关键词: 儿童, 再治疗, 结核, 疾病特征

Abstract:

To explore the clinical characteristics of children with retreated tuberculosis, we enrolled 41 children with retreatment drug-sensitive tuberculosis who were admitted to the Tuberculosis Department of Shanghai Public Health Clinical Center from January 2015 to June 2021 as the research objects. Data of their basic characteristics (sex, age), clinical diagnosis and classification, reasons for retreatment, chest CT manifestations of tuberculosis, treatment and prognosis were collected and analyzed. The results showed that among the 41 children, pulmonary tuberculosis accounted for 58.5% (24/41), and extrapulmonary tuberculosis accounted for 41.5% (17/41). Among extrapulmonary tuberculosis, lymph node tuberculosis accounted for 41.2% (7/17), tuberculous meningitis accounted for 29.4% (5/17). The percentage of children who were defaulters, relapsed, and treatment failure were 58.5% (24/41), 31.7% (13/41), and 9.8% (4/41), respectively. Besides, 18 (75.0%) of the defaulters were caused by adverse drug reactions. Among all the 24 pulmonary tuberculosis patients who had chest CT, 12 (50.0%) patients showed unilateral lung lesions without cavities, 9 (37.5%) showed bilateral lung lesions, 2 (8.3%) showed unilateral plural effusion with pleural thickening,and 1 (4.2%) showed cavities. The retreatment regimen of 23 (56.1%) relapsed children was 3H-R-Z-E/9-15H-R-E or 3H-R-Z/9-15H-R-E (H: isoniazid, R: rifampicin, Z: pyrazinamide, E: ethambutol). While the remaining 18 (43.9%) cases were treated with non-standardized regimes. After follow-up, 35 cases (85.4%) completed the treatment and cured, 2 (4.8%) were still taking medicines with stable condition, and 4 (9.8%) were lost to follow-up. In summary, among children with retreatment drug-sensitive tuberculosis, pulmonary tuberculosis and defaulters are more common, unilateral lung non-cavitary lesions are more common in chest CT, and the overall prognosis is good. However, attention should be paid to the follow-up of children, especially those with adverse drug reactions during initial treatment.

Key words: Child, Retreatment, Tuberculosis, Disease attributes