儿童肺结核的诊断进展

摘要

On November 9,2017,the health standard of the People's Republic of China "Diagnosis for pulmonary tuberculosis (WS 288-2017)" was introduced.The author would like to explain and analyze the new standard,focusing on several issues of children's tuberculosis,combined with the literature to discuss the advances in the diagnosis of tuberculosis in children.Clinical manifestations,imaging findings,a history of close contact with tuberculosis patients and Tuberculin Skin Test are the main basis for the clinical diagnosis of tuberculosis in children.Gamma-interferon release assay has better specificity than the tuberculin skin test.When pulmonary tuberculosis is suspected in children,efforts should be taken to keep two or more specimens including gastric juice,sputum or nasopharyngeal aspirate for smear microscopy,solid and liquid culture and molecular test to increase the positive rate of the pathogen.Bronchoscopy should be performed when airway involvement is suspected.Xpert MTB/RIF positive results can be used as the etiological basis for the diagnosis of pediatric pulmonary tuberculosis.%2017年11月9日,中华人民共和国卫生行业新标准《WS 288-2017肺结核诊断》出台,作者就新标准中关于儿童肺结核的若干问题进行解读,并结合文献论述儿童肺结核的诊断进展.临床和影像学表现、结核病患者密切接触史及结核菌素皮肤试验是儿童肺结核临床诊断的主要依据.γ-干扰素释放试验较结核菌素皮肤试验有更好的特异性.怀疑儿童肺结核时应尽可能留取2份以上胃液、痰液或鼻咽吸取物等标本进行涂片镜检、固体和液体培养,以及进行分子生物学检测,以增加病原学检测的阳性率.怀疑气道受累时应进行支气管镜检查.利福平耐药实时荧光定量抗酸扩增(Xpert MTB/RIF)检测阳性可作为儿童肺结核确诊的病原学依据.