67例婴幼儿肺结核临床诊断分析

目的分析婴幼儿肺结核的临床诊断特点。方法对67例婴幼儿肺结核的卡介苗接种情况、结核接触史、临床表现、实验室检查、胸部影像学特点、PPD试验结果进行回顾性分析。结果67例患儿中未接种卡介苗20例(29.9%);有结核接触史31例(46.3%),外来人口26例(38.8%);发热51例(76.1%),有呼吸道症状者59例(88.1%),有神经系统症状者15例(22.4%);PPD(-)14例(20.9%),CRP升高50例,ESR升高45例(67.1%)血常规检查示白细胞升高45例(67.2%),白细胞分类中性粒为主者49例(73.1%);67例行X线胸片检查,其中16例(23.9%)仅见两肺纹理增多增粗、未见实质性病灶,CT检查58例,其中2例未见明显异常。最后诊断为原发型肺结核40例,占59.7%,血行播散性肺结核14例,占20.9%;继发性肺结核5例,占7.5%;结核性胸膜炎8例,占11.9%。结论婴幼儿肺结核有一定的临床特点,临床应注意早期诊断;同时应该加强外来流动人口的结核病防治工作,普及外来人口儿童的卡介苗接种率。

Clinical analysis of 67 cases with pulmonary tuberculosis in infant

Objective To analyze the clinical features of pulmonary tuberculosis in infant. Methods Retrospective analysis of the clinical features of 67 cases with pulmonary tuberculosis in infant,including BCG vaccine,contact history with tuberculosis,clinical manifestation,laboratory examination,chest imaging and PPD test was conducted. Results Twenty cases(29.9%) were found with no BCG vaccine. Thirty-one cases(46.3%) had contact history with tuberculosis and 26 cases(38.8%) were temporary resident children.Fifty-one cases(76.1%) were found with fever,59(88.1%) with respiratory symptom,and 15(22.4%) with nerve system symptom.Fourteen cases(20.9%) were found with negative PPD test,50(74.6%) with elevatory CRP,45(67.1%) with elevatory ESR,45(67.2%) with leucocytosis.Chest x-ray was performed in 67 cases,while 16 cases(23.9%) showed increased bronchovascular shadows.CT examination was performed in 58 cases and 2 cases were normal.Finally,40 cases(59.7%) were diagnosed with primary pulmonary tuberculosis,14(20.9%) with hematogenous pulmonary tuberculosis,5(7.5%) with secondary pulmonary tuberculosis and 8(11.9%) with tuberculous pleurisy. Conclusion Pulmonary tuberculosis in infant has a certain clinical characteristics and clinical physician should attach weight to the early diagnosis.Prevention and cure with pulmonary tuberculosis in recurrent population should be strengthened and BCG vaccination in temporary resident children should be extended.