儿童肺结核45例临床特点及诊断分析

目的 分析儿童肺结核的临床特点，为提高儿童肺结核的诊治水平提供依据。方法 回顾性分析45例肺结核患儿的一般资料、实验室检查以及影像学检查结果，比较并分析胸部CT与胸X线片检查结果，并查阅纤维支气管镜检查、治疗支气管内膜结核情况。结果 45例患儿中男28例，女17例。明确接种卡介苗者42例（93.3%）。有明确近期活动性肺结核接触史者11例（24.4%），既往家庭成员有结核病史者33例（73.3%）。单纯肺结核者37例（82.2%），合并肺外结核者以结核性胸膜炎多见。常见症状为发热、咳嗽、喘息以及结核中毒症状。儿童肺结核以不同形式起病，以支气管炎和肺炎起病29例（64.4%），以支气管哮喘起病3例（6.7%），以慢性咳嗽起病5例（11.1%），以发热待查起病6例（13.3%），手术创伤后起病2例（4.4%）。结核菌素纯化蛋白衍生物试验中度以上阳性38例（84.4%）。胸部CT比胸X线片能更好地发现病变。45例中42例进行了纤维支气管镜检查，发现支气管内膜结核13例（31.0%），予冷冻以及利奈唑胺灌洗治疗，2~3次后支气管内壁变光滑。结论 胸部CT的诊断价值优于胸X线片；纤维支气管镜下予冷冻及利奈唑胺灌洗治疗是治疗支气管内膜结核的有效方法。

Clinical features and diagnostic analysis of 45 children with pulmonary tuberculosis

Objective To analyze the clinical characteristics of pulmonary tuberculosis in children, and provide the basis for improving the diagnosis and treatment of pulmonary tuberculosis in children. Methods The general data, laboratory examination and imaging examination of 45 children with pulmonary tuberculosis admitted to our hospital were retrospectively analyzed. The results of chest CT and chest X-ray were compared and analyzed. The fiberoptic bronchoscopy and treatment of endobronchial tuberculosis were reviewed. Results There were 28 males and 17 females in the 45 patients. Forty-two cases (93.3%) were definitely vaccinated with Bacille Calmette-Guérin (BCG) vaccine. There were 11 cases (24.4%) with definite recent contact history of active tuberculosis, and 33 cases (73.3%) with past family history of tuberculosis. There were 37 cases (82.2%) with simple pulmonary tuberculosis. Tuberculous pleurisy was more common in patients with extrapulmonary tuberculosis. The common symptoms were fever, cough, wheezing and tuberculosis poisoning symptoms. Pulmonary tuberculosis occurred in different forms in children. There were 29 cases (64.4%) with bronchitis and pneumonia, 3 cases (6.7%) with bronchial asthma, 5 cases (11.1%) with chronic cough, 6 cases (13.3%) with fever, and 2 cases (4.4%) with postoperative trauma. The tuberculin test was moderately positive in 38 cases (84.4%). Chest CT scan can detect tubercular lesions better than chest X-ray examination. Among the 45 cases, 42 cases underwent fiberoptic bronchoscopy, and 13 cases (31.0%) were found to have endobronchial tuberculosis. Patients (n=42) were treated with freezing and linezolid lavage. The endobronchial wall became smooth after 2-3 times of treatment. Conclusion The diagnostic value of chest CT scan is superior to chest X-ray examination. Bronchoscopic freezing and linezolid lavage are effective methods for the treatment of endobronchial tuberculosis.