泌尿生殖道结核多发于0 - 14岁儿童结构中的其他部位结核

I. V. Drozdetskaya, A. Mordyk, N. I. Porkulevich
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At the first stage, the structure of clinical forms of TB was assessed in 2306 children. Three comparison groups were formed following ten-year periods. At the second stage, 4 groups were identified according to age: early age, preschool age, primary school age, prepubertal age. The data obtained in the course of the study were statistically processed using the Microsoft Office 2007 (Microsoft Corp., USA) and Biostat 2009 (AnalystSoft Inc., USA) software package. The differences between the groups were determined using the χ2 test, and significant differences were considered when the value of the p < 0.05 criterion.Results. It was found that throughout the entire observation period in the region, the predominant localization of the specific process was respiratory TB. The proportion of isolated extrapulmonary lesions in children decreased from 11.1% in the period from 1999 to 2008 to 3.4% in the period from 2009 to 2018 (p = 0.000). At the same time, the most frequent localization (60.4 - 77.8% of cases) among EPTB remains urinary TB. In the dynamics from 1989 to 2018, the number of cases of the disease with combined forms of tuberculosis increased (from 3.1% to 7.2%; p = 0.000), mainly due to the establishment of several localizations of the lesion. The frequency of bacteriological confirmation of the diagnosis was significantly different at various localizations of the specific process. In children of the compared periods of childhood, the predominant localization of the specific process was isolated respiratory TB. The isolated extrapulmonary process localizations were more common in the age groups 7 - 11 and 12 - 14 yo, where it accounted for 10.8 - 12.4% of TB cases (p = 0.000). The localization of the EPTB also depended on the children's age. So, young children often developed damage to the osteoarticular system, in preschool children - the genitourinary and lymphatic (peripheral lymphadenopathy) systems, in younger schoolchildren and preschoolers - the genitourinary system. The frequency of bacteriological confirmation of the EPTB increased with the age. The combined forms of a specific process were more often observed in the age group of 7 - 11 yo, in the other groups their share was 77.4%, 87.1%, and 95.0% of cases. Respiratory TB and TB of other organs was confirmed bacteriologically more often in the age group 7 - 11 yo (19.4%), and in the group 12 - 14 yo in 12.9%, 4 - 6 yo in 10.0%, early age in 9.7%, which is much more frequent than confirmation of isolated respiratory TB.Conclusions. EPTB in children has not lost its position and due to the widespread introduction of the recombinant TB allergen and CT into clinical practice. It has become more often detected in combination with respiratory TB. 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引用次数: 0

