儿童气管支气管结核的临床及支气管镜下特征分析

彭帅; 张光莉; 洪婧娴; 丁浩; 王崇杰; 罗健; 罗征秀

doi:10.7499/j.issn.1008-8830.2210116

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中国当代儿科杂志 ›› 2023, Vol. 25 ›› Issue (4) : 381-387. DOI: 10.7499/j.issn.1008-8830.2210116

论著·临床研究

儿童气管支气管结核的临床及支气管镜下特征分析

彭帅¹, 张光莉¹, 洪婧娴¹, 丁浩², 王崇杰¹, 罗健¹, 罗征秀¹

作者信息 +

Clinical and bronchoscopy features of tracheobronchial tuberculosis in children

PENG Shuai, ZHANG Guang-Li, HONG Jing-Xian, DING Hao, WANG Chong-Jie, LUO Jian, LUO Zheng-Xiu

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文章历史 +

摘要

目的总结气管支气管结核（tracheobronchial tuberculosis，TBTB）患儿临床和支气管镜下特点，并分析气道闭塞或瘢痕狭窄的影响因素。方法回顾性收集TBTB患儿的临床资料，根据随访1年内最后1次支气管镜结果分为气道闭塞或瘢痕狭窄组（n=34）和无气道闭塞或瘢痕狭窄组（n=58）。采用多因素logistic回归分析探讨儿童TBTB遗留气道闭塞或瘢痕狭窄的影响因素，使用受试者工作特征（receiver operating characteristic，ROC）曲线分析影响因素对儿童TBTB遗留气道闭塞或瘢痕狭窄的预测价值。结果 92例TBTB患儿主要症状为咳嗽（90%）、发热（68%）；<1岁组患儿气促、喘息发生率高于其他年龄组（P<0.008）。胸部CT常见改变为纵隔或肺门淋巴结肿大（90%）、气管支气管狭窄或堵塞（61%）。TBTB镜下以淋巴结瘘型为主（77%）。所有患儿均行介入治疗，有效率为84%。随访1年，34例患儿遗留气道闭塞或瘢痕狭窄。气道闭塞或瘢痕狭窄组比无气道闭塞或瘢痕狭窄组TBTB的诊断时间和启动介入治疗时间均显著延迟（P<0.05）。多因素logistic回归分析显示TBTB诊断时间与患儿遗留气道闭塞或瘢痕狭窄密切相关（P<0.05）。ROC曲线分析发现TBTB诊断时间取92 d是预测TBTB患儿遗留气道闭塞或瘢痕狭窄的最佳截断值，曲线下面积为0.707，灵敏度为58.8%，特异度为75.9%。结论 TBTB临床表现无特异性，<1岁患儿临床症状更重。对胸部影像学提示气道受累的肺结核患儿应警惕TBTB发生。TBTB诊断延迟与气道闭塞或瘢痕狭窄发生相关。［中国当代儿科杂志，2023，25（4）：381-387］

Abstract

Objective To study the clinical and bronchoscopic characteristics of tracheobronchial tuberculosis (TBTB) in children and to identify factors influencing residual airway obstruction or stenosis. Methods The clinical data of children with TBTB were retrospectively collected. The children were divided into two groups based on the last bronchoscopic result within one year of follow-up: a group with residual airway obstruction or stenosis (n=34) and a group without residual airway obstruction or stenosis (n=58). A multivariate logistic regression analysis was used to identify the factors influencing residual airway obstruction or stenosis in children with TBTB. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of the factors influencing residual airway obstruction or stenosis in children with TBTB. Results A total of 92 children with TBTB were included, and the main symptoms were cough (90%) and fever (68%). In children under 1 year old, the incidence rates of dyspnea and wheezing were significantly higher than in other age groups (P<0.008). Chest CT findings included mediastinal or hilar lymph node enlargement (90%) and tracheobronchial stenosis or obstruction (61%). The lymphatic fistula type was the main type of TBTB observed bronchoscopically (77%). All children received interventional treatment, and the effective rate was 84%. During one year of follow-up, 34 children had residual airway obstruction or stenosis. The TBTB diagnostic time and the initiation of interventional treatment were significantly delayed in the group with residual airway obstruction or stenosis compared with the group without residual airway obstruction or stenosis (P<0.05). The multivariate logistic regression analysis showed that the TBTB diagnostic time was closely related to residual airway obstruction or stenosis in children (P<0.05). ROC curve analysis showed that at the cut-off value of 92 days of TBTB diagnostic time, the area under the curve for predicting residual airway obstruction or stenosis in children with TBTB was 0.707, with a sensitivity of 58.8% and a specificity of 75.9%. Conclusions The clinical manifestations of TBTB are nonspecific, and symptoms are more severe in children under 1 year old. TBTB should be suspected in children with tuberculosis and chest imaging indicating airway involvement. Delayed diagnosis of TBTB is associated with the development of residual airway obstruction or stenosis. Citation:Chinese Journal of Contemporary Pediatrics, 2023, 25(4): 381-387

