基于CT分型分析高原地区不同年龄儿童肺结核发病特点及其重症结核发病的影响因素

Analysis of the clinical characteristics of pulmonary tuberculosis in children of different ages at plateau region based on CT typing and the influencing factors of the incidence of severe tuberculosis

目的:基于X射线计算机断层扫描(CT)分型,探讨分析高原地区不同年龄儿童肺结核的发病特点。方法:选取医院收治的107例高原地区儿童肺结核患者,根据儿童年龄的不同将其分为婴儿组、幼儿组、学龄前组和学龄期组,对其临床资料进行回顾性分析。所有患儿均行CT扫描检查,并根据CT征象分为原发性肺结核、继发性肺结核、血行播散性肺结核及结核性胸膜炎,分析不同年龄段患儿的发病特点。根据病情严重程度,将107例患儿分为非重症组(50例)和重症组(57例),采用多因素Logistic回归分析筛选重症结核发病的独立危险因素。结果:婴儿组患儿原发性和继发性肺结核占比分别为100.00%和0.00%,幼儿组为75.00%和20.83%,学龄前组为65.52%和27.59%,学龄期组为29.73%和56.76%,各组比较差异均有统计学意义(x^2=28.226,x^2=20.129;P<0.05);而结核性胸膜炎和血行播散性肺结核占比各组比较差异无统计学意义。婴儿组和幼儿组的原发性肺结核发病比率较学龄期组均明显升高,差异有统计学意义(x^2=23.039,x^2=11.963;P<0.05);婴儿组、幼儿组及学龄前组继发性肺结核发病率较学龄期组均明显降低,差异有统计学意义(x^2=15.789,x^2=7.682,x^2=5.616;P<0.05)。107例患儿中原发性肺结核合并血行播散性肺结核发生率明显高于继发性肺结核,差异有统计学意义(x^2=5.266,P<0.05);原发性肺结核合并结核性胸膜炎发生率与继发性肺结核无统计学差异。重症组与非重症组患儿的性别、年龄、结核接触史、接种卡介苗情况和结核菌素试验(PPD)结果比较,差异有统计学意义(x^2=7.609,x^2=11.876,x^2=27.505,x^2=24.464,x^2=17.210;P<0.05);年龄<3岁、有结核接触史、未接种卡介苗和PPD阴性是重症结核的独立危险因素。结论:高原地区是我国儿童肺结核发病的高危地区,受到自然环境、医疗条件、民风民俗等影响,其重症结核的比例较高。不同年龄的高原地区肺结核患儿的病变分布和CT影像学特征等有一定差异,年龄<3岁、有结核接触史、未接种卡介苗和PPD阴性是高原地区儿童重症结核的独立危险因素。

Objective:To explore and analyze the clinical characteristics of pulmonary tuberculosis in children of different ages at plateau region based on computed tomography(CT)typing.Methods:107 children with pulmonary tuberculosis in plateau region who admitted to hospital were selected as the research objects,and they were divided into infant group,young children group,preschool group and school-age group according to the different age.And their clinical data were analyzed retrospectively.All of children with pulmonary tuberculosis underwent CT scan examination,and they were divided into primary pulmonary tuberculosis,secondary pulmonary tuberculosis,disseminated pulmonary tuberculosis along with the blood flow and tuberculous pleurisy according to the CT signs.And the clinical characters of children with disease of different ages were analyzed.And they were divided into non-severe group and severe group according to the severity of disease.And multiple Logistic regression analysis was adopted to screen pathogenic independent risk factor of severe tuberculosis.Results:The proportions of primary and secondary pulmonary tuberculosis in infant group were 100.00%and 0.00%,and those in young children group were 75.00%and 20.83%,and those in preschool group were 65.52%and 27.59%,and those in school-age group were 29.73%and 56.76%,respectively.There were significant differences among the various groups(x^2=28.226,x^2=20.129,P<0.05).But there were no significant differences in the proportions of tuberculous pleurisy and disseminated pulmonary tuberculosis along with the blood flow among various groups.The incidences of primary pulmonary tuberculosis in infant group and young children group were significantly higher than that in school-age group(x^2=23.039,x^2=11.963,P<0.05).The incidences of secondary pulmonary tuberculosis in infants group,young children group and preschool group were significantly lower than that in school-age group(x^2==15.789,x^2=7.682,x^2=5.616,P<0.05),respectively.In 107 children with pulmonary tuberculosis,the incidence of primary pulmonary tuberculosis combined with disseminated pulmonary tuberculosis along with the blood flow was significantly higher than that of secondary pulmonary tuberculosis(x^2=5.266,P<0.05).And there was not significant difference in incidence between primary pulmonary tuberculosis combined with tuberculous pleurisy and secondary pulmonary tuberculosis.There were significant differences in gender,age,tuberculosis contact history,the situation of inoculating bacillus calmette guerin(BCG)vaccination and PPD results between the severe group and the non-severe group(x^2=7.609,x^2=11.876,x^2=27.505,x^2=24.464,x^2=17.210,P<0.05).Age under 3 years old,tuberculosis contact history,without inoculating BCG vaccination and PPD negative were independent risk factors of severe tuberculosis.Conclusion:Plateau region is high-risk region of pulmonary tuberculosis in children.The proportion of severe tuberculosis is higher in this region due to the influence of natural environment,medical condition and folk tradition and fold customs and so on.There are some differences in the pathological distribution and CT characteristics of children with pulmonary tuberculosis at different ages in plateau region.The age that is under 3 years old,with a tuberculosis contact history,without inoculating BCG vaccination and PPD negative are the independent risk factors of severe tuberculosis of children in plateau region.