17例儿童泌尿系结核临床特征与疗效分析

目的 探讨儿童泌尿系结核临床特征与疗效,提高儿科医师对该病的认识。方法 搜集2015年1月至2020年1月南华大学附属长沙中心医院儿童结核科收治的符合诊断标准的17例泌尿系结核患儿的临床资料进行整理及描述性统计分析。结果 17例患儿均来自湖南各地,其中农村15例,男童11例,年龄中位数(四分位数)为11.0(8.5,16.5)岁。16例接种过卡介苗,6例有明确肺结核密切接触史。并发肺结核、结核性脑膜脑炎和结核性脊髓脊膜炎、腹腔结核分别为14、8、7例。12例有泌尿系症状,其中尿频、尿急、尿痛11例,夜间盗汗9例,发热8例。尿常规异常者12例,PPD试验和结核感染T淋巴细胞斑点试验(T-SPOT.TB)阳性者分别为9和12例。泌尿系CT扫描显示结核典型表现、泌尿系受累、膀胱壁增厚者分别为15、15、9例。本组患儿均延误诊断,延误时间为15d至9个月。均以H-R-Z-E抗结核治疗方案(强化期3~6个月,巩固期12~15个月)为基础,仅1例原发性癫痫患儿将异烟肼改为帕司烟肼,并因病情或疗效原因而联用其他一、二线抗结核药品(如丙硫异烟胺、链霉素、左氧氟沙星、利奈唑胺),最终6例治愈,9例病情好转,处于继续治疗中,2例死亡。结论 本省儿童泌尿系结核患儿以农村、男童、大龄多见,接种卡介苗对该年龄段患儿无保护性;有明显结核病密切接触史、泌尿系症状和其他器官结核,PPD试验和T-SPOT.TB阳性、CT扫描有疑似典型病灶改变有助于辅助诊断。积极治疗后效果良好。     

结核感染T细胞斑点试验在结核病诊断中的应用价值

目的 评价结核感染T细胞斑点试验(T-SPOT.TB)在结核病诊断及鉴别结核病是否为活动性方面的价值。 方法 回顾性分析2011年7月至2012年4月内蒙古医科大学附属医院587例住院患者（结核性疾病患者128例,其中活动性结核组103例,陈旧性结核组25例;非结核性疾病患者459例,免疫损害组241例,非免疫损害组218例）的年龄、性别、病程、临床表现、T-SPOT.TB、病理、PPD、抗酸杆菌涂片及Mtb-Ab等的结果,数据采用SPSS 16.0 软件处理,计量资料比较采用Wilcoxon秩和检验,计数资料采用卡方检验,以P<0.05为差异有统计学意义。 结果 187例T-SPOT.TB阳性者中确诊结核病患者106例,阳性预测值56.68%（106/187）,400例阴性者中确诊非结核病患者378例,阴性预测值 94.50%(378/400)。587例中共确诊结核性疾病128例,T-SPOT.TB检测的敏感度为82.81%（106/128）,均高于结核菌素纯蛋白衍化物（PPD）35.71%（30/84）、抗酸杆菌涂片8.74%（9/103）及结核抗体(Mtb-Ab)14.06%（9/64）的敏感度,活动性与陈旧性结核的检测敏感度分别为93.20%（96/103)和40.00% (10/25);459例非结核性疾病患者中免疫损害组与非免疫损害组T-SPOT.TB的检测特异度分别为71.37%（172/241）和94.50%(206/218)。结核性胸膜炎及腹膜炎患者T-SPOT.TB的敏感度为100.00%（37/37）。活动性结核与陈旧性结核病患者混合肽ESAT-6和CFP-10总SFCs计数中位数分别为502个/10⁶ PBMCs和430个/10⁶ PBMCs, 四分位数间距（P₂₅, P₇₅）分别为(217个/10⁶ PBMCs,1287个/10⁶ PBMCs)和(140个/10⁶ PBMCs,1303个/10⁶ PBMCs),两组间比较采用Wilcoxon秩和检验,差异无统计学意义（U=429.5,P=0.585）。肺结核与肺外结核患者混合肽ESAT-6和CFP-10总SFC中位数分别为456个/10⁶ PBMCs和528个/10⁶ PBMCs, 四分位数间距（P₂₅, P₇₅）分别为(264个/10⁶ PBMCs,950个/10⁶ PBMCs)和(186个/10⁶ PBMCs,1244个/10⁶ PBMCs),两组间差异无统计学意义（U=1083.0,P=0.871）。 结论 T-SPOT.TB在低风险人群中检测的特异度较好,而在有潜在结核分枝杆菌感染的高危人群中检测的特异度明显降低,在结核性浆膜腔积液中检测的敏感度较高,与PPD、抗酸杆菌涂片及Mtb-Ab相比,敏感度较高,但对鉴别是否为活动性结核病并不理想。     

