婴儿肺结核203例临床特征分析

Clinical features of 203 infants with pulmonary tuberculosis

目的总结分析婴儿肺结核的临床特点及相关因素。方法回顾性分析2001年至2011年收治的203例婴儿肺结核的临床资料。结果 203例住院肺结核患儿中,来自农村127例(62.56%),城市76例(37.44%);城市患儿BCG接种率(64.47%)高于农村(46.46%),差异有统计学意义(P<0.05)。有明确活动性肺结核接触史78例(38.42%),可疑结核接触史26例(12.81%);临床表现发热175例(86.21%),呼吸道症状165例(81.28%),有肺部体征107例(52.71%),肝脾肿大80例(39.41%);病原学确诊91例(44.83%);合并肺外结核54.68%,最常见为结核性脑膜炎;病初误诊率39.90%,最常误诊为支气管肺炎。重症肺结核婴儿卡介苗接种率(44.83%)低于非重症肺结核患儿(74.14%),且重症肺结核婴儿有结核接触史的比例更高,差异有统计学意义(P均<0.05)。结论婴儿结核病起病急,进展快,容易造成播散,临床表现不典型,误诊率高,应引起临床医师高度重视。未接种BCG及活动性肺结核接触史是婴儿肺结核诊断的重要线索。

Objectives To summarize the clinical features and relevant factors of 203 cases with infantile pulmonary tuberculosis. Methods Clinical data of 203 infantile with pulmonary tuberculosis were retrospectively reviewed. Results Among 203 infants, 127 （62.6%） were from country, 76 （37.4%） from city;64.5%of city infants have received BCG vaccination, which is higher than 46.5%in country infants;78 cases （38.4%） have clear evidence for active tuberculosis exposure, 26 cases （12.8%） have suspicious tuberculosis exposure;175 cases （86.2%） have fever, 165 cases （81.3%） have respiratory symptoms, 107 cases （52.7%） have pulmonary signs, 80 cases （39.4%） have hepatosplenomegaly;Etiology was conifrmed in 91 cases （44.8%）;54.7%of patients were found with concurrent extrapulmonary tuberculosis, and the most commonly seen was formis tuberculous meningitis. In this study, the misdiagnosis rate is 39.9%, and 84.0%patients were often misdiagnosed as bronchial pneumonia;Vaccinated BCG rate is lower in infants with severe tuberculosis （44.83%） than that of infants with mild tuberculosis （74.14%）. Conclusions Infantile pulmonary tuberculosis is featured with acute onset, severe clinical performance and easily complicated with extrapulmonary tuberculosis, atypical clinical performance, and high misdiagnosed rate which needs early detection and diagnosis. Unvaccinated BCG and active tuberculosis exposure were important clues for the diagnosis of infantile pulmonary tuberculosis.