北京儿童医院2002至2010年结核病住院患儿临床流行病学研究

摘要

Objective To analyze the clinical epidemic-logical characteristics of pediatric tuberculosis ( TB ) patients. Methods A retrospective, descriptive study was undertaken among pediatric TB patients admitted to Beijing Children's Hospital from January 2002 to December 2010. Clinical data including age, manifestation, type of TB and treatment were collected. Patients were classified into 3 group based on their history of BBC vaccination. Logistic regression analysis was applied to analyze the risk factors to the efficacy of TB treatment. Results ① Overall, 1 212 hospitalized TB children were enrolled. Distribution of types of TB in 9 years was similar. Main types of TB were pulmonary TB ( 45. 5% , 552/1 212), extra-pulmonary TB ( 23. 5% , 285/1 212 and hematogenous disseminated pulmonary TB( 15. 8% , 191/1 212 ). 57. 2% ( 163/285 ) extra-pulmonary TB was mainly meningitis. ② The age of onset for all forms of TB showed a bimodal distribution, under 4 years old and 7-12 years old, accounting for 42. 0% ( 509/1 212 ) and 30. 5% ( 370/1 212 ) of the total cases respectively. Severe TB ( hematogenous disseminated pulmonary TB or tubercular meningitis ) were mainly observed in infants, and the proportion gradually decreased with increasing age. ③ The proportion of severe TB in BCG-vaccinated patients was lower than that in non-vaccinated patients, 26. 9% and 34. 6% respectively(P = 0. 004 ). ④ TB treatment rate of success was related to sex and types of TB in children. Treatment rate of success was lower in females (77. 8% ) than in males (83. 8% ), P =0.015. Treatment rate of success was the highest in patients with Pulmonary TB ( 84. 2% ) and was the lowest in patients with hematogenous disseminated pulmonary TB ( 73. 8% ), P=0. 006. Conclusions Pediatric TB was mainly observed in children under 4 years old. Compared with adults TB, children were more susceptible to extra-pulmonary TB and severe TB. Treatment outcome of pediatric TB was poor in severe TB patients and in females. BCG was effective in preventing severe TB especially in infants. BCG vaccination should be strengthened in order toprevent the occurrence of TB in young age children, especially the occyrrence of severe TB.%目的 分析结核病住院患儿的临床流行病学特征,为结核病的防治提供帮助.方法 回顾性收集2002年1月至2010年12月北京儿童医院(我院)0~17岁的结核病住院患儿,采集性别、年龄、临床表现、结核病接触史、卡介苗接种史和治疗等资料.根据卡介苗接种情况,将结核病患儿分为卡介苗接种组、卡介苗未接种组和卡介苗接种史不详组.并对结核病的类型、接触史和疗效进行评价.采用Logistic回归分析与儿童结核病疗效相关的危险因素.结果 研究期间我院共收治结核病住院患儿1 212例,其中男性766例(63.2%),女性446例;年龄2月龄至17岁,中位年龄5.5岁.农村患儿938例(77.4%),城市患儿274例.①肺结核占45.5%(552例),肺外结核和血行播散性结核病分别占23.5%(285例)和15.8%(191例).在肺外结核中,结核性脑膜炎为主要类型,占57.2%(163/285例).②0~3岁509例(42.0%)、~6岁158例(13.0%)、~12岁370例(30.5%)、~17岁175例(14.4%).重症结核病主要见于1岁以下儿童,随着年龄增长,其所占比例逐渐减少.③卡介苗接种组重症结核病比例(26.9%,180/670例)低于卡介苗未接种组(34.4%,170/494例),P=0.004.④有结核病密切接触史患儿中重症结核病比例(43.7%,159/364例)高于无结核病密切接触史者(34.6%,280/809例),P=0.003.⑤好转或治愈989例(81.6%),未愈或死亡223例.女性患儿治疗成功率(77.8%,347例)低于男性(83.8%,642例),P=0.015;肺结核治疗成功率最高(84.2%,465/552例),血行播散性结核病治疗成功率最低(73.8%,141/191例),P=0.006.结论 儿童结核病主要见于4岁以下患儿,与成人结核病相比,儿童更易发生肺外及重症结核病,且重症结核病及女性患儿抗结核治疗效果较差;卡介苗对重症结核病具有一定的免疫保护作用.