免疫缺陷患儿合并结核分枝杆菌感染的临床特征分析

Clinical features of children with immunodeficiency and Mycobacterium tuberculosis infection

摘要:

目的 探讨继发性免疫缺陷病（SID）及原发性免疫缺陷病（PID）患儿合并结核分枝杆菌感染的临床特征。方法 回顾性分析合并结核分枝杆菌感染的免疫缺陷患儿（SID组36例、PID组52例）及非免疫缺陷患儿（对照组108例）的临床资料。结果 PID组患儿起病年龄低于对照组和SID组（P < 0.05），男性比例高于对照组和SID组（P < 0.05）。SID组及PID组患儿其他结核中毒症状（盗汗、消瘦、乏力、食欲下降）及PPD试验阳性率均低于对照组（P < 0.05），且更易出现肺叶受累≥ 3叶（P < 0.05）。PID患儿更易合并多器官受累（P < 0.05）。SID组肺部粟粒影发生率高于对照组和PID组（P < 0.05），PID组γ-干扰素释放试验阳性率低于对照组和SID组（P < 0.05）。结核分枝杆菌感染在SID组表现为潜伏结核感染（36.1%）和活动性结核病（63.9%）；在PID组以卡介苗病（90.4%）为主，有2例（3.8%）同时合并结核病。结论 免疫缺陷患儿合并结核分枝杆菌感染的临床症状不典型，易出现播散性感染，PPD试验及γ-干扰素释放试验阳性率较低，容易出现误诊及漏诊。免疫缺陷患儿应常规进行结核相关筛查，早期识别及干预以改善预后。

Abstract:

Objective To study the clinical features of Mycobacterium tuberculosis infection in children with secondary immunodeficiency disease (SID) versus primary immunodeficiency disease (PID). Methods A retrospective analysis was performed on the medical data of children with immunodeficiency and Mycobacterium tuberculosis infection (36 children with SID and 52 with PID) and 108 children with Mycobacterium tuberculosis infection but without immunodeficiency (control group). Results The onset age in the PID group was significantly lower than those in the control and SID groups (P < 0.05), and the proportation of males in the PID group was significantly higher than those in the control and SID groups (P < 0.05). Compared with the control group, the SID and PID groups had significantly lower incidence rates of tuberculosis poisoning symptoms (night sweeting, weight loss, fatigue and loss of appetite) and positive rate of PPD test (P < 0.05), as well as a significantly higher incidence rate of the involvement of ≥ 3 pulmonary lobes (P < 0.05). The children with PID tended to have the involvement of multiple organs (P < 0.05). The SID group had a significantly higher incidence rate of miliary shadow on chest CT than the control and PID groups (P < 0.05). The PID group had a significantly lower positive rate of IFN-gamma release assay (IGRA) than the control and SID groups (P < 0.05). Mycobacterium tuberculosis infection manifested as latent tuberculosis infection (36.1%) and active tuberculosis (63.9%) in the SID group. The infection mainly manifested as bacille Calmette-Guérin disease in the PID group (90.4%), among whom 2 children (3.8%) also had tuberculosis. Conclusions Children with immunodeficiency and Mycobacterium tuberculosis infection have atypical clinical symptoms, with a high incidence rate of disseminated infection and low positive rates of PPD and IGRA tests, which may lead to misdiagnosis and missed diagnosis. Children with immunodeficiency should undergo regular tuberculosis screening for early identification and intervention.