临床儿科杂志 ›› 2019, Vol. 37 ›› Issue (6): 413-.doi: 10.3969/j.issn.1000-3606.2019.06.004

• 呼吸系统疾病专栏 • 上一篇    下一篇

920 例儿童肺结核临床流行病学特征分析

杨丽燕1,黄延风1,余雅2,刘英2   

  1. 1.重庆医科大学附属儿童医院感染科 儿童发育疾病研究教育部重点实验室 儿童发育重大疾病 国家国际科技合作基地 儿科学重庆市重点实验室(重庆 400014);2. 重庆市结核病防治所 防治科(重庆 400050)
  • 出版日期:2019-06-15 发布日期:2019-06-10
  • 通讯作者: 黄延风 电子信箱:ymhykq@126.com
  • 基金资助:
    重庆市卫生计生委医学科研项目(No.2015MSXM106)

Clinical epidemiological characteristics of 920 children with pulmonary tuberculosis

YANG Liyan1,HUANG Yanfeng1,YU Ya2,LIU Ying2   

  1. 1.Department of Infection, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child development and Critical disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China;2.Control and Prevention Department,Chongqing Institute of Tuberculosis Control and Prevention, Chongqing 400050, China
  • Online:2019-06-15 Published:2019-06-10

摘要: 目的 分析儿童肺结核的临床流行病学特征。方法 回顾分析2010年-2015年收治的920例肺结核患儿临 床资料,并根据病情严重程度分为重症组及非重症组,分析引起重症结核的危险因素。结果 920例患儿的中位发病年龄 为7.66岁(9天~17岁7个月)。 单纯肺结核470例(51.1%),肺结核合并肺外结核450例(48.9%),其中以合并结核性脑 膜炎最为多见(236/450,52.4%)。 最常见症状为发热(80.4%)和咳嗽(71.3%)。T-SPOT.TB试验阳性率81.5%。胸部CT 阳性率优于胸片。重症结核355例、非重症565例。与非重症相比,重症患儿中男性比例较低,农村患儿、PPD阴性以及年 龄0~3岁的比例较高,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,女孩(OR=1.58,95%CI:1.03~2.42)、 年龄0~3岁(0~1岁:OR=6.78,95%CI 3.66~12.56;1~3岁:OR=4.90,95%CI 2.68~8.98)、农村患儿(OR=2.49, 95%CI:1.54~4.04)是重症结核的独立危险因素,PPD阳性为保护因素(OR=0.31,95%CI:0.19~0.49)。 结论 儿童肺 结核临床表现不典型,病原学阳性率低,需重视接触史、卡介苗接种情况,并强调综合分析,提高对重症结核危险因素的 认识。

关键词: 肺结核; 临床特征; 儿童

Abstract: Objective To analyze the clinical epidemiological characteristics of pediatric pulmonary tuberculosis, (PTB) patient. Methods A retrospective,descriptive study was undertaken among PTB patients from 2010 to 2015 in the hospital, we collected the clinical data and evaluated related factors,and divided these cases into severe tuberculosis group and non-severe tuberculosis group by the severity of the disease,to analyzes the risk factors of severe tuberculosis. Results A total of 920 children with PTB were enrolled,age ranged from 9 days to 17 years, the peak age at onset was 7~14 years. 48.9% of patients were complicated with extrapulmonary tuberculosis, and the most commonly seen was tuberculous meningitis(52.4%). The most common symptoms of pulmonary tuberculosis were fever(80.4%)and cough(71.3%). The positive rate of T-SPOT.TB (81.5%) was higher than the sputum/gastric bacterium smear (26.9%), PPD (35.5%) and Mycobacterium tuberculosis-PCR (29.6%). CT scanning was superior to X-ray examination in all aspects. There were 355 severe tuberculosis and 565 non-severe tuberculosis. Univariate analysis showed that the gender, age, household registration and PPD test between two groups were significantly different (all P<0.05). Multivariate logistic regression analysis showed that the girls, age at 0-3 years, rural origin and negative PPD were independent risk factors for children with severe tuberculosis. Conclusions PTB is featured with atypical clinical performance,low etiological positive rate,so we need to pay attention to tuberculosis exposure and BCG vaccination, to analysis comprehensively and improve the understanding of the risk factors for severe tuberculosis.

Key words: pulmonary tuberculosis; clinical feature; child