12 18:26

【摘要】：目的：总结203例婴儿肺结核的临床及影像学特点，分析婴儿肺结核的预后及重症肺结核的相关因素，提高临床儿科医生对婴儿肺结核的认识和诊断水平，减少误诊及漏诊。方法：对2001年1月～2011年12月我院诊断的203例婴儿肺结核的病例资料进行回顾性分析。分别对婴儿肺结核的预后及发生重症肺结核的相关因素首先进行单因素分析（χ2检验、t检验）并逐一筛选，然后将所有P0.05的单因素进行非条件Logistic回归分析。结果：例住院婴儿肺结核中男125例（61.6%），女78例（38.4%）；农村127例（62.6%），城市76例（37.4%）；年龄≤3月44例（21.7%），3～6月67例（33.0%），6～9月58例（28.6%），9～12月34例（16.7%）；卡介苗(BacilleCalmette Guérin,BCG)接种史：接种BCG108例（53.2%），未接种BCG70例（34.5%），接种史不详25例（12.3%），城市BCG接种率较农村高（P=0.013）；活动性肺结核接触史：有明确活动性肺结核接触史78例(38.4%)，可疑结核接触史26例（12.8%）；临床表现：发热175例（86.2%），呼吸道症状165例（81.3%），，神经系统症状97例（47.8%），肺部湿罗音107例（52.7%），肝脾肿大80例（39.4%）；辅助检查：PPD阳性41例（41/92,44.6%），PPD阴性51例(51/92，55.4％)；胸部平片显示肺实质浸润115例（115/132,87.1%），纵膈增宽33例（33/132,25.06%），肺门增大9例（9/132,6.8%）；胸部CT(computed tomography,CT)显示肺实质浸润143例（143/144，99.3%），纵膈、肺门淋巴结肿大120例（120/144，83.3%）；病原学确诊91例（44.8%），涂片阳性48例，培养阳性19例，涂片及培养均阳性24例；合并肺外结核94例（50.5%），合并肺外结核的患儿年龄分布差异不具有统计学意义（P=0.732），肺外结核病中结核性脑膜炎(Tuberculosis Meningitis,TBM)87例（92.6%）；病初误诊率高达39.9%，其中最常误诊为支气管肺炎（84.0%）；Logistic回归分析筛出住院时间短和未接种BCG是婴儿重症肺结核发生的独立危险因素，较高的中性粒细胞比例和较短的住院时间是婴儿肺结核预后的不良独立危险因素。结论： 1.婴儿肺结核好发于3～6月龄。城市患儿BCG接种率较农村高，应加强农村地区的BCG普种工作。活动性肺结核接触史对婴儿肺结核的诊断是一个重要的线索，应加强对密切接触的亲属进行结核病的相关检查及病史询问。 2.婴儿肺结核起病急，发热伴呼吸系统症状是最常见临床表现，容易合并肺外结核，特别是TBM。临床表现不典型，可出现类白血病反应，PPD往往阴性，误诊率高，应引起临床医生高度重视。 3.病原学是诊断婴儿肺结核最重要依据，多部位、反复多次通过体液涂片及培养可显著提高病原学诊断的阳性率。 4.胸部影像学检查是婴儿肺结核诊断的重要手段之一。肺实质浸润伴淋巴结肿大是婴儿肺结核影像学上基本特点。胸部CT特别是增强CT在检测淋巴结病变、支气管病变、空洞、钙化等方面优于胸片。 5.BCG对婴儿重型肺结核有预防作用。
[Abstract]:Objective: to summarize the clinical and imaging features of 203 cases of infantile pulmonary tuberculosis, analyze the prognosis of infantile pulmonary tuberculosis and related factors of severe pulmonary tuberculosis, improve the understanding and diagnosis of infantile pulmonary tuberculosis by clinical pediatricians, and reduce misdiagnosis and missed diagnosis. Methods: the data of 203 cases of infantile pulmonary tuberculosis diagnosed in our hospital from January 2001 to December 2011 were analyzed retrospectively. The prognosis of infant pulmonary tuberculosis and the related factors of severe pulmonary tuberculosis were analyzed by univariate analysis (蠂 2 test / t test), and then all the factors were analyzed by non conditional Logistic regression analysis. Results: 125 cases (61.6%) were male, 78 cases (38.4%) were female, 127 cases (62.6%) were in rural areas, 76 cases (37.4%) were in urban areas, 67 cases (33.0%) were aged from 3 to 6 months, 58 cases (28.6%) were from September to September, and 34 cases (16.7%) were from September to December. The vaccination history of BacilleCalmette Gu 茅 rinn BCG: BCG108 (53.2%), BCG70 (34.5%), unknown history (12.3%), urban BCG (0.013%), active pulmonary tuberculosis (78 cases (38.4%), suspicious tuberculosis (12.8%), active pulmonary tuberculosis (78 cases), suspicious tuberculosis (12.8%), active tuberculosis (38.4%), suspected tuberculosis (12.8%), active tuberculosis (38.4%), suspected tuberculosis (12.8%), active pulmonary tuberculosis (38.4%), suspected tuberculosis (12.8%), active pulmonary tuberculosis (38.4%), suspected tuberculosis (12.8%) and active pulmonary tuberculosis (38.4%). Clinical manifestations: fever 175 cases (86.2%), respiratory symptoms 165 cases (81.3%), nervous system symptoms 97 cases (47.8%), lung wet rales 107 cases (52.7%), hepatosplenomegaly 80 cases (39.4%), positive PPD 41 cases (41 / 924.6%), negative PPD 51 cases (51.92%). Chest plain film showed pulmonary parenchyma infiltration in 115 cases (115 / 132%), mediastinal enlargement in 33 cases (33 / 132, 25.06%), hilar enlargement in 9 cases (9 / 132 卤6. 