儿童耐药结核病5例临床分析

Clinical analysis of 5 cases of drug-resistant tuberculosis

目的总结儿童耐药结核病的临床特点,提高其诊治水平。方法回顾性分析2013年3月至2017年3月,首都医科大学附属北京儿童医院收治的5例有实验室证据的耐药结核病患儿临床资料,包括一般资料、结核接触史、临床影像表现、病原学检查及药敏试验、治疗方案及转归等。5例患儿中男4例,女1例,均患有肺结核,2例合并结核性脑膜炎,4例合并支气管结核。结果 5例中2例经分子技术Xpert MTB/RIF检测诊断为利福平耐药结核病(RR-TB);1例经颈淋巴结穿刺脓液培养药敏诊断为耐多药结核病(MDR-TB);1例经痰培养诊断为泛耐药结核病前期(Pre-XDR);另1例是其父痰培养为MDR-TB。5例患儿诊断耐药结核病后,均采用世界卫生组织推荐的包括二线抗结核药物在内的治疗方案。5例中2例治愈,2例好转,1例治疗失败。5例患儿均未发生严重药物不良反应。结论儿童耐药结核病可通过分子技术Xpert MTB/RIF检测和结核杆菌培养表型耐药检测确诊,分子技术具有较高的早期快速诊断价值。儿童耐药结核病经及时有效治疗后多数预后良好。儿童使用二线抗结核药物的严重不良反应发生率较低。

Objective To summarize the clinical characteristics of drug-resistant tuberculosis in children and improve the level of diagnosis and treatment of the disease. Methods The clinical data of 5 children with drug-resistant tubercu- losis treated in Beijing Children＇s Hospital from March 2013 to March 2017 were retrospectively analyzed. Clinical data included general information, tuberculosis exposure history, clinical and imaging performance, etiological examination, drug sensitivity test, treatment protocol and outcome. All five patients （4 male and 1 female） had pulmonary tuberculosis; two had tuberculous meningitis;four had bronchial tuberculosis. Results All had laboratory-confirmed drug-resistant tuberculosis ; two were with rifampicin-resistant tuberculosis （RR-TB） confirmed by Xpert MTB/RIF ; one had c, onfirmed by multidrug-resistant tuberculosis （MDR-TB） cervical lymph node puncture fluid culture;one had by pre-extensive drug- resistant tuberculosis （Pre-XDR） sputum culture and the other case was MDR-TB confirmed by the positive cul- ture of his father＇s sputum. All patients received regimens recommended by WHO, containing second-line anti-tubercu- losis drugs, after diagnosis of drug-resistant tuberculosis. Two children were cured ; two children were improved, but still receiving anti-tuberculosis treatment. Treatment failed in one child. All children had no severe adverse events. Conclu- sion The drug-resistant tuberculosis in children can be diagnosed by molecular technique Xpert MTB/R1F and myco- bacterium tuberculosis culture. The molecular technique is of great value in early and rapid diagnosis of drug-resistant tuberculosis. Most children with drug-resistant tuberculosis have a favourable prognosis after timely and effective treat- ment. The incidence of serious adverse effects of second-line anti-tuberculosis drugs is low in children.