Chinese General Practice ›› 2022, Vol. 25 ›› Issue (08): 930-936.DOI: 10.12114/j.issn.1007-9572.2022.01.601

Special Issue: 儿科最新文章合集

• Original Research • Previous Articles     Next Articles

  

  • Received:2021-12-16 Revised:2022-01-10 Published:2022-03-15 Online:2022-03-02

气管支气管结核患儿并发肺不张的临床特征及危险因素研究

  

  1. 1.610000 四川省成都市,成都市公共卫生临床医疗中心结核科
    2.610000 四川省成都市,成都市公共卫生临床医疗中心病案室
    3.610000 四川省成都市,成都市公共卫生临床医疗中心胸外科
  • 通讯作者: 何畏
  • 基金资助:
    四川省医学会医学科研课题(S19033;S18027)

Abstract: Background

Due to nonspecific clinical and thoratic imaging characteristics, pediatric tracheobronchial tuberculosis (TBTB) is easy to be misdiagnosed or missed. And repeated infections, lung function deterioration and even lobectomy could be induced if pulmonary atelectasis occurs in pediatric TBTB, causing great harm to children's health.

Objective

To investigate the clinical characteristics and risk factors of pulmonary atelectasis in pediatric TBTB, providing clinical evidence for interventionally managing pediatric TBTB and for exploring the pathogenesis of this disease.

Methods

A retrospective study was conducted. Participants were TBTB children (≤14 years old) who were selected from Public Health Clinical Center of Chengdu from July 2017 to November 2019. TBTB children were ivided into two groups based on whether accompanied with pulmonary atelectasis, with atelectasis (n=23) and without atelectasis (n=137) . Baseline data, including demographics, clinicalsymptoms, complications, results of etiological test, chest imaging and bronchoscopic examination, were collected. Binary Logistic regression equation was used to analyze the risk factors of pulmonary atelectasis in pediatric TBTB.

Results

One hundred and sixty patients were enrolled, with a male-to-female ratio of 1.08∶1, an median age of 12 (9, 13) years old. The prevalence of pulmonary atelectasis at admission was 14.4% (23/160) . Among the cases with pulmonary atelectasis, the prevalence of pulmonary atelectasis occurring in the right lung, and the right middle lobe was 65.2% (15/23) , and 39.1% (9/23) , respectively. Compared with those without pulmonary atelectasis, those with pulmonary atelectasis had younger median age of onset〔9 (8, 12) years old vs 12 (10, 13) years old〕, and lower rate of tuberculous cavities〔4.3% (1/23) vs 27.0% (37/137) 〕 (P<0.05) . Moreover, those with pulmonary atelectasis had lower prevalence of bilateral lobes involved (χ2=5.692, P=0.017) . Those with pulmonary atelectasis had higher prevalence of granulation hyperplasia TBTB than those without (χ2=11.915, P=0.001) . Age 〔OR=0.827, 95%CI (0.710, 0.965) 〕and granulation hyperplasia TBTB〔OR=7.382, 95%CI (1.979, 27.539) 〕were associated with pulmonary atelectasis in pediatric TBTB (P<0.05) .

Conclusion

In our study, pulmonary atelectasis occurred in 14.4% of the children with TBTB, which was more present in the right lung, especially the right middle lobe. Younger age and granulation hyperplasia TBTB were associated with pulmonary atelectasis in pediatric TBTB.

Key words: Tuberculosis, pulmonary, Tracheobronchial tuberculosis, Children, Pulmonary atelectasis, Risk factors, Root cause analysis, Regression analysis

摘要: 背景

儿童气管支气管结核(TBTB)的临床表现和影像学缺乏特异性,易误诊、漏诊,一旦并发肺不张可致反复感染、肺功能恶化,甚至肺叶切除,造成极大危害。

目的

探讨TBTB患儿并发肺不张的临床特征与危险因素,同时为介入诊治TBTB患儿及TBTB发生机制的探讨提供一定的临床依据。

方法

回顾性分析2017年07月至2019年11月在成都市公共卫生临床医疗中心治疗的TBTB患儿的临床资料,纳入患儿均≤14岁,根据是否并发肺不张分为并发肺不张组(n=23例)、无肺不张组(n=137例),收集两组人口学特征、临床症状、合并症、病原学检查、影像学检查、气管镜检查等临床资料,采用二元Logistic回归方程分析TBTB患儿并发肺不张的危险因素。

结果

共纳入160例TBTB患儿,男女比例为1.08∶1,中位年龄为12(9,13)岁,14.4%(23/160)的TBTB患儿入院时同时并发肺不张,65.2%(15/23)的TBTB患儿肺不张发生在右肺,39.1%(9/23)的TBTB患儿为右肺中叶不张。并发肺不张组的年龄〔9(8,12)岁〕、空洞率〔4.3%(1/23)〕低于无肺不张组〔12(10,13)岁〕、〔27.0%(37/137)〕(P<0.05);无肺不张组病变累及肺部双侧多叶的占比高于并发肺不张组(χ2=5.692,P=0.017);肺不张组分型为肉芽增殖型TBTB的比例高于无肺不张组(χ2=11.915,P=0.001)。年龄〔OR=0.827,95%CI(0.710,0.965)〕和肉芽增殖型TBTB〔OR=7.382,95%CI(1.979,27.539)〕是TBTB患儿并发肺不张的影响因素(P<0.05)。

结论

本研究中14.4%的TBTB患儿并发肺不张,肺不张更易发生在右肺,而右肺中叶为常见肺不张发生部位;TBTB患儿年龄越小、分型为肉芽增殖型更容易并发肺不张。

关键词: 结核,肺, 气管支气管结核, 儿童, 肺不张, 危险因素, 影响因素分析, 回归分析

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