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1、Tuberculosis,The 2nd Xiangya Hospital, CSU,Nov. 2, 2010,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 Infection,Children with asymptomatic tuberculous infection,reac
2、tive tuberculin skin testnormal chest radiographnormal physical examination,Primary 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 Tuberculosis,The
3、 manifestation of TB in children are variableOnset of TB, chronic & hidingAsymptom cases 80%Upper respiratory tract infectionToxic symptoms of tuberculous infectionMalnutrition,临床表现-manifestation,The manifestation of TB in children are variableHypersensitivity erythema nodosum/皮肤结节性红斑phlyctenular co
4、njunctivitis /疱疹性眼结膜炎arthritis /关节炎On occasion, the onset of TB, abruptLung symptomsasthmatic breathing, cough, etc.,临床表现-manifestation,Diagnosis,Case History/Physical ExaminationEtiology diagnosisPathology diagnosisImmunology examination Chest X-ray examinationFibrobronchoscope examination,Case His
5、tory,Toxic symptoms of tuberculous 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 History,Toxic symptoms of tuberculous infectionmild fever / 低热night sweat / 盗汗 fatigue / 乏力poor appetite / 食欲减退weight lo
6、ss / 消瘦,Case History,History of contact with pulmonary patientsopen active pulmonary TB patient,Case History,History of BCG vaccination,History of BCG vaccinationCheck the scar of BCG / 卡痕,Case History,Past illness history,TBmeasles / 麻疹chickenpox / 水痘etc.,Superficial lymph node swell Lung signs 多无明
7、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,Etiology diagnosis Culture &/or smear of samples for tubercle bacilli gastric washing or induced sputum结核菌检查（查痰液、胃液等）,Diagnosis,Diagnosis,Diagnosis,Pathology diagnosisLymph Nodes punctureTissue BiopsyFibrobronchoscope,Diagnosis,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
8、在Langerhans巨细胞,Diagnosis,Immunological 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
9、lymphangitis/淋巴管炎regional tuberculous 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 Lymphonodus,Diagnosis,Bio-Molecular TechniquePCR, Poly
10、merase Chain Reaction Southern BlotNorthern 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 tuberculosis 2HRZ/4HR or 9HR,结核感染治疗（推荐）3个月INH+RFP2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 提倡直接督导下服药（DOTS）,原发性肺结核治疗的注意点,结核病的早期诊断最为重要 结核病的规范化治疗非常重要,TB is a chronic contagious disease caused by tubercle bacilli.,Thank you !,The end,The 2nd Xiangya Hospital, CSU,
