80例儿童中枢神经系统结核病临床特征分析

Analysis of clinical features of 80 cases of central nervous system tuberculosis in children

目的 分析儿童中枢神经系统结核病(central nervous system tuberculosis,CNSTB)的临床特征,以便临床早期诊断和治疗。方法 回顾性收集2016年2月至2022年4月于广州市胸科医院诊治的80例儿童CNSTB病例作为研究组,41例成人CNSTB病例作为对照组,对比分析两组临床特征。结果 研究组患儿临床表现主要为发热(88.8%)、呕吐(38.8%)、咳嗽(33.8%)等,其中58.8%有明确肺结核接触史,73.8%诊断前病程大于14d,56.3%脑脊液生化指标异常,41.2%头颅MRI表现为脑膜型。研究组中明确肺结核接触史、诊断前病程时长、脑脊液生化指标异常率、头颅MRI主要表现与对照组的差异具有统计学意义(χ^(2)=21.43、10.30、4.92、6.19,均P<0.05),而两组间临床症状(除头痛外)、神经系统查体、临床分期、外周血结核感染T细胞斑点试验、结核菌素纯蛋白衍化物试验、脑积水、预后不良差异无统计学意义(均P>0.05);研究组中未合并肺结核与合并肺结核患儿危重症发生率差异有统计学意义(χ^(2)=5.83,P<0.05)。结论 儿童CNSTB患儿临床症状不具有特异性,但通常有明确的肺结核接触史,头颅MRI以脑膜受累为主,未合并肺结核的CNSTB患儿易出现危重症病例,临床医生应提高对儿童CNSTB的认识。

Objective To analyze the clinical characteristics of central nervous system tuberculosis(CNSTB)in children for early clinical diagnosis and treatment.Method A total of 80 cases of CNSTB in children treated in Guangzhou Chest Hospital from February 2016 to April 2022 were retrospectively collected as the study group and 41 cases of CNSTB in adults as the control group.The clinical characteristics of the two groups were compared and analyzed.Result The main clinical manifestations of the children in the study group were fever(88.8%),vomiting(38.8%)and cough(33.8%),among which 58.8%had a clear history of contact with tuberculosis,73.8%had a course of disease longer than 14 days before diagnosis,56.3%had biochemical abnormalities of cerebrospinal fluid,and 41.2%showed meningeal type on head MRI.There were significant differences between the study group and the control group in pulmonary tuberculosis contact history,disease duration before diagnosis,cerebrospinal fluid biochemical abnormality rate,and head MRI findings(χ^(2)=21.43,10.30,4.92,6.19,all P<0.05).There were no significant differences in clinical symptoms(except headache),nervous system physical examination,clinical stage,blood tuberculosis infection T-cell spot test(T-SPOT.TB),tuberculin pure protein derivative(PPD)test,hydrocephalus and poor prognosis between the two groups(all P>0.05).There was a statistically significant difference in the rate of critical illness between patients with uncomplicated tuberculosis and those with complicated tuberculosis in the study group(χ^(2)=5.83,P<0.05).Conclusion The clinical symptoms of children with CNSTB are non-specific,but are usually accompanied by a clear history of pulmonary tuberculosis exposure.Brain MRI mainly showed meningeal involvement,Children with CNSTB without pulmonary tuberculosis are prone to severe cases.Clinical doctors should improve their understanding of the clinical characteristics of CNSTB in children.