导出引用

彭帅, 张光莉, 洪婧娴, 丁浩, 王崇杰, 罗健, 罗征秀. 儿童气管支气管结核的临床及支气管镜下特征分析[J]. 中国当代儿科杂志. 2023, 25(4): 381-387 https://doi.org/10.7499/j.issn.1008-8830.2210116

PENG Shuai, ZHANG Guang-Li, HONG Jing-Xian, DING Hao, WANG Chong-Jie, LUO Jian, LUO Zheng-Xiu. Clinical and bronchoscopy features of tracheobronchial tuberculosis in children[J]. Chinese Journal of Contemporary Pediatrics. 2023, 25(4): 381-387 https://doi.org/10.7499/j.issn.1008-8830.2210116

参考文献

1 中华医学会结核病学分会儿童结核病专业委员会, 中国研究型医院学会结核病学专业委员会, 国家呼吸系统疾病临床医学研究中心, 等. 儿童肺结核诊断专家共识[J]. 中华实用儿科临床杂志, 2022, 37(7): 490-496. DOI: 10.3760/cma.j.cn101070-20211207-01436.
2 Jiao AX, Sun L, Liu F, et al. Characteristics and clinical role of bronchoscopy in diagnosis of childhood endobronchial tuberculosis[J]. World J Pediatr, 2017, 13(6): 599-603. PMID: 28623556. DOI: 10.1007/s12519-017-0046-1.
3 祁雪, 彭小姗, 郭琰, 等. 支气管肺泡灌洗液Xpert MTB/RIF检测对儿童肺结核诊断准确性研究[J]. 中国循证儿科杂志, 2019, 14(6): 418-421. DOI: 10.3969/j.issn.1673-5501.2019.06.004.
4 Peng AZ, Yang A, Li SJ, et al. Incidence, laboratory diagnosis and predictors of tracheobronchial tuberculosis in patients with pulmonary tuberculosis in Chongqing, China[J]. Exp Ther Med, 2020, 20(6): 174. PMID: 33093909. PMCID: PMC7571346. DOI: 10.3892/etm.2020.9304.
5 Jung SS, Park HS, Kim JO, et al. Incidence and clinical predictors of endobronchial tuberculosis in patients with pulmonary tuberculosis[J]. Respirology, 2015, 20(3): 488-495. PMID: 25620110. PMCID: PMC4409824. DOI: 10.1111/resp.12474.
6 Hanaoka J, Ohuchi M, Kaku R, et al. Bronchoscopic balloon dilatation combined with laser cauterization of high and long segmental tracheal stenosis secondary to endobronchial tuberculosis: a case report[J]. Respir Med Case Rep, 2019, 28: 100917. PMID: 31388485. PMCID: PMC6677927. DOI: 10.1016/j.rmcr.2019.100917.
7 Yaguchi D, Ichikawa M, Shizu M, et al. Bronchoscopic local steroid spray to prevent bronchial tuberculosis-induced cicatricial bronchial stenosis: a case series[J]. Medicine (Baltimore), 2018, 97(28): e11464. PMID: 29995804. PMCID: PMC6076191. DOI: 10.1097/MD.0000000000011464.
8 中华医学会结核病学分会,《中华结核和呼吸杂志》编辑委员会. 气管支气管结核诊断和治疗指南(试行)[J]. 中华结核和呼吸杂志, 2012, 35(8): 581-587. DOI: 10.3760/cma.j.issn.1001-0939.2012.08.007.
9 丁卫民, 唐神结, 傅瑜. 重视气管支气管结核的早期正确分型分期诊断[J]. 中华结核和呼吸杂志, 2021, 44(3): 167-169. PMID: 33721931. DOI: 10.3760/cma.j.cn112147-20210110-00036.
10 Jin F, Mu D, Xie Y, et al. Application of bronchoscopic argon plasma coagulation in the treatment of tumorous endobronchial tuberculosis: historical controlled trial[J]. J Thorac Cardiovasc Surg, 2013, 145(6): 1650-1653. PMID: 22999589. DOI: 10.1016/j.jtcvs.2012.08.042.
11 World Health 0rganization. Global tuberculosis report 2021[EB/OL]. [2021-10-14]. https://www.who.int/publications/digital/global-tuberculosis-report-2021.
