小儿肺外结核病213例临床特点分析

The analysis of clinical characteristic on 213 cases with extrapulmonary tuberculosis in children

目的:探讨小儿肺外结核病的临床特点,总结诊断过程的经验教训,提高肺外结核病的诊断率,降低肺外结核病误诊率。方法:回顾性分析了临床确诊的213例肺外结核患者的临床资料、诊断方法。结果:肺外结核的患病率逐年增高,农村患儿所占比例较大(68.5%)。农村儿童患肺外结核病的风险是城镇儿童的2.131倍。其临床表现变化多端,缺乏特异性,误诊率高(60.6%);影像学检查是揭示病变部位的重要方法;血沉可作为诊断参考依据;病理学、病原学和诊断性抗痨治疗是确诊的重要手段。结论:农村仍然是肺外结核病的高发区。肺外结核诊断过程中病原学和血清学阳性率都很低,提高对肺外结核的认识,采取综合性诊断措施,是提高诊断率的关键。

Objective： To discuss the clinical characteristics of children with extrapulmonary tuberculosis （EPT）, to sum up the experiences and lessons in the diagnosing process, to improve diagnostic rate of extrapulmonary tuberculosis, to reduce the misdiagnosis rate of extrapulmonary tuberculosis. Methods： We retrospectly analyzed the clinical data and diagnosis methods of 213 pediatric cases with extrapulmanory tu- berculosis that were clinically diagnosed. Results： The morbidity increases year by year and patients in the countryside have a greater proportion （68.5%）among all the patients. The risk of extrapulmonary tuberculosis in rural children was 2. 131 times than urban children. The clinical characteristics of extrapulmanory tuberculosis were variable and short of peculiarity and the misdiagnosis rate （60.6%） was high; Imageology is a very important method to reveal the diseased region; Erythrocyte sedimentation rate might consult a basis as the diagnosis; Pathology , nosetiology and diagnostic antituberculosis treatment were important means for the definite diagnosis. Conclusions： There is still a great morbidity of extrapulmanory tuberculosis in the conutryside. The positive rates of nosetiology and serology are all very low in the diag- nose process of extrapulmanory tuberculosis. The key to improve diagnostic rate is improving the cognition about extrapulmanory tuberculosis and adopting a comprehensive diagnosing method.