嬰兒肺結(jié)核臨床分析
發(fā)布時間：2018-08-12 18:26
【摘要】：目的：總結(jié)203例嬰兒肺結(jié)核的臨床及影像學(xué)特點，分析嬰兒肺結(jié)核的預(yù)后及重癥肺結(jié)核的相關(guān)因素，提高臨床兒科醫(yī)生對嬰兒肺結(jié)核的認識和診斷水平，減少誤診及漏診。 方法：對2001年1月～2011年12月我院診斷的203例嬰兒肺結(jié)核的病例資料進行回顧性分析。分別對嬰兒肺結(jié)核的預(yù)后及發(fā)生重癥肺結(jié)核的相關(guān)因素首先進行單因素分析（χ2檢驗、t檢驗）并逐一篩選，然后將所有P0.05的單因素進行非條件Logistic回歸分析。 結(jié)果：例住院嬰兒肺結(jié)核中男125例（61.6%），女78例（38.4%）；農(nóng)村127例（62.6%），城市76例（37.4%）；年齡≤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)接種史：接種BCG108例（53.2%），未接種BCG70例（34.5%），接種史不詳25例（12.3%），城市BCG接種率較農(nóng)村高（P=0.013）；活動性肺結(jié)核接觸史：有明確活動性肺結(jié)核接觸史78例(38.4%)，可疑結(jié)核接觸史26例（12.8%）；臨床表現(xiàn)：發(fā)熱175例（86.2%），呼吸道癥狀165例（81.3%），，神經(jīng)系統(tǒng)癥狀97例（47.8%），肺部濕羅音107例（52.7%），肝脾腫大80例（39.4%）；輔助檢查：PPD陽性41例（41/92,44.6%），PPD陰性51例(51/92，55.4％)；胸部平片顯示肺實質(zhì)浸潤115例（115/132,87.1%），縱膈增寬33例（33/132,25.06%），肺門增大9例（9/132,6.8%）；胸部CT(computed tomography,CT)顯示肺實質(zhì)浸潤143例（143/144，99.3%），縱膈、肺門淋巴結(jié)腫大120例（120/144，83.3%）；病原學(xué)確診91例（44.8%），涂片陽性48例，培養(yǎng)陽性19例，涂片及培養(yǎng)均陽性24例；合并肺外結(jié)核94例（50.5%），合并肺外結(jié)核的患兒年齡分布差異不具有統(tǒng)計學(xué)意義（P=0.732），肺外結(jié)核病中結(jié)核性腦膜炎(Tuberculosis Meningitis,TBM)87例（92.6%）；病初誤診率高達39.9%，其中最常誤診為支氣管肺炎（84.0%）；Logistic回歸分析篩出住院時間短和未接種BCG是嬰兒重癥肺結(jié)核發(fā)生的獨立危險因素，較高的中性粒細胞比例和較短的住院時間是嬰兒肺結(jié)核預(yù)后的不良獨立危險因素。 結(jié)論： 1.嬰兒肺結(jié)核好發(fā)于3～6月齡。城市患兒BCG接種率較農(nóng)村高，應(yīng)加強農(nóng)村地區(qū)的BCG普種工作。活動性肺結(jié)核接觸史對嬰兒肺結(jié)核的診斷是一個重要的線索，應(yīng)加強對密切接觸的親屬進行結(jié)核病的相關(guān)檢查及病史詢問。 2.嬰兒肺結(jié)核起病急，發(fā)熱伴呼吸系統(tǒng)癥狀是最常見臨床表現(xiàn)，容易合并肺外結(jié)核，特別是TBM。臨床表現(xiàn)不典型，可出現(xiàn)類白血病反應(yīng)，PPD往往陰性，誤診率高，應(yīng)引起臨床醫(yī)生高度重視。 3.病原學(xué)是診斷嬰兒肺結(jié)核最重要依據(jù)，多部位、反復(fù)多次通過體液涂片及培養(yǎng)可顯著提高病原學(xué)診斷的陽性率。 4.胸部影像學(xué)檢查是嬰兒肺結(jié)核診斷的重要手段之一。肺實質(zhì)浸潤伴淋巴結(jié)腫大是嬰兒肺結(jié)核影像學(xué)上基本特點。胸部CT特別是增強CT在檢測淋巴結(jié)病變、支氣管病變、空洞、鈣化等方面優(yōu)于胸片。 5.BCG對嬰兒重型肺結(jié)核有預(yù)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 鹵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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R529.9
本文編號：2179915
[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 鹵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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R529.9
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