8%), chest CT (computed tomographyCT showed pulmonary parenchyma infiltration in 143 cases (143 / 14499.3%), mediastinal and hilar lymphadenomegaly in 120 cases (120 144 / 83.3%), etiology confirmed 91 cases (44.8%), smear positive 48 cases, There were 94 cases (50.5%) with extrapulmonary tuberculosis, and there was no significant difference in age distribution among the children with extrapulmonary tuberculosis (P0. 732), and 87 cases (92. 6%) of Tuberculosis meningitis were found in extrapulmonary tuberculosis (Extrapulmonary tuberculosis), the positive rate of culture was 19 cases, smear and culture were all positive in 24 cases, there were 94 cases (50.5%) complicated with extrapulmonary tuberculosis, and there was no significant difference in age distribution between them (P0. 732). The rate of initial misdiagnosis was as high as 39.9%, among which the most common misdiagnosis was bronchopneumonia (84.0%). Logistic regression analysis showed that short hospital stay and uninoculated BCG were independent risk factors for the occurrence of severe pulmonary tuberculosis in infants. Higher neutrophil ratio and shorter hospital stay are independent risk factors for poor prognosis of infantile pulmonary tuberculosis. Conclusion: 1. Tuberculosis is common in infants at the age of 3 to 6 months. The coverage rate of BCG in urban children is higher than that in rural areas, so we should strengthen the work of popularizing BCG in rural areas. The contact history of active pulmonary tuberculosis is an important clue to the diagnosis of infantile tuberculosis. Infantile pulmonary tuberculosis, fever with respiratory symptoms is the most common clinical manifestation, easy to be associated with extrapulmonary tuberculosis, especially TBM. The clinical manifestation is not typical, the PPD may appear the similar leukemia reaction often negative, the misdiagnosis rate is high, should cause the clinician to attach great importance to.. Etiology is the most important basis for the diagnosis of infantile pulmonary tuberculosis. The positive rate of etiological diagnosis can be significantly improved by repeated and repeated body fluid smear and culture. Chest imaging is one of the important methods in the diagnosis of infant pulmonary tuberculosis. Pulmonary parenchyma invasion with lymphadenopathy is the basic imaging feature of pulmonary tuberculosis in infants. Chest CT, especially enhanced CT, is superior to chest radiographs in detecting lymph node lesions, bronchial lesions, cavities and calcifications. 5.BCG can prevent severe pulmonary tuberculosis in infants.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R529.9

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