【摘要】：目的探討兒童全身播散性結(jié)核病的臨床特點(diǎn)、誤診原因及診治要點(diǎn)。方法收集北京兒童醫(yī)院2010年7月至2014年9月收治的5例全身播散性結(jié)核患兒,分析其臨床特點(diǎn)和診治經(jīng)過。結(jié)果 5例患兒中男2例,女3例,年齡3歲至11歲3個(gè)月,病程14~91 d。5例免疫功能均未見異常。起病均急驟,高熱,3例伴咳嗽,1例伴腹痛,1例無明顯伴隨癥狀,炎癥指標(biāo)升高,外院曾誤診為細(xì)菌性肺炎、真菌性肺炎、惡性腫瘤等。2例有結(jié)核接觸史,3例卡介苗瘢痕(卡疤)陰性。病變累及多臟器系統(tǒng),包括肺、支氣管、胸膜、外周淋巴結(jié)、腹膜、腹腔淋巴結(jié)、肝、脾、腸、腦膜、腦實(shí)質(zhì)、腦血管、骨骼等,其中肺結(jié)核5例,支氣管結(jié)核1例,結(jié)核性胸膜炎1例,腹腔結(jié)核4例(其中肝結(jié)核1例、脾結(jié)核2例、腸結(jié)核4例、腹腔淋巴結(jié)結(jié)核4例、結(jié)核性腹膜炎2例),結(jié)核性腦膜炎4例,脊柱結(jié)核1例,外周淋巴結(jié)結(jié)核1例。5例患兒抗癆治療效果好,預(yù)后良好。結(jié)論兒童全身播散性結(jié)核病屬重癥結(jié)核病,起病急驟,炎癥指標(biāo)高,臨床表現(xiàn)復(fù)雜多樣,多臟器受累,臨床診斷困難。完善輔助檢查,特別是舊結(jié)核菌素(PPD)試驗(yàn)、多部位影像學(xué)檢查、病原學(xué)檢查,并積極鑒別診斷及臨床療效觀察等,對(duì)明確診斷有重要作用。
[Abstract]:Objective to investigate the clinical characteristics, causes of misdiagnosis and key points of diagnosis and treatment of systemic disseminated tuberculosis in children. Methods five children with systemic disseminated tuberculosis admitted to Beijing Children's Hospital from July 2010 to September 2014 were collected and their clinical features, diagnosis and treatment were analyzed. Results among the 5 cases, there were 2 males and 3 females, aged from 3 to 11 years and 3 months old. There was no abnormal immune function in 14 鈮，

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