摘要
目的 探讨儿童结核性胸膜炎（TP）的临床特点,为本病的临床诊治提供思路.方法 回顾性分析重庆医科大学附属儿童医院2009年1月至2014年12月收治的113例确诊为TP住院患儿的临床资料.结果 113例患儿中,病程在1个月内者85例（75.2％）,发病年龄≥5岁占92.9％（105/113例）;有明确结核接触史者占21.1％（24/113例）,其中直系亲属占70.8％（17/24例）.主要临床表现为发热[96.5％ （109/113例）]、咳嗽[76.1％（86/113例）]、胸痛[38.9％（44/113例）],其中中高热者比例高达89.0％（97/109例）.涂片找抗酸杆菌、结核培养的阳性率分别为12.2％（17/139例）、22.7％（15/66例）;41例行胸膜活组织检查,其中40例（97.6％）见典型结核病理改变;11例患儿直接利用胸膜组织行抗酸染色试验,均呈阳性结果.89.1％（98/113例）患儿胸部CT检查可见肺实质病变.82.4％（90/109例）的患儿在较短时间内体温恢复正常,98例复查胸部影像学的患儿中86例提示积液较前有吸收.结论 儿童TP多急性起病,诊断较成人困难,需综合多方面因素考虑,结核病人接触史、病原学检查、胸膜活组织检查、胸部CT检查对该病诊断尤为重要.
Objective To investigate the clinical characteristics of tuberculous pleurisy（TP） in children in order to provide a good solution to the diagnosis and treatment of this disease.Methods Retrospective analysis was performed on the clinical data of 113 cases confirmed with TP who were admitted to Children＇s Hospital of Chongqing Medical University from January 2009 to December 2014.Results Among the 113 pediatric inpatients with TP,85 cases （75.2%） were sick for less than 1 month;92.9% （105/113 cases） age ≥≥5 years old by onset;and 21.2% （24/113 cases） patients demonstrated the contact with tuberculosis ,among whom 70.8% （17/24 cases） attributed to linear relatives.The primary clinical manifestations included fever[96.5% （109/113 cases）], cough [76.1% （86/113 cases）] and chest pain[38.9% （44/113 cases）] ,with as high as 89.0% （87/109 cases） of the patients experiencing moderate or ardent fever.The positive rates of acid-fast bacilli smear and mycobacterium tuberculosis culture were 12.2% （17/139 cases） and 22.7% （15/66 cases）, respectively;among the 41 patients who received pleural biopsy,40 cases （97.6%） were identified with the typical pathological changes in tuberculosis;and all 11 patients who received acid fast stain test on pleural tissues were positive to the test.Pulmonary parenchymatous lesions were revealed on CT examination in 89.1% patients（98/113 cases）,82.4% （90/109 cases） of the patients had normal body temperature within a short period,and reduced effusion was revealed in 86 out of 98 patients who received repeated chest imaging examinations.Conclusions TP in children has acute onset typically, and the diagnosis of TP in children is more difficult than in adults,requiring considering multiple factors.Contact history with tubercular patients, etiological examination, pleural biopsy and chest CT are essential for the diagnosis of this disease.
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2015年第24期1891-1893,共3页
Chinese Journal of Applied Clinical Pediatrics
关键词
结核性胸膜炎
临床特点
儿童
Tuberculous pleurisy
Clinical characteristics
Child
