19例先天性结核病患儿临床特征分析并文献复习

Clinical characteristics of 19 infants with congenital tuberculosis and literature review

目的分析先天性结核病患儿的临床特点,并结合文献探讨先天性结核病的诊治要点。方法搜集2012年1月至2019年9月期间在上海市公共卫生临床中心结核科住院的6月龄以内的19例先天性结核病患儿的病历资料,包括发病年龄、临床表现、影像学及实验室检查资料、治疗及转归等信息,并结合文献复习进行归纳总结。结果 19例先天性结核病患儿中,男10例(52.6%),女9例(47.4%),年龄3~60d,中位数(四分位数)为53(30,60)d;发病时间最短为出生后1d,最长为出生后45d,平均发病时间为(19.3±13.1)d。10例(52.6%)患儿为急性血行播散性肺结核,9例(47.4%)为原发性肺结核;9例(47.4%)患儿有发热症状,8例(42.1%)有呼吸困难、发绀症状。9例(47.4%)患儿结核感染T细胞斑点试验(T-SPOT.TB)检测结果阳性,6例(31.6%)患儿胃液抗酸染色涂片及培养阳性;17例患儿行胃液GeneXpert MTB/RIF检查,7例(41.2%)阳性。10例(52.6%)患儿胸部CT扫描显示为双肺弥漫性粟粒状影,8例(42.1%)为局部斑片状影伴肺门淋巴结肿大,1例(5.3%)为两肺多发斑片状影并发胸腔积液;1例(5.3%)头颅CT扫描显示存在脑积液;9例(47.4%)肝胆脾B超检查提示肝脾肿大。所有患儿均给予抗结核药品治疗,17例痊愈,2例死亡。结论先天性结核病患儿发病多在2~4周内,病情多发展迅速且危重,死亡率较高,早期积极行抗结核药品治疗对患儿的预后有决定性作用。

Objective This study aimed to analyze the clinical characteristics of infants with congenital tuberculosis,and investigate the diagnosis and therapeutic schedule of congenital tuberculosis combined with the literature. Methods The data of 19 infants under the age of 6 months with congenital tuberculosis who were hospitalized in the Tuberculosis Department of Shanghai Public Health Clinical Center from January 2012 to September 2019 were collected,including age of onset,clinical manifestations,imaging and laboratory examination data,treatment and outcome,and then summarized combined with literature review. Results Among the19 infants with congenital tuberculosis,there were 10 male(52.6%)and 9 female(47.4%),with the age of 3-60 days and the median age of 53(30,60)days;the shortest time of onset was 1 day after birth,and the longest was 45 days after birth,with the average onset time of(19.3±13.1)days.There were 10 cases(52.6%)with acute hematogenous disseminated tuberculosis,and 9 cases(47.4%)with primary tuberculosis;9 cases(47.4%)had fever,and 8 cases(42.1%)had dyspnea and cyanosis.T-SPOT.TB test was positive in 9 cases(47.4%),and acid-fast staining smear and culture were positive in 6 cases(31.6%);GeneXpert MTB/RIF was performed in17 cases,and 7 cases(41.2%)showed positive results.The chest CT imaging manifestations revealed 10 cases(52.6%)with diffuse miliary shadow of both lungs,8 cases(42.1%)with local patchy shadow and enlargement of hilar lymph node,and 1 case(5.3%)with multiple patchy shadows of both lungs and pleural effusion;skull CT scanning showed 1 case(5.3%)with brain effusion;and gallbladder and spleen ultrasound examination showed hepatosplenomegaly in 9 cases(47.4%).All the infants received anti-tuberculosis treatment,and 17 cases recovered,2 cases died. Conclusion The onset time of infants with congenital tuberculosis is usually within 2-4 weeks,the disease develops rapidly and critically,with a high mortality.Early positive anti-tuberculosis treatment plays a decisive role in the prognosis of infant with congenital tuberculosis.