摘要
目的探讨先天性结核病的临床特点。方法回顾分析20例先天性结核病患儿的临床资料。结果在20例患儿中19例(95.0%)母亲明确有孕期结核病史,产前诊断5例(25%);患儿发病日龄中位数26天(1～90天)。20例患儿中,咳嗽15例,发热14例,呼吸困难12例,肝脏伴脾脏肿大9例,腹胀7例。抗酸杆菌涂片或结核培养阳性10例,12例行T-SPOT检查9例阳性。20例患儿的胸部影像学检查均异常,表现为广泛结节和斑片影12例,弥漫粟粒结节影6例,右肺散在斑片影2例。16例行腹部超声和/或CT检查,发现肝脏和脾脏内多发结节影7例,腹腔淋巴结肿大6例,腹腔积液6例。结核感染部位主要为肺部20例均有,肝脏7例、脾脏7例、腹膜腔8例、颅内7例。3例患儿因病情危重家属要求放弃抗结核药物治疗,余17例使用抗结核药物,10例病情好转出院,7例病情恶化放弃治疗。结论先天性结核病常呈全身播散性感染,综合母孕期结核病史、反复查找病原学证据、影像学、T-SPOT等辅助检查,可提高早期诊断率,早期、正规抗结核治疗有望降低病死率。
Objective To explore the clinical features of congenital tuberculosis. Method The clinical data of congenital tuberculosis in 20 infants were retrospectively analyzed. Results The mothers of 19 infants (95.0%) were found to have tuberculosis in pregnancy and only five (25%) were diagnosed with tuberculosis pre-partum. The median age at onset was 26 days (1-90 days). Among the 20 infants, cough was a symptom in 15 infants, fever in 14 infants, respiratory distress in 12 infants, hepatosplenomegaly in 9 infants, and abdominal distension in 7 infants. Acid-fast bacillus smear or tuberculosis culture was positive in 10 infants, and T-SPOT was positive in 9 infants. Chest imaging findings were abnormal in all 20 infants, including extensive nodules and patchy shadows in 12 infants, diffuse miliary nodules in 6 infants, and sporadic patchy shadows in right lung in 2 infants. Abdominal ultrasonography and/or CT were performed in 16 infants, and multiple nodules in liver and spleen were found in 7 infants, lymph node enlargement in abdominal cavity in 6 infants, and ascites in 6 infants. The main sites of tuberculosis infection were lung (in all 20 cases), liver (in 7 cases), spleen (in 7 cases), peritoneal cavity (in 8 cases) and brain (in 7 cases). Because 3 infants were in critical condition, their families asked to terminate the diagnosis and treatment, and they did not receive anti-tuberculosis drugs. In the remaining 17 infants who were treated with anti-tuberculosis drugs, 10 infants were discharged after their condition improved, and 7 infants gave up treatment after their condition worsened. Conclusion Congenital tuberculosis is often characterized by systemic disseminated infection. The early diagnosis rate can be improved by combination of maternal tuberculosis history during pregnancy, repeatedly searching for etiological evidence, imaging examination, T-SPOT and other auxiliary examinations. Early and standard anti-tuberculosis treatment is expected to reduce the mortality rate.
作者
吴小英
许红梅
赵瑞秋
WU Xiaoying;XU Hongmei;ZHAO Ruiqiu(Infections Department of Children’s Hospital of Chongqing Medical University,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2019年第3期196-199,共4页
Journal of Clinical Pediatrics
关键词
结核
临床表现
婴儿
tuberculosis
clinical manifestation
infant
