920例儿童肺结核临床流行病学特征分析

Clinical epidemiological characteristics of 920 children with pulmonary tuberculosis

目的分析儿童肺结核的临床流行病学特征。方法回顾分析2010年-2015年收治的920例肺结核患儿临床资料,并根据病情严重程度分为重症组及非重症组,分析引起重症结核的危险因素。结果920例患儿的中位发病年龄为7.66岁(9天~17岁7个月)。单纯肺结核470例(51.1%),肺结核合并肺外结核450例(48.9%),其中以合并结核性脑膜炎最为多见(236/450,52.4%)。最常见症状为发热(80.4%)和咳嗽(71.3%)。T-SPOT.TB试验阳性率81.5%。胸部CT阳性率优于胸片。重症结核355例、非重症565例。与非重症相比,重症患儿中男性比例较低,农村患儿、PPD阴性以及年龄0~3岁的比例较高,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,女孩(OR=1.58,95%CI:1.03~2.42)、年龄0~3岁(0~1岁:OR=6.78,95%CI 3.66~12.56;1~3岁:OR=4.90,95%CI 2.68~8.98)、农村患儿(OR=2.49,95%CI:1.54~4.04)是重症结核的独立危险因素,PPD阳性为保护因素(OR=0.31,95%CI:0.19~0.49)。结论儿童肺结核临床表现不典型,病原学阳性率低,需重视接触史、卡介苗接种情况,并强调综合分析,提高对重症结核危险因素的认识。

Objective To analyze the clinical epidemiological characteristics of pediatric pulmonary tuberculosis,(PTB)patient.Methods A retrospective,descriptive study was undertaken among PTB patients from 2010 to 2015 in the hospital,we collected the clinical data and evaluated related factors,and divided these cases into severe tuberculosis group and non-severe tuberculosis group by the severity of the disease,to analyzes the risk factors of severe tuberculosis.Results A total of 920 children with PTB were enrolled,age ranged from 9 days to 17 years,the peak age at onset was 7~14 years.48.9%of patients were complicated with extrapulmonary tuberculosis,and the most commonly seen was tuberculous meningiti(s 52.4%).The most common symptoms of pulmonary tuberculosis were feve(r 80.4%)and cough(71.3%).The positive rate of T-SPOT.TB(81.5%)was higher than the sputum/gastric bacterium smear(26.9%),PPD(35.5%)and Mycobacterium tuberculosis-PCR(29.6%).CT scanning was superior to X-ray examination in all aspects.There were 355 severe tuberculosis and 565 non-severe tuberculosis.Univariate analysis showed that the gender,age,household registration and PPD test between two groups were signi ficantly different(all P<0.05).Multivariate logistic regression analysis showed that the girls,age at 0-3 years,rural origin and negative PPD were independent risk factors for children with severe tuberculosis.Conclusions PTB is featured with atypical clinical performance,low etiological positive rate,so we need to pay attention to tuberculosis exposure and BCG vaccination,to analysis comprehensively and improve the understanding of the risk factors for severe tuberculosis.