1360例儿童结核病临床特征分析

发布时间：2018-09-15 05:58

【摘要】：儿童结核病临床表现不典型，并且多表现为结核性脑膜炎、血行播散性结核和肺外结核等重症结核，形势严峻，已逐渐成为我国结核防治中的难题。目的针对以重庆医科大学附属儿童医院1360例儿童结核住院病人的资料做分析，总结各型结核的临床特征，提高诊断意识和手段，，减低误诊率，并对我院的治疗效果初步总结。方法回顾性分析我院1360份儿童结核病病历的一般情况、临床症状、体格检查、实验室资料及影像学资料。结果1.男性664例（58.8%），女性465例（41.2%），男性患儿明显多于女性患儿。0-2岁、11-13岁为两个好发年龄高峰，且男性患儿与女性患儿的发病年龄均值分别为6.0岁、6.8岁，两者有显著差异；患儿中来自农村者高于在城镇患儿；38.8%的患儿有明确结核病人接触史。2.卡介苗可以有效降低血行播散型肺结核、结核性脑脊膜炎的发生。3.血清结核抗体阳性率约10.8%，分泌物结核杆菌PCR阳性17例（25%），痰、胃液涂片阳性276/679例（40.6%），痰、胃液培养阳性131/583例（22.5%），手术病检确诊163例（91.6%）。4.影像学检查及其他检查：胸部改变以右肺为主；头颅CT中改变最明显为脑室丰满或扩大（55.1%）、脑积水（49.7%）、基底节区病变（42.2%），以上表现合并者也多见。纤支镜对结核感染诊断率较高，提示结核感染15例，占53.6%。5.首次住院患儿中，确诊为肺结核患者有832例（73.7%），其中原发性肺结核病变为263例（31.6%）；继发型肺结核230例（27.6%）；结核性胸膜炎230例（27.6%）；血源播散性肺结核210例（25.2%）。6.肺外结核中，结核性脑脊髓炎432例（38.3%）；腹腔结核142例（12.6%）；骨关节结核115例（10.2%）；淋巴结结核57例（5.0%）；泌尿系、生殖系结核23例（2.0%）；支气管内膜结核14例（1.2%），其他耳部、心包、皮肤等感染32例。7.粟粒性肺结核好发年龄为0-6月；继发性肺结核好发年龄无显著差别；原发性肺结核好发年龄为1岁以后儿童，结核性脑脊膜炎在6月-3岁为好发年龄段；骨关节结核1-6岁为好发年龄段；腹腔结核、结核性胸膜炎、泌尿系统结核好发年龄均为12-18岁。8.正规抗结核治疗同时加用小剂量激素可增加血行播散型肺结核、结核性胸膜炎、结核性脑脊膜炎、腹腔结核的好转率（均采用卡方检验，P＜0.05）。结论我院儿童结核的临床分析与国内外文献报道大致相同，但我院结核性脑脊膜炎患儿发病率较高，骨关节结核发病率较低。一般治疗效果较好，好转率为70.5%，但结核性脑脊膜炎死亡率较高（6.0%）。目前儿童结核感染形势严峻，患儿病程长，病原学阳性率低，需加强对临床、实验室检测、影像学综合分析，必要时可积极行诊断性治疗。
[Abstract]:The clinical manifestation of child tuberculosis is not typical, and most of them are tuberculous meningitis, disseminated tuberculosis and extrapulmonary tuberculosis. The situation is severe and has gradually become a difficult problem in the prevention and treatment of tuberculosis in China. Objective to analyze the data of 1360 hospitalized children with tuberculosis in the Children's Hospital affiliated to Chongqing Medical University, summarize the clinical characteristics of various types of tuberculosis, improve the diagnostic awareness and means, reduce the misdiagnosis rate, and preliminarily summarize the therapeutic effect of our hospital. Methods the general situation, clinical symptoms, physical examination, laboratory data and imaging data of 1360 cases of tuberculosis in children in our hospital were retrospectively analyzed. Result 1. There were 664 males (58.8%) and 465 females (41.2%). There were significant differences between males and females. 38.8% of children from rural areas had definite history of contact with tuberculosis. BCG can effectively reduce blood disseminated pulmonary tuberculosis, tuberculous meningitis. 3. 3. The positive rate of tuberculosis antibody in serum was about 10.8%, the positive rate of PCR in secretion was 25%, the positive rate of sputum and gastric smear was 276 / 679 (40.6%), the positive rate of sputum and gastric juice culture was 131 / 583 (22.5%), and the diagnosis of operation was 163 (91.6%) .4. Imaging examination and other examinations: the chest changes were mainly in the right lung, the most obvious changes in CT were ventricular fullness or enlargement (55.1%), hydrocephalus (49.7%), basal ganglia lesions (42.2%). The diagnostic rate of tuberculosis infection by fiberoptic bronchoscopy was higher, suggesting that 15 cases (53.6%) had tuberculosis infection. Among the first hospitalized children, 832 cases (73.7%) were diagnosed as pulmonary tuberculosis, including 263 cases (31.6%) with primary pulmonary tuberculosis, 230 cases (27.6%) with secondary pulmonary tuberculosis, 230 cases (27.6%) with tuberculous pleurisy, 210 cases (25.2%) with hematogenous disseminated pulmonary tuberculosis. Among them, 432 (38.3%) were tuberculous encephalomyelitis, 142 (12.6%) were celiac tuberculosis, 115 (10.2%) were osteoarticular tuberculosis, 57 (5.0%) were lymph node tuberculosis, 23 (2.0%) were tuberculosis of urinary system and genital system, 14 cases (1.2%) of endobronchial tuberculosis, and 14 cases (1.2%) of endobronchial tuberculosis, other ear, pericardium, pericardium and pericardium. 32 cases of skin infection. The age of onset of miliary pulmonary tuberculosis was 0-6 months, the age of secondary pulmonary tuberculosis was not significantly different, the age of primary pulmonary tuberculosis was after 1 year old, and the age of tuberculous meningitis was 3 years old in June. Osteoarticular tuberculosis (1-6 years old), abdominal tuberculosis, tuberculous pleurisy (TB), and urinary tuberculosis (age 12-18 years). The improvement rate of disseminated pulmonary tuberculosis, tuberculous pleurisy, tuberculous meningitis and intraperitoneal tuberculosis was increased by regular anti-tuberculosis therapy and low dose hormone (all P < 0.05 by chi-square test). Conclusion the clinical analysis of tuberculosis in children in our hospital is almost the same as that reported in domestic and foreign literatures, but the incidence of tuberculous meningitis in our hospital is higher and the incidence of tuberculosis of bone and joint is lower. The cure rate was 70.5%, but the mortality rate of tuberculous meningitis was higher (6.0%). At present, the situation of tuberculosis infection in children is severe, the course of disease is long and the positive rate of etiology is low. It is necessary to strengthen the comprehensive analysis of clinic, laboratory examination, imaging and, if necessary, to actively carry out diagnostic treatment.
【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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