Mancuso James D, Mody Rupal M, Olsen Cara H, Harrison Lee H, Santosham Mathuram, Aronson Naomi E
Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.
Department of Medicine, William Beaumont Army Medical Center, El Paso, TX.
Chest. 2017 Aug;152(2):282-294. doi: 10.1016/j.chest.2017.01.001. Epub 2017 Jan 10.
Bacille Calmette-Guérin (BCG) vaccination is known to cause false-positive tuberculin skin test (TST) results from cross-reactions with mycobacterial antigens. However, the duration of BCG vaccination influence on the TST is poorly characterized. The objective of this study was to assess the long-term effect of BCG vaccination on TST reactivity.
Data on TST reactivity were prospectively collected during 1935 to 1947 as part of a clinical trial among Native Americans/Alaskan Natives and were retrospectively collected thereafter between 1948 and 1998. TST induration of ≥ 10 mm was defined as a positive reaction. Kaplan-Meier analysis and multivariate Cox regression were used to compare the time to TST conversion and reversion between the BCG and placebo groups.
BCG vaccination after infancy was associated with an increased risk of TST reactivity in the first 15 years after vaccination (adjusted hazard ratio [HR], 2.33). This association remained during the interval 16 to 55 years after vaccination, although the effect was attenuated (adjusted HR, 1.26). Age at vaccination modestly impacted the effect of BCG on TST results in the first 15 years. Positive TST results among the BCG-vaccinated group were more likely to revert to negative results during the first 15 years but not in the latter period.
This study provides evidence that BCG vaccination after infancy may influence TST results beyond the 10-year period conventionally accepted by the Centers for Disease Control and Prevention (CDC), extending up to 55 years after vaccination. This suggests that BCG vaccination should be taken into account when interpreting TST results regardless of the time elapsed since vaccination.
已知卡介苗（BCG）接种会因与分枝杆菌抗原的交叉反应导致结核菌素皮肤试验（TST）结果出现假阳性。然而，卡介苗接种对TST的影响持续时间却鲜有描述。本研究的目的是评估卡介苗接种对TST反应性的长期影响。
作为一项针对美洲原住民/阿拉斯加原住民的临床试验的一部分，于1935年至1947年前瞻性收集TST反应性数据，之后于1948年至1998年进行回顾性收集。TST硬结≥10mm被定义为阳性反应。采用Kaplan-Meier分析和多变量Cox回归比较卡介苗组和安慰剂组TST转换和逆转的时间。
婴儿期后接种卡介苗与接种后前15年TST反应性风险增加相关（调整后风险比[HR]，2.33）。尽管这种关联在接种后16至55年期间有所减弱（调整后HR，1.26），但依然存在。接种时的年龄对卡介苗在前15年对TST结果的影响有一定程度的影响。卡介苗接种组的TST阳性结果在最初15年内更有可能转为阴性结果，但在后期则不然。
本研究提供的证据表明，婴儿期后接种卡介苗可能会在疾病控制与预防中心（CDC）传统认可的10年期限之后仍影响TST结果，可延长至接种后55年。这表明在解释TST结果时应考虑卡介苗接种情况，无论自接种后已过去多长时间。