T-SPOT.TB与PPD在消化系统结核感染鉴别诊断中的价值

目的评估快速T细胞计数体外酶联免疫斑点技术(T-ELISPOT.tuberculosis,T-SPOT.TB)与PPD试验在消化系统结核感染的诊断价值。方法回顾性分析2011年6月-2013年7月于南京军区南京总医院消化内科收治的60例患者,其中14例确诊为结核感染的患者,46例为非结核感染的消化系统疾病患者,抽取患者外周血送检,T-SPOT.TB与PPD试验结果的准确性进行比较。结果 14例确诊结核感染患者,46例非结核感染的患者,T-SPOT.TB的灵敏度与PPD试验相近,差异无统计学意义(78.6%vs71.4%,P=1.000);T-SPOT.TB的特异性显著大于PPD试验(91.3%vs 69.6%,P=0.009);T-SPOT.TB阳性预测率显著大于PPD试验(73.3%vs 41.7%,P=0.001);T-SPOT.TB阴性预测率与PPD试验相近,差异无统计学意义(93.3.%vs 91.1%,P=1.000)。T-SPOT.TB与PPD试验在诊断消化系统结核感染方面有较好的吻合性(K=0.341,P=0.018)。结论 T-SPOT.TB应用于消化系统感染的诊断,尤其适合PPD阳性的疑似消化系统结核感染患者的鉴别诊断。     

酶联免疫斑点试验在菌阴肺结核诊断中的价值

目的探讨酶联免疫斑点检测技术(enzyme-linked immunospot assay,ELISPOT)(T-SPOT.TB)在菌阴肺结核诊断中的应用价值。方法应用T-SPOT.TB试剂盒对55例菌阴肺结核(A组)和36例其他肺部疾病(B组)患者的外周血中Mtb特异性T淋巴细胞进行检测,同时对两组患者进行PPD试验、血清结核抗体(Mtb-AB)检测。结果A组T-SPOT.TB的阳性率为89.1%(49/55),要明显高于B组的19.4%(7/36)(χ2=44.59,P<0.001)。在A组,T-SPOT.TB的阳性率要明显高于PPD试验[36.4%(20/55)]、Mtb-AB[52.7%(29/55)]及PPD试验+Mtb-AB的阳性率[23.6%(13/55)],(χ2=12.13,χ2=7.08,χ2=21.54,P值均<0.01)。T-SPOT.TB在B组中的阴性率为80.6%(29/36),较PPD试验[86.1%(31/36)]及Mtb-AB阴性(63.9%,23/36)和PPD+Mtb-AB检测方法的阴性率[88.9%(32/36)]经检验,差异无统计学意义(χ2=0.39,χ2=2.69,χ2=0.41,P值均>0.05)。结论T-SPOT.TB检测特异度和敏感度要优于PPD试验及Mtb-AB的检测,可用于菌阴肺结核的辅助诊断,具有一定的临床推广使用的价值。     

T淋巴细胞斑点试验在结核性腹膜炎诊断中的临床应用价值

[目的]研究T淋巴细胞斑点试验(T-SPOT.TB)在结核性腹膜炎临床诊断中的应用价值。[方法]对40例结核性腹膜炎、38例非结核性腹膜炎的患者的腹腔积液实施T-SPOT结核试验。[结果]40例结核性腹膜炎患者中T-SPOT.TB阳性36例(阳性率90.00%),对照组38例非结核性腹膜炎T-SPOT.TB阳性3例(阳性率7.89%)。[结论]T-SPOT.TB是一种鉴别腹腔积液是否为结核性腹膜炎的较好的方法,具有很好的临床应用价值。     

