54 例儿童结核病诊治及误诊分析

席秀红; 卢水华

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微生物与感染 ›› 2009, Vol. 4 ›› Issue (3) : 137-139.

论著

54 例儿童结核病诊治及误诊分析

席秀红；卢水华

作者信息 +

Characteristics of 54 diagnosed and misdiagnosed cases of pediatric
tuberculosis

XI Xiu-Hong；LU Shui-Hua

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文章历史 +

摘要

近年来, 由于流动人口增加以及基层预防接种和诊治工作尚存在薄弱环节, 儿童结核病发病率有增长趋势。为分析儿童结核病的临床诊断、治疗及误诊特点, 对我院2006 年3 月― 2008 年7 月住院治疗的54 例儿童结核病病例从年龄、性别、实验室及影像学检查、临床表现、诊断、治疗、误诊等方面进行综合分析。结果显示, 儿童结核年龄≤5 岁者所占比例最高( 64. 8% ) ; 临床分布以肺结核合并肺外结核者最多( 44. 5% ) , 其次为单纯肺结核( 37. 0% ) 和肺外结核( 18. 5% ) 。本研究中患儿在外院误诊率为55. 6% ; 影像学主要表现为肺部弥漫性结节影、斑片状模糊影, 胸膜增厚或伴胸腔积液, 纵隔及( 或) 肺门淋巴结肿大, 腹腔淋巴结肿大, 颅脑断层扫描( CT) 或磁共振成像( MRI) 异常等。结果提示, 年龄≤5 岁是儿童结核病的好发年龄; 结核菌素试验联合影像学诊断可明显提高儿童结核病临床确诊率, 减少误诊、漏诊; 积极正规的抗结核治疗对绝大多数儿童结核病患者有效。

Abstract

In recent years, the incidence rate of pediatric tuberculosis is increasing due to an increase of migrating populations, reduced coverage of vaccination and other issues related to the diagnosis and treatment practice in the rural clinics. This study was conducted in order to determine the characteristics of clinical diagnosis, and treatment of children with tuberculosis. Fifty-four pediatric cases of confirmed tuberculosis, hospitalized from March 2006 to July 2008, were analyzed for age, sex, clinical manifestations, laboratory and imaging test results, final diagnosis and treatment. The results showed that among 54 cases, children younger than 5 years old were most represented
( 64. 8% ) . Pulmonary complicated with extra-pulmonary tuberculosis was the most common clinical type ( 44. 5% ) , followed by pulmonary tuberculosis alone ( 37. 0% ) , and extra-pulmonary tuberculosis alone ( 18. 5% ) . The initial misdiagnosis rate was 55. 6% prior to hospitalization. The major imaging findings included diffuse pulmonary nodular or patchy shadows, pleural thickening with or without pleural effusion, enlargement of mediastinal or hilar lymph nodes, enlargement of celiac lymph nodes, and brain computer tomography ( CT) or magnetic resonance imaging ( MRI) abnormalities. This study suggests that children under 5 years old are particularly susceptible to tuberculosis. Tuberculin tests, when combined with imaging techniques, can increase the positive diagnosis rate significantly. Prompt standard anti-tuberculosis therapy is effective for the majority of pediatric tuberculosis patients.

导出引用

席秀红；卢水华. 54 例儿童结核病诊治及误诊分析[J]. 微生物与感染. 2009, 4(3): 137-139

XI Xiu-Hong；LU Shui-Hua. Characteristics of 54 diagnosed and misdiagnosed cases of pediatric
tuberculosis[J]. Journal of Microbes and Infections. 2009, 4(3): 137-139