目的 了解儿童肺外结核病的临床特点，诊治方法以及预后相关因素，以提高对该病的诊治水平。方法 回顾性分析2011年1月至2020年12月北京儿童医院收治住院的确诊和临床诊断肺外结核病患儿的临床资料。结果 共收治住院肺外结核病473例，占结核病患儿36.3%（473/1303），男 269例（56.9%），农村378例（79.9%）。发病中位年龄为4.1（1.2~9.9）岁，≤5岁250例（52.9%）。经病原学或病理学检查确诊110例（23.3%），临床诊断363例（76.7%），其中结核性脑膜炎占比居首位（202例，42.7%）。307例患儿肺外标本中，抗酸染色涂片、Xpert MTB/RIF、结核杆菌培养、病理学检查4种检验方法的阳性率差异有统计学意义（P<0.01），病理学检查和Xpert MTB/RIF阳性率较高。313例胸部影像提示存在活动或陈旧性结核病。截至2022年6月18日，共随访336例，预后好211例，预后差125例（其中死亡23例）。多因素logistic回归分析发现，年龄≤5岁是影响预后的独立危险因素（P<0.05），腹腔结核病、骨及关节结核病（以结核性脑膜炎为参考）是影响预后的独立保护因素（P<0.05）。结论 住院结核病患儿中约三分之一为肺外结核病，最常见为结核性脑膜炎，大多为临床诊断，分子诊断技术Xpert MTB/RIF在肺外结核标本中敏感度较高。≤5岁患儿和结核性脑膜炎相对预后较差。

Objective To understand the clinical characteristics, diagnosis and treatment methods and prognostic factors of extrapulmonary tuberculosis in children, so as to improve the level of diagnosis and treatment of this disease. Methods The clinical data of children with confirmed and clinically diagnosed extrapulmonary tuberculosis admitted to Beijing Children's Hospital from January 2011 to December 2020 were retrospectively analyzed. Results A total of 473 children with extrapulmonary tuberculosis were hospitalized, accounting for 36.3% (473/1303) of the children with tuberculosis, including 269 boys (56.9%) and 378 rural patients (79.9%). The median age of onset was 4.1 (1.2-9.9) years, and 250 patients (52.9%) were less than 5 years old. One hundred and ten children (23.3%) were confirmed by etiology or pathology, and 363 children (76.7%) were clinically diagnosed, of whom tuberculous meningitis was the commonest (202 cases, 42.7%). In 307 children's extrapulmonary samples, the positive rates of acid-fast staining smear, Xpert MTB/RIF, Mycobacterium tuberculosis culture and pathological examination were significantly different (P<0.01), and the positive rates of pathological examination and Xpert MTB/RIF were higher. Chest imaging of 313 patients indicated active or old tuberculosis. As of June 18, 2022, a total of 336 children were followed up, of whom 211 had a good prognosis and 125 had a poor prognosis (including 23 deaths). Multivariate logistic regression analysis showed that age≤5 years old was an independent risk factor for prognosis (P<0.05), and abdominal tuberculosis, bone and joint tuberculosis (with tuberculous meningitis as reference) were independent protective factors for prognosis (P<0.05). Conclusions About one-third of hospitalized children with tuberculosis have extrapulmonary tuberculosis, and tuberculous meningitis is the commonest. Most of the patients were clinically diagnosed, and the molecular diagnostic technique of Xpert MTB/RIF was highly sensitive to extrapulmonary tuberculosis specimens. The prognosis of children under 5 years old and tuberculous meningitis is relatively poor.