PICU严重结核感染的临床特征与诊断

目的探讨PICU结核感染的临床特征及诊断方法，加强对结核病的认识。方法分析总结2009年1月至2012年12月我院PICU收治的重症结核感染患儿的临床特征及诊断方法。应用小儿危重病例评分对病情进行评估。肺结核诊断符合中华医学会儿科分会呼吸学组制定的儿童肺结核临床诊断标准，结核性脑膜炎及腹膜炎根据临床、实验室检查及病理诊断。结果22例患儿中，肺部结核16例，肺外结核感染6例，其中结核性脑膜炎3例。重症结核感染的临床特点：除结核感染一般症状外，均伴有一个或多器官功能障碍，其中16例有呼吸功能障碍、2例有心血管功能障碍、3例中枢神经系统功能障碍、1例有心血管、肺及胃肠功能障碍。16例肺内结核菌感染除发热、咳嗽、气促和结核中毒症状外，均有呼吸衰竭，2例患儿合并呼吸窘迫综合征，8例需要机械通气治疗；2例心包积液患儿出现心包填塞。12例腺苷脱氨酶增高；14例结核分支杆菌感染T细胞斑点试验阳性。结论PICU危重病患儿需警惕重症结核病，腺苷脱氨酶和结核分支杆菌感染T细胞斑点试验可作为儿童结核诊断的重要辅助手段。

Clinical features and diagnosis of severe tuberculosis infection in PICU

Objective To explore the clinical features and diagnostic methods of tuberculosis infection in PICU, and improve the understanding of tuberculosis. Methods We analysed the clinical features and diagnostic methods of severe tubercle bacillus infectious diseases in PICU from Jan 2009 to Dec 2012. Severity of disease was graded by pediatric critical illness score. The diagnosis of the pulmonary tuberculosis was in accord with the diagnostic criteria of paediatric pulmonary tuberculosis established by Chinese Medical Association paediatrics branch. And the diagnosis of tuberculosis meningitis and tuberculosis peritonitis based on the clinical physical examination, laboratory examination and pathologic finding. Results Among 22 cases enrolled in this study,totally 16 cases were pulmonary tuberculosis,6 cases were extrapulmonary tuberculosis, and 3 cases were tuberculosis meningitis, The clinical feature of severe tuberculosis infection in PICU was accompanying with one or multiple organ dysfunction besides tuberculosis infection symptom, among them, respiratory dysfunction occurred in 16 cases, cardiovascular dysfunction was observed in 2 cases, and central nervous system dysfunction was found in 3 cases, even 1 patient experienced cardiovascular system dysfunc- tion, respiratory disorder as well as gastrointestinal system dysfunction simultaneously. Sixteen cases of pulmonary tubercle bacillus infection manifested respiratory failure besides fever, cough, shortness of breath and tuberculosis toxicosis symptom, 2 cases of them developed into acute respiratory distress syndrome, 8 cases needed mechanical ventilation. Two cases of pericardial effusion presented cardiac tamponade. The level of adenosine deaminase elevated in 12 cases, and the positive result of enzyme-linked immunospot assay for tubercle bacillius was observed in 14 cases. Conclusion It is very important to be aware of that severe tuber- cle bacillus infection exist in critically ill patients admitted in PICU, measuring the level of adenosine deaminase and taking enzyme-linked immunospot assay for tubercle bacillius test are important accessory examina- tion for tuberculosis diagnosis in children.