摘要

介绍。肺外结核(EPTB)仍有许多特点:不同国家对其定义的方法不同,没有筛查,诊断极其困难并需要财政费用,细菌学验证不超过46%,治疗中使用复杂的修复和重建手术。孤立性肺外定位在肺结核患者中的比例较低。研究目的:目的:研究目前情况下EPTB加重儿童结核(TB)的结构,确定预防和诊断措施的发展领域。材料和方法。在1989年至2018年期间,对0 - 14岁住院儿童进行了回顾性两阶段研究。在第一阶段,对2306名儿童的结核病临床形态结构进行了评估。每隔十年形成三个比较组。第二阶段按年龄分为4组:幼儿、学龄前、小学、青春期前。研究过程中获得的数据使用Microsoft Office 2007 (Microsoft Corp., USA)和Biostat 2009 (AnalystSoft Inc., USA)软件包进行统计处理。各组间差异采用χ2检验,以p < 0.05为差异有统计学意义。结果发现,在整个观察期,该地区的特定过程的主要定位是呼吸道结核。儿童孤立性肺外病变比例从1999 - 2008年的11.1%下降到2009 - 2018年的3.4% (p = 0.000)。同时,EPTB中最常见的定位仍然是尿路结核(60.4 ~ 77.8%)。在1989年至2018年的动态中,该疾病合并结核病的病例数有所增加(从3.1%增加到7.2%;P = 0.000),主要是由于建立了病变的几个定位。在特定过程的不同部位,细菌学确诊的频率有显著差异。在儿童的比较时期,主要定位的具体过程是孤立的呼吸道结核。孤立性肺外过程定位在7 ~ 11岁和12 ~ 14岁年龄组更为常见,占结核病例的10.8 ~ 12.4% (p = 0.000)。EPTB的定位也与儿童的年龄有关。因此,年幼的儿童通常会对骨关节系统造成损害,学龄前儿童会对泌尿生殖系统和淋巴系统(外周淋巴结病)造成损害,学龄儿童和学龄前儿童会对泌尿生殖系统造成损害。细菌学证实EPTB的频率随年龄增加而增加。某一特定过程的合并形式多见于7 - 11岁年龄组,其余年龄组分别为77.4%、87.1%和95.0%。呼吸道结核及其他器官结核细菌学确诊以7 ~ 11岁年龄组(19.4%)多见,12 ~ 14岁年龄组(12.9%)、4 ~ 6岁年龄组(10.0%)、早期年龄组(9.7%)多见,远高于单纯呼吸道结核确诊。由于重组结核过敏原和CT广泛引入临床实践,儿童EPTB并没有失去其地位。它更常与呼吸道结核合并发现。在EPTB中,泌尿生殖系统结核占多数,这可以与其他器官的损害相比加以证实。提高儿科医生和儿科医生对EPTB发生频率的认识水平,就有可能对其发展的可能性形成警觉性,并在早期阶段及时发现疾病。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Urogenital tuberculosis in children 0 - 14 years old in the structure of other localizations of tuberculosis
Introduction. Extrapulmonary tuberculosis (EPTB) still has many features: there is a different approach to its definition in different countries, there is no screening, diagnosis is extremely difficult and requires financial costs, and bacteriological verification does not exceed 46%, complex restorative and reconstructive operations are used in treatment. the proportion of patients with isolated extrapulmonary localizations among tuberculosis patients is low.Purpose of the study. To study the structure of tuberculosis (TB) in children with the accentuation of EPTB in the current conditions to determine the development areas of preventive and diagnostic measures.Materials and methods. A retrospective two-stage study was carried out in the period from 1989 to 2018 among in-patient children aged 0 - 14 yrs. At the first stage, the structure of clinical forms of TB was assessed in 2306 children. Three comparison groups were formed following ten-year periods. At the second stage, 4 groups were identified according to age: early age, preschool age, primary school age, prepubertal age. The data obtained in the course of the study were statistically processed using the Microsoft Office 2007 (Microsoft Corp., USA) and Biostat 2009 (AnalystSoft Inc., USA) software package. The differences between the groups were determined using the χ2 test, and significant differences were considered when the value of the p < 0.05 criterion.Results. It was found that throughout the entire observation period in the region, the predominant localization of the specific process was respiratory TB. The proportion of isolated extrapulmonary lesions in children decreased from 11.1% in the period from 1999 to 2008 to 3.4% in the period from 2009 to 2018 (p = 0.000). At the same time, the most frequent localization (60.4 - 77.8% of cases) among EPTB remains urinary TB. In the dynamics from 1989 to 2018, the number of cases of the disease with combined forms of tuberculosis increased (from 3.1% to 7.2%; p = 0.000), mainly due to the establishment of several localizations of the lesion. The frequency of bacteriological confirmation of the diagnosis was significantly different at various localizations of the specific process. In children of the compared periods of childhood, the predominant localization of the specific process was isolated respiratory TB. The isolated extrapulmonary process localizations were more common in the age groups 7 - 11 and 12 - 14 yo, where it accounted for 10.8 - 12.4% of TB cases (p = 0.000). The localization of the EPTB also depended on the children's age. So, young children often developed damage to the osteoarticular system, in preschool children - the genitourinary and lymphatic (peripheral lymphadenopathy) systems, in younger schoolchildren and preschoolers - the genitourinary system. The frequency of bacteriological confirmation of the EPTB increased with the age. The combined forms of a specific process were more often observed in the age group of 7 - 11 yo, in the other groups their share was 77.4%, 87.1%, and 95.0% of cases. Respiratory TB and TB of other organs was confirmed bacteriologically more often in the age group 7 - 11 yo (19.4%), and in the group 12 - 14 yo in 12.9%, 4 - 6 yo in 10.0%, early age in 9.7%, which is much more frequent than confirmation of isolated respiratory TB.Conclusions. EPTB in children has not lost its position and due to the widespread introduction of the recombinant TB allergen and CT into clinical practice. It has become more often detected in combination with respiratory TB. Among the EPTB, genitourinary tuberculosis prevailed, which can be verified in contrast to damage to other organs. Raising the level of awareness of paediatricians and phthisiatrician-paediatricians about the frequency of EPTB occurrence makes it possible to form alertness in terms of the possibility of their development and to timely detect the disease at an early stage.
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