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目的探讨儿童结核性胸膜炎(TP)的临床特点,提高对该病诊断的准确性。方法回顾性分析天津市儿童医院呼吸二科2015年6月至2016年8月收治的5例临床确诊为结核性胸膜炎患儿的临床资料。结果 5例患儿均经临床表现分析、结核菌素纯蛋白衍生物(TB-PPD)试验、T细胞斑点检测结核感染(T-SPOT)及胸腔积液或血液细菌学检查确诊为TP。经异烟肼、利福平及吡嗪酰胺三联抗痨联合糖皮质激素治疗好转出院。随访3个月,2例15岁患儿胸腔积液吸收好转,遗留胸膜肥厚;1例7岁患儿出现胸壁结核球;1例8岁患儿继发结核性肝脓肿;另1例6岁患儿因包裹性胸腔积液于胸腔镜下行黏连分离术。结论儿童结核性胸膜炎需综合临床表现、结核接触史、病原学检查等多方面因素而确诊,胸腔积液腺苷脱氢酶(ADA)、TB-DNA及血和胸腔积液T-SPOT检测对诊断具有较高的特异性。
Objective To investigate the clinical features of children with tuberculous pleurisy (TP) and to improve the accuracy of the diagnosis of the disease. Methods The clinical data of 5 clinically diagnosed tuberculous pleurisy patients admitted to Respiratory Department of Tianjin Children’s Hospital from June 2015 to August 2016 were retrospectively analyzed. Results All the 5 children were diagnosed as TP by clinical manifestations, TB-PPD test, T-SPOT and pleural effusion or blood bacteriological examination. After isoniazid, rifampicin and pyrazinamide triple anti-糖 combined glucocorticoid treatment was discharged. The follow-up of 3 months, 2 cases of 15-year-old children with pleural effusion improved absorption, left pleural hypertrophy; 1 case of 7-year-old children with chest wall tuberculoma; 1 case of 8-year-old children with tuberculosis secondary liver abscess; Children with pleural effusion due to adhesions in thoracoscopic surgery. Conclusions Children with tuberculous pleurisy should be diagnosed by comprehensive clinical manifestations, contact history of TB, etiological examination and many other factors. Pleural effusion adenosine dehydrogenase (ADA), TB-DNA and blood and pleural effusion T-SPOT detection Diagnosis is of high specificity.