摘要
目的提高对新生儿期起病的肺结核的认识。方法回顾性分析首都医科大学附属北京儿童医院呼吸科收治的2例新生儿期起病的肺结核患儿的临床特点、实验室检查、影像学分析等，提出本病诊断思路与鉴别诊断。结果2例患儿系33^＋3周双胞胎早产儿，出生26d起病，起病隐匿，以间断干咳为主要表现，病程中伴一过性发热，胸部CT提示双肺多发结节样病变，1例同时合并胸腔积液、肺不张，多种抗生素治疗效果不佳，考虑特殊病原体感染，结核菌素（PPD）试验阴性，γ-干扰素释放试验阳性，痰液、胃液抗酸染色及结核菌培养均阳性，最终确诊为肺结核。结论新生儿结核病临床及影像学表现往往不典型，PPD试验阴性，给临床诊断带来困难。对一些用常见病原不能鳃释的疾病，应该考虑到特殊病原，如结核病的可能，并加以甄别。
Objective To improve the understanding of neonatal - onset pulmonary tuberculosis. Methods The clinical features, laboratory examination and imaging were analyzed in 2 cases with neonatal - onset pulmonary tuberculosis in the Respiratory Department of Beijing Children＇s Hospital, Capital Medical University. Results The 2 patients were premature twins, were born at 33 ＋3 weeks of gestation, presented with intermittent cough and transient fever on 26 days after birth. Chest CT scan showed pulmonary muhifocal nodules. One case was complicated with pleural effusion, atelectasis and no effectiveness with antibiotics. The untypical pathogen infection was considered. The result of PPD was negative, the result of interferon gamma release array, gastric acid fast staining and mycobacterium tuberculosis culture were positive,finally they were diagnosed with pulmonary tuberculosis. Conclusions The clinical features and imaging of neonatal tuberculosis are always untypical and PPD is negative, which brings difficulties to clinical diagno- sis. We should take untypical pathogens into account, such as tuberculosis, when some diseases cannot be explained by common pathogens.
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2017年第17期1338-1342,共5页
Chinese Journal of Applied Clinical Pediatrics
关键词
肺内结节样病变
肺结核
Γ-干扰素释放试验
Pulmonary muhifocal nodules
Pulmonary tuberculosis
Interferon-γ, release array