卡介苗接种对体液免疫的影响及其临床意义

目的观察卡介苗接种(简称种卡)与体内抗结核抗体变化间的关系?方法测定53例新兵种卡前及种卡后第12周和第24周时血清中抗PPD抗体(PPD IgG)的OD值并与种卡前进行对比分析?结果53例新兵种卡前PPD IgG2例(3.8%)阳性,种卡12周后15例(28.3%)阳性,种卡24周后9例(17.0%)阳性,抗PPD抗体OD值种卡后第12周较种卡前明显升高(P<0.001)?结论接种卡介苗后PPD IgG水平升高说明种卡可以提高机体对结核菌的体液免疫水平,且可在较长时间内维持,这对于儿童活动性结核病的血清学诊断结果可能会产生干扰作用。     

结核感染T细胞斑点试验在手、腕部腱鞘结核诊断中的应用评价

目的 探讨结核感染T细胞斑点试验(T-cell spot of Tuberculosis,T-SPOT.TB)在手、腕部腱鞘结核诊断中的临床应用价值.方法 通过对2012年1月至2018年1月我院收集64例怀疑手、腕部腱鞘结核临床资料进行回顾性分析,根据病理诊断及临床表现判断有无结核分枝杆菌感染;全部病例均经过T-SP...     

Isoniazid resistant tuberculosis in a school outbreak: the protective effect of BCG

An outbreak of isoniazid resistant tuberculosis occurred in a large second level school. A total of 1,160 teenage pupils were at risk. Nineteen cases of tuberculosis were diagnosed, 15 were students, 9 of whom were among 251 non-vaccinated students and 6 among 909 vaccinated students. Two cases of miliary tuberculosis, one of whom also had tuberculous (TB) meningitis, occurred in the non-vaccinated group. The number of children with Heaf grade +3 or +4 was significantly greater among children who had been given Bacille Calmette-Guérin (BCG) vaccination (8 vs 4.4%). This suggests a boosting effect on the response in vaccinated children. The protective effect of neonatal BCG vaccination in this school outbreak suggests that it provides significant protection against tuberculosis lasting into adolescence.     

上海地区四小学高年级学生结核感染率及影响因素的横断面研究

目的 了解上海地区小学生潜伏结核感染的分布情况并分析影响儿童潜伏结核感染的因素.方法 以上海市浦东新区和杨浦区四所小学四、五年级在校学生作为研究对象,问卷调查形式收集研究对象的基本信息和结核感染相关信息,结核感染T细胞斑点试验(T-SPOT.TB)技术了解结核感染情况,单因素和多因素分析研究影响小学生结核感染状况的因素.结果 本研究共纳入小学生472名,其中有卡介苗接种史者439人,占93.0%,与结核患者既往有过接触的学生10人,占2.1%.472名小学生中16人T-SPOT.TB检测阳性,占3.4%,但无结核相关的临床症状和体征,为潜伏结核感染者.接种卡介苗者潜伏结核感染率为2.7%,未接种者为12.1%(OR:6.972,95% CI:1.834～26.500);有结核接触史者潜伏结核感染率为30.0%,无接触史者为2.8%(OR:16.38,95% CI:3.692～72.700).结论 上海市小学高年级学生的潜伏结核感染率为3.4%,卡介苗接种对预防上海学龄儿童潜伏结核感染有保护作用,而日常生活中与结核患者接触增加了儿童潜伏结核感染的危险性.

Abstract：

Objective To investigate the prevalence of latent tuberculosis infection(LTBI),and to identify the risk factors in primary schoolchildren from Shanghai through the population-based field investigation combined with the tuberculosis infection enzyme-linked immunospot assay(T-SPOT.TB)assay.Methods The children in grade 4 and 5 were enrolled from four primary schools in Pudong new district and Yangpu district of Shanghai.Questionnaire interview was applied to investigate the soeiodemographic and clinical information related to LTBI.The T-SPOT.TB assay was used to detect LTBI in the enrolled subjects.Univaitate and multivariate analyses were used to identify the risk factors associated with LTBI among the primary schoolchildren.Results Totally 472 schoolchildren were enrolled in the present study,with 439(93.0%)being vaccinated with bacillus calmette-guerin (BCG) and ten (2.1%) having contact history with tuberculosis (TB) patients.Among the 472 eligible subjects,16(3.4%) children were T-SPOT.TB positive,who had no clinical symptoms andsigns relevant to TB and were defined as LTBI.The LTBI prevalence in BCG vaccinated and unvaccinated children were 2.7% and 12.1%,respectively (OR:6.972;95%CI:1.834-26.500);those in TB contacts and children without TB contact history were 30.0% and 2.8%, respectively (OR: 16. 38; 95% CI: 3. 692-72. 700). Conclusions The prevalence of LTBI among senior schoolchildren in Shanghai is 3.4%. BCG vaccination is protective for children from LTBI, while daily contacts with TB patients increases the risk of LTBI in schoolchildren.     

