肺结核Tuberculosis解析

1、肺结核Tuberculosis解析病因清楚-结核杆菌治 有办法-抗结核药物防 有措施-BCG讲授内容 两类结核病 潜伏结核感染 原发性肺结核 儿童结核病的临床表现 辅助诊断方法 结核病的治疗由结核菌感染引起的结核菌素试验阳性（除 外卡介苗接种后反应），X线胸片或临床无 活动性结核病证据者，称为潜伏结核感染有结核感染的依据，但没有明确的结核病灶潜伏结核感染Latent Tuberculosis InfectionChildren with asymptomatic tuberculous infection reactive tuberculin skin test normal chest r

2、adiograph normal physical examinationPrimary pulmonary tuberculosis is the major type of pulmonary tuberculosis developed in children during initial infection原发型肺结核是指结核菌初次侵入肺部后发生的原发感染原发型肺结核是小儿肺结核的主要类型，占儿童各型肺结核总数的85.3%原发型肺结核Primary Pulmonary TuberculosisThe manifestation of TB in children are variabl

3、e Onset of TB, chronic & hiding Asymptom cases 80% Upper respiratory tract infection Toxic symptoms of tuberculous infection Malnutrition临床表现-manifestationThe manifestation of TB in children are variable Hypersensitivity erythema nodosum/皮肤结节性红斑 phlyctenular conjunctivitis /疱疹性眼结膜炎 arthritis /关节炎 On

4、 occasion, the onset of TB, abrupt Lung symptoms asthmatic breathing, cough, etc.临床表现-manifestationDiagnosis Case History/Physical Examination Etiology diagnosis Pathology diagnosis Immunology examination Chest X-ray examination Fibrobronchoscope examinationCase HistoryToxic symptoms of tuberculous

5、infection 结核中毒症状History of contact with pulmonary patients 结核接触史History of BCG vaccination 卡介苗接种史History of other infection illness 既往病史 Case HistoryToxic symptoms of tuberculous infection mild fever / 低热 night sweat / 盗汗 fatigue / 乏力 poor appetite / 食欲减退 weight loss / 消瘦Case HistoryHistory of conta

6、ct with pulmonary patients open active pulmonary TB patient Case History History of BCG vaccination History of BCG vaccination Check the scar of BCG / 卡痕Case HistoryPast illness history TB measles / 麻疹 chickenpox / 水痘 etc. Superficial lymph node swell Lung signs 多无明显体征 叩诊可为浊音 听诊呼吸音减低 听诊少许湿罗音PE-Signs

7、Etiology diagnosisCulture &/or smear of samples for tubercle bacilli gastric washing or induced sputum 结核菌检查 （查痰液、胃液等）DiagnosisDiagnosisDiagnosisPathology diagnosis Lymph Nodes puncture Tissue Biopsy FibrobronchoscopeDiagnosis 结核性肉芽肿结核特征性病变：中央为干酪样坏死，周围为增生的上皮样细胞，其内散在Langerhans巨细胞Diagnosis Immunologic

8、al diagnosis Tuberculin Skin Test (PPD or OT test)/ 结核菌素试验 ELISA（PPD-IgM、IgG）结核菌素接种后，多长时间观察结果？接触结核后，多长时间结素试验出现反应？Diagnosis Chest Roentgenography (Chest X-ray) Diagnosis Chest X-ray Primary Complex (原发综合征) primary focus at the site of implantation/原发病灶 tuberculous lymphangitis/淋巴管炎 regional tuberculo

9、us lymphadenopathy/淋巴结炎 呈典型“哑铃状双极影”Diagnosis Chest X-ray 原发综合征：哑铃状双极影Diagnosis Chest X-ray Tuberculosis of Tracheobronchial Lymphonodus 支气管淋巴结结核表现为：肺门影增浓Diagnosis Chest X-ray Tuberculosis of Tracheobronchial LymphonodusDiagnosis Bio-Molecular Technique PCR, Polymerase Chain Reaction Southern Blot No

10、rthern Blot无细菌培养条件下小儿肺结核的诊断标准 有与成人结核、尤其开放结核接触史； 持续两周以上的咳嗽，抗生素治疗无效； 结素试验阳性：无卡介苗接种史者10mm 有卡介苗接种史者15mm符合肺结核诊断的X线征象；抗结核治疗有效（两个月后体重增加10%以上， 症状好转）。 -具有以上两点或两点以上条件（供参考）Treatment 治 疗DOTS Directly Observed Treatment, Short-course直接督导下的短程化疗DOTS for primary pulmonary tuberculosis2HRZ/4HR or 9HR 结核感染治疗（推荐） 3个月INH+RFP 2个月INH+RFP+EMB最坏的治疗是单一用药标准化疗方案：2HRZ/4HR推荐日剂量顿服提倡直接督导