儿童结核病和卡介苗（BCG）相关不良反应的临床特征：一项为期 12 年的研究。
Clinical features of tuberculosis and Bacillus Calmette-Guérin (BCG) -associated adverse effects in children: A 12-year study.
机构信息
Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
出版信息
J Formos Med Assoc. 2021 Jan;120(1 Pt 2):443-451. doi: 10.1016/j.jfma.2020.06.012. Epub 2020 Jun 15.
PURPOSE
To investigate the clinical feature of tuberculosis and BCG adverse effects in children and to examine whether delayed BCG vaccination changes the incidence of BCG osteomyelitis.
METHODS
We analyzed patients younger than 18 years with tuberculosis or BCG-associated adverse effects from 2008 to 2019. We compared their clinical features, laboratory tests and outcomes.
RESULTS
Totally 137 patients were collected, with 27% of pulmonary tuberculosis (PTB), 31% of extrapulmonary tuberculosis (EPTB) and 42% of BCG-associated adverse effects. The median age was older in PTB than EPTB group (17.1 vs 15.4 years; p = 0.015). More patients in EPTB group had fever than PTB group (55% vs 25%; p = 0.008). Compared with exclusively EPTB, more patients in EPTB plus PTB group had fever (78% vs 38%; p = 0.009), and had more systemic symptoms (67% vs 25%; p = 0.007), lower absolute lymphocyte count (1230 vs 1850/μL; p = 0.033), higher CRP level (5.62 vs 2.21 mg/dL; p = 0.024) and longer hospital stay (20 vs 11 days; p = 0.031). In BCG osteomyelitis group, the median time interval from vaccination to diagnosis was 16.4 months (IQR 15.0-20.2). Age at vaccination, either at birth or 5-8 month-old, did not affect the proportion of BCG osteomyelitis among children with BCG-associated adverse effects.
CONCLUSION
Children with EPTB plus PTB had more fever, lower lymphocyte count and higher CRP. The median time interval from vaccination to diagnosis of BCG osteomyelitis was 16.4 months and the proportion of BCG osteomyelitis among children with BCG-associated adverse effects was not affected by delayed vaccination in this study.
目的
探讨儿童结核病和卡介苗不良反应的临床特征，并探讨延迟接种卡介苗是否会改变卡介苗骨髓炎的发病率。
方法
我们分析了 2008 年至 2019 年期间年龄小于 18 岁的患有结核病或卡介苗相关不良反应的患者。我们比较了他们的临床特征、实验室检查和结果。
结果
共收集了 137 例患者，其中肺结核（PTB）占 27%，肺外结核（EPTB）占 31%，卡介苗相关不良反应占 42%。PTB 组的中位年龄大于 EPTB 组（17.1 岁比 15.4 岁；p=0.015）。EPTB 组发热患者多于 PTB 组（55%比 25%；p=0.008）。与单纯 EPTB 相比，EPTB 加 PTB 组发热患者更多（78%比 38%；p=0.009），全身症状更多（67%比 25%；p=0.007），绝对淋巴细胞计数更低（1230 比 1850/μL；p=0.033），C 反应蛋白水平更高（5.62 比 2.21mg/dL；p=0.024），住院时间更长（20 比 11 天；p=0.031）。在卡介苗骨髓炎组中，从接种到诊断的中位时间间隔为 16.4 个月（IQR 15.0-20.2）。接种时的年龄（出生时或 5-8 个月）并不影响卡介苗相关不良反应患儿中卡介苗骨髓炎的比例。
结论
EPTB 加 PTB 患儿发热更多，淋巴细胞计数更低，C 反应蛋白水平更高。从接种到诊断为卡介苗骨髓炎的中位时间间隔为 16.4 个月，本研究中延迟接种卡介苗并未改变卡介苗相关不良反应患儿中卡介苗骨髓炎的比例。
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