| 徐莉莉,李昌崇.儿童结核病467例临床分析[J].浙江中西医结合杂志,2020,30(3): |
| 儿童结核病467例临床分析 |
| The clinical analysis of 467cases of childhood tuberculosis |
| 投稿时间：2019-09-05 修订日期：2019-12-30 |
| DOI： |
| 中文关键词: 结核病 临床特征 儿童 |
| 英文关键词:tuberculosis clinical features children |
| 基金项目: |
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| 中文摘要: |
| 目的 分析儿童结核病的临床特点，提高对儿童结核病的认识，为儿童结核病的早期诊断提供经验，降低误诊率。方法 回顾性分析2000年1月-2014年12月诊断为结核病的467例0~14岁儿童的病历资料。结果 本组患儿中男性281例（60.2%），女性186例（39.8%），年龄17天至14岁不等，以7~14 岁学龄期儿童最多见，占比54.2%；临床表现以发热（77.7%）和咳嗽（53.1%）最多见，延误诊断174 例（37.3％ ），误诊为肺炎者最多见；467例患儿中以肺结核最多见，224例（48.0%），重症结核病156例（33.4%），其中包括单纯性结核性脑膜炎86/156例，肺外结核（除外结核性脑膜炎）68例（14.6%），肺结核合并肺外结核19例（4.1%）；多因素logistic回归分析显示，接触史阳性（OR=2.20，95%CI：1.01~4.77）、未接种卡介苗（OR=4.32，95 %CI：1.98~9.43）、PPD阴性（OR=5.79，95 %CI：2.40~13.98）是重症结核的独立危险因素。结论 儿童结核病的临床诊断主要根据病史询问、临床表现、影像学改变、免疫学检测等多方面综合分析，需要提高对儿童重症结核病危险因素的认识。 |
| 英文摘要: |
| Objective To analyze the clinical characteristics of childhood tuberculosis, improve the understanding of tuberculosis in children, provide experience for early diagnosis of tuberculosis in children, and reduce the rate of misdiagnosis. Methods Clinical and imaging data of 467 children aged 0-14 years who were diagnosed with tuberculosis from January 2000 to December 2014 were retrospectively analyzed. Results There were 281 males (60.2%) and 186 females (39.8%) in this group. The age ranged from 17 days to 14 years, and the most common was 7 to 14 years old, accounting for 54.2%. Clinical manifestations were most common with fever (77.7%) and cough (53.1%), and 174 cases (37.3%) were misdiagnosed. The most common cases were misdiagnosed as pneumonia. Among the 467 cases, Pulmonary tuberculosis was the most common, with 224 cases (48.0%), 156 cases (33.4%) of severe tuberculosis, including 86/156 cases of tuberculous meningitis, 68 cases (14.6%) of extrapulmonary tuberculosis (excluding tuberculous meningitis), 19 cases (4.1%) of tuberculosis complicated with extrapulmonary tuberculosis,Logistic regression analysis showed that the contact history was positive (OR=2.20, 95% CI: 1.01~4.77), BCG was not vaccinated (OR=4.32, 95% CI: 1.98~9.43), and the PPD test was negative (OR=5.79, 95%) CI: 2.40~13.98) is an independent risk factor for severe tuberculosis. Conclusion The clinical diagnosis of tuberculosis in children is based on a comprehensive analysis of medical history, clinical manifestations, imaging changes, and immunological tests, and needs to improve the understanding of the risk factors of severe tuberculosis in children. |
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