12 卢春容, 房宏霞, 陆普选, 等. WHO 2021年全球结核病报告: 全球与中国关键数据分析[J]. 新发传染病电子杂志, 2021, 6(4): 368-372. DOI: 10.19871/j.cnki.xfcrbzz.2021.04.023.
13 刘芳, 申晨, 孙琳, 等. 儿童气管支气管结核临床和支气管镜下的表现特征[J]. 中国防痨杂志, 2018, 40(9): 917-923. DOI: 10.3969/j.issn.1000-6621.2018.09.003.
14 Thomas TA. Tuberculosis in children[J]. Pediatr Clin North Am, 2017, 64(4): 893-909. PMID: 28734517. PMCID: PMC5555046. DOI: 10.1016/j.pcl.2017.03.010.
15 陈晴, 吴桂辉, 黄涛, 等. 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[J]. 中国全科医学, 2022, 25(8): 930-936. DOI: 10.12114/j.issn.1007-9572.2022.01.601.
16 宾松涛, 王继, 谭力, 等. 11例儿童气管支气管结核支气管镜诊断与介入治疗效果观察[J]. 中国防痨杂志, 2020, 42(5): 523-526. DOI: 10.3969/j.issn.1000-6621.2020.05.019.
17 刘家起, 姜婧, 王亮, 等. 2008-2017年全国肺结核发病的时空分布特征分析[J]. 现代预防医学, 2020, 47(19): 3461-3464.
18 陈卉, 夏愔愔, 张灿有, 等. 2014-2018年全国学生肺结核疫情变化趋势及特征分析[J]. 中国防痨杂志, 2019, 41(6): 662-668. DOI: 10.3969/j.issn.1000-6621.2019.06.013.
19 Zhao L, Guan R, Yu H, et al. Endobronchial anthracofibrosis: possibly a new indication of aggressive treatment for active endobronchial tuberculosis[J]. J Thorac Dis, 2018, 10(7): E511-E515. PMID: 30174922. PMCID: PMC6105961. DOI: 10.21037/jtd.2018.07.03.
20 宋永春. 气管支气管结核的临床特点及危险因素分析[D]. 郑州: 郑州大学, 2019.
21 张慧珊, 陈熙泼, 叶乐平, 等. 经支气管镜冷冻介入在儿童气管支气管结核诊疗中的临床应用[J]. 中华儿科杂志, 2021, 59(11): 963-967. PMID: 34711032. DOI: 10.3760/cma.j.cn112140-20210504-00378.
22 胡静. 支气管镜介入治疗25例儿童支气管结核临床分析[D]. 重庆: 重庆医科大学, 2019.
23 胡春梅, 尹春阳, 顾小燕, 等. 15例儿童支气管结核的误诊分析[J]. 国际呼吸杂志, 2018, 38(6): 428-430. DOI: 10.3760/cma.j.issn.1673-436X.2018.06.006.
24 次仁公布, 杨元琴, 玉珍. 高原地区儿童支气管结核54例支气管镜下诊断及治疗分析[J]. 世界最新医学信息文摘(连续型电子期刊), 2019, 19(33): 90-91. DOI: 10.19613/j.cnki.1671-3141.2019.33.055.
25 刘芳, 焦安夏. 儿童气管支气管结核诊疗现状[J]. 中华实用儿科临床杂志, 2020, 35(10): 743-748. DOI: 10.3760/cma.j.cn101070-20200224-00230.
26 刘芳, 饶小春, 马渝燕, 等. 252例儿童气管支气管结核分型探讨[J]. 中华结核和呼吸杂志, 2022, 45(3): 282-288. PMID: 35279992. DOI: 10.3760/cma.j.cn112147-20210624-00444.
27 焦伟伟, 孙琳, 肖婧, 等. 国家结核病规划指南——儿童结核病管理(第2版)[J]. 中国循证儿科杂志, 2016, 11(1): 65-74. DOI: 10.3969/j.issn.1673-5501.2016.01.016.
28 任红梅, 王影, 杨雪, 等. 儿童支气管结核的临床特点[J]. 中国中西医结合儿科学, 2016, 8(4): 411-413, 414. DOI: 10.3969/j.issn.1674-3865.2016.04.013.
29 刘芳, 饶小春, 马渝燕, 等. 经支气管镜介入治疗儿童淋巴结瘘型气管支气管结核有效性评价[J]. 中国防痨杂志, 2021, 43(8): 826-831. DOI: 10.3969/j.issn.1000-6621.2021.08.014.
30 楼巧勤, 祝春亚, 周华, 等. 35例气管支气管结核临床、影像和气管镜下表现[J]. 中国感染与化疗杂志, 2018, 18(5): 486-489. DOI: 10.16718/j.1009-7708.2018.05.008.
31 Su Z, Cheng Y, Wu Z, et al. Incidence and predictors of tracheobronchial tuberculosis in pulmonary tuberculosis: a multicentre, large-scale and prospective study in southern China[J]. Respiration, 2019, 97(2): 153-159. PMID: 30205411. DOI: 10.1159/000492335.
32 Kashyap S, Solanki A. Challenges in endobronchial tuberculosis: from diagnosis to management[J]. Pulm Med. 2014, 2014: 594806. PMID: 25197570. PMCID: PMC4147266. DOI: 10.1155/2014/594806.