| Objective:The clinical characteristics of tuberculous pleurisy in children and the influencing factors of pleural tuberculoma are analyzed to reduce the misdiagnosis rate,missed diagnosis rate and disability rate of tuberculous pleurisy and pleural tuberculoma,and improve the level of diagnosis and treatment.Methods:Retrospectively analyze the clinical data of 92 children hospitalized and diagnosed with tuberculous pleurisy in the affiliated Changsha Central Hospital,Hengyang Medical School,University of South China from January 2017 to March 2021,of which 36 cas es developed pleural tuberculoma.All children’s clinical manifestations,laboratory tests,pathology and imaging data were collected and statistically analyzed.Results:1.General data: 56 boys and 36 girls were 92 children with tuberculous pleurisy,74 in rural areas and 18 in urban areas,and the median age was 10.0(7.3,13.8)years.There were 83 cases with a history of BCG vaccination,34 cases with a history of close contact with tuberculosis,and 16 cases with extrapulmonar y tuberculosis.The main symptoms were 23 cases of fever,21 cases of cough,10 cases of chest pain,and 5 cases of no clinical symptoms.Pleural tuberculoma developed in 36 children.2.Laboratory data: All children underwent rapid culture of Mycobacterium sputum tuberculosis,and 8 cases were positive.82 cases underwent tuberculin skin tests,and 53 cases were positive.87 cases of T-SPOT.TB test,82 cases of positive.79 patients had alveolar lavage fluid Gene Xpert MTB/RIF,and 23 patients were positive.74 cases had pleural effusion Mycobacterium tuberculosis DNA test,and 16 cases were positive.75 cases were rapidly cultured with Mycobacterium tuberculosis in pleural effusion,and 17 cases were positive.3.Imaging data: all children underwent chest ul trasound,and 46 cases of pleural effusion were net-separated and wrapped.85 patients were followed up with pulmonary CT to show pleural thickening,and chest CT scans of 36 children with pleural tuberculoma showed typical manifestations of tuberculosis,with 30 single lesions and 6multiple lesions,22 cases with lesions on the right side,12 cases on the left side,and 2 cases on both sides.4.Histopathology and molecular biology data: 13 pediatric pathological reports suggest microscopic granuloma form ation,coagulant necrosis,or caseous necrosis,consistent with tuberculosis degeneration.Six cases of nodule polymerase chain reaction tested positive.5.Treatment: All children had isoniazid + rifampicin +pyrazinamide as the core anti-TB regimen(> 13 years of age with ethambutol).In the end,81 cases were cured by internal medicine,9cases were treated surgically,and 2 cases were under treatment.6.Risk factor analysis: The results of univariate analysis showed that chest CT suggested pleural hy pertrophy,color Doppler ultrasound suggested pleural fluid encapsulation,and separation were risk factors for the development of tuberculous tuberculoma(P<0.05).The risk factors were further analyzed by logistic stepwise regression analysis,and the res ults showed that chest CT suggested pleural hypertrophy,and color Doppler ultrasound suggested that pleural fluid separation and wrapping were not independent risk factors for pleural tuberculoma formation.Conclusion:Pleural tuberculosis in children oc curs within 3 months of anti-tuberculosis treatment for tuberculous pleurisy in older boys,and chest CT is conducive to the detection of pleural tuberculosis,and most of the children are cured by medical treatment.Color Doppler ultrasound suggests pleur al fluid separation and wrapping,and chest CT suggests that pleural hypertrophy is a risk factor for pleural tuberculoma formation,but is not an independent risk factor. |
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