芜湖地区52例女性生殖结核流行病学和临床特征分析

Epidemiological and clinical characteristics of female genital tuberculosis in 52 cases in Wuhu area

目的:探讨提高女性生殖结核(FGTB)的早期诊断措施。方法:回顾性分析2013年1月~2019年10月芜湖地区52例FGTB患者的住院资料,比较青年组(15~35岁)和中老年组(36岁~)流行病学和临床特征差异。结果:两组患者例数接近(23∶29)。23.1%(12/52)存在妇科手术史或病前分娩史,青年组占比高于中老年组(P<0.05)。69.2%(36/52)首发症状为腹痛或腹胀,36.5%(19/52)发病至确诊时间超过6个月。腹胀多见于中老年组(P<0.05),不孕多见于青年组(P<0.05)。两组T细胞斑点试验(T-SPOTTB)中~强阳性率均高于PPD(P<0.01)。两组肺结核检出率接近(P>0.05),但青年组附件包块检出率高于中老年组(P<0.05)。两组均易呈现输卵管病变、腹盆腔粟粒样结节及腹盆腔粘连等手术特征(P>0.05),但附件包块、输卵管积脓或积水多见于青年组(P<0.05)。结论:芜湖地区FGTB呈多年龄段分布,就诊症状多样且不典型,早期诊断困难。青年FGTB易发生输卵管器质性病变,中老年FGTB多呈轻症化且结核特征性检测阳性率偏低。应采取包括T-SPOTTB在内的多种措施,以提高FGTB早期诊断。

Objective:To investigate the measures to improve early diagnosis of female genital tuberculosis(FGTB).Methods:Epidemiological and clinical data were retrospectively analyzed in 52 cases of FGTB in Wuhu area from 2013 to 2019.The cases were divided into youth group(aged between 15 and 35 years)and middle-older group(aged over 36 years),and compared concerning the epidemiological and clinical features between group.Results:Case number was almost equal for the two group(23:29).Of the 52 FGTB patients,23.1%(12/52)had history of gynecological surgery or recent birth,with a significantly higher proportion in the youth group(P<0.05).69.2%(36/52)of the patients presented with the first symptoms by abdominal pain or distension,and 36.5%(19/52)experienced a time interval of over 6 months from onset to final diagnosis.Abdominal distension was more seen in middle-older patients(P<0.05).Younger patients had higher incidence of infertility than the older ones(P<0.05).The two age groups showed higher rate of stronger positive T-SPOTTB test than PPD(P<0.01).Although detected rate of FGTB was similar between groups(P>0.05),yet the detected rate of adnexal masses was higher in youth group than in control group(P<0.05).Surgical findings of tubal lesions,pelvic miliary nodules,and pelvic adhesion were equal in the two age groups(P>0.05),yet youth group had higher incidence of severe tubal lesions(P<0.05).Conclusion:FGTB occurs in females in Wuhu area at multiple age range,with diverse and atypical symptoms at clinic visit,which makes difficult early diagnosis.Young FGTB patients are more susceptible to severer tubal lesions,and the clinical symptoms of FGTB appears milder in older patients,with lower rate of positive tuberculosis tests.Multiple diagnostic methods,including T-SPOTTB test,are recommended in order to improve the early diagnosis of this disease.