关键词: 儿童, 结核, 支气管疾病, 支气管镜检查, 疾病特征

Abstract:

Objective We analyzed the associated clinical factors and bronchoscopic characteristics of children with Tracheobronchial tuberculosis (TBTB) to provide clues for the early diagnosis of tracheobronchial tuberculosis.Methods We retrospectively analyzed 240 cases of tuberculosis patients who had gone through bronchoscopy and been hospitalized in Beijing Children’s Hospital, Capital Medical University between July 2006 and December 2014. In the end, 130 cases of TBTB (“TBTB group”) and 110 cases of non-TBTB tuberculosis (“non-TBTB group”) were confirmed according to the results of bronchoscopy. The general information, clinical symptoms, imaging features, and characteristics under bronchoscopy of the two groups were analyzed and compared. We used SPSS 22.0 statistical software for a Chi-square test and Spearman rank correlation test, with statistical significance of P<0.05. Results The median age of the TBTB group (1.6 years old (Quartile: 0.8 years old, 5.5 years old)) was significantly lower than the non-TBTB group (4.5 years old (Quartile: 1.1 years old, 10.1 years old)) (U=5309.500,P=0.001). The proportion of children younger than 2 years old in the TBTB group (75 cases, 57.7%) was significantly higher than in the non-TBTB group (38 cases, 34.5%) (χ²=12.813, P=0.000). The incidence of wheezing and tachypnea in the TBTB group (23.1%, 30/130) was significantly higher than non-TBTB group (5.5%, 6/110) (χ²=14.513, P=0.000). The positive rate of Mycobacterium tuberculosis culture in the TBTB group(21.5%, 28/130)was significantly higher than non-TBTB group(7.3%, 8/110) (χ²=9.510, P=0.002). Among the TBTB group, 22.3% (29/130) had airway obstruction on chest CT, which was significantly higher than non-TBTB group (4.5%, 5/110) (χ²=15.460, P=0.000). Results from the bronchoscopy showed that lymph node erosion (LNE) happened in 95.4% (124/130) of the TBTB group, and caseous pneumonia erosion (CPE) happened in 6.2% (8/130) of the TBTB group. At the first bronchoscopy, 77.7% (101/130) of the TBTB group was in the burst stage of LNE, and 17.7% (23/130) were in the early stage of LNE. The most common sites of TBTB were in the right main bronchus (33 cases), the middle right bronchus (32 cases) and the right upper lobe bronchus (30 cases). The median age of single bronchus involved (2.2 years old (Quartile: 1.0 years old, 6.1 years old)) was significantly higher than the median age of those with multi-bronchus involved (1.0 years old (Quartile: 0.5 years old, 1.8 years old)) in the TBTB group (U=1176.500,P=0.002).The number of bronchial involvement showed a negative correlation (Pearson correlation coefficien t=-0.222, P=0.001) with the ages of the children.Conclusion TBTB is highly suspected in children with pulmonary tuberculosis with wheezing and tachypnea, with chest images indicating obstructed ventilation. Bronchoscopy needs to be operated as early as possible to confirm the diagnosis.

Key words: Child, Tuberculosis, Bronchial diseases, Bronchoscopy, Disease attributes