血T-SPOT.TB联合肺泡灌洗液TbDNA检测对诊断肺结核的应用价值

目的分析血T-SPOT.TB联合肺泡灌洗液(BALF)Tb DNA检测对肺结核诊断的价值。方法选择2013.3~11月86例疑似肺结核患者,经确诊后分为肺结核组46例、肺炎组40例,均行T-SPOT.TB、BALF-Tb DNA、BALF涂片、痰涂片、PPD、结核抗体检测,对各检测结果进行对比,并行T-SPOT.TB与BALFTb DNA联合检测与单用检测、涂片法、PPD、结核抗体对比分析。结果血T-SPOT.TB、BALF-Tb DNA敏感性分别为84.8%、80.4%,特异性分别为80.0%、77.5%,两者联合检测敏感性为100.0%,阳性预测值为97.1%,阴性预测值为100.0%,与单用检测对比,差异有统计学意义(P0.05),与涂片法、PPD、结核抗体对比,存在显著差异(P0.01)。结论血T-SPOT.TB与BALF-Tb DNA联合检测提高了肺结核的诊断阳性率,弥补对方不足,减少肺结核的漏诊、误诊,是一个有前途的检测方法。     

结核感染T细胞斑点试验在不同患者群中的检测结果分析

目的 探讨影响结核感染T细胞斑点试验(T-SPOT.TB)检测结果的因素。方法收集2014年5月至2015年4月同济大学附属上海市肺科医院共1537例住院患者的临床资料。以《临床诊疗指南:结核病分册》的标准将患者分为临床诊断结核病组(1159例)和临床诊断非结核病组(378例);再经病原学诊断及随访排除不能做出最终诊断的39例患者后,将患者分为结核病组(1103例;包括经分枝杆菌培养及菌种鉴定确诊的229例和最终临床诊断的874例)和非结核病组(395例;包括既往有结核病史或肺部存在陈旧性病灶者94例,无病史者301例);1103例结核病组患者中,肺结核557例,结核性胸膜炎107例,淋巴结结核16例,骨关节结核51例,脑结核7例,多组织器官结核363例,其他肺外结核2例;395例非结核病组患者中,经分枝杆菌培养及菌种鉴定确诊的非结核分枝杆菌(NTM)感染患者93例。回顾性分析临床诊断结核病组和结核病组患者T-SPOT.TB检测结果的敏感度、特异度,结核病组与非结核病组患者T-SPOT.TB检测反应强度,不同结核病类型T-SPOT.TB检测阳性率,以及NTM感染患者与结核病患者的年龄差异。结果 (1)临床诊断结核病组T-SPOT.TB检测的敏感度为81.97% (950/1159)、特异度为53.44%(202/378);结核病组T-SPOT.TB检测的敏感度为83.77%(924/1103)、特异度为54.43%(215/395);结核病组中抗酸染色阳性患者T-SPOT.TB检测阳性率为90.73%(235/259);培养阳性患者T-SPOT.TB检测阳性率为92.58%(212/229)。(2)非结核病组有结核病史或肺部显示陈旧性结核病灶的患者与无病史者T-SPOT.TB检测的阳性率分别为69.15%(65/94)和38.21%(115/301),两组间差异有统计学意义(χ ²=27.65,P=0.000)。(3)结核病组与非结核病组T-SPOT.TB检测结果以斑点计数表示反应强度,结核病组对A、B抗原刺激出现阳性反应(斑点数≥1)的患者中,明显阳性及超强阳性(斑点数≥11)的比率分别为69.81%(652/934)和69.67%(627/900),明显高于非结核病组[分别为46.83%(96/205)和46.63%(83/178)];经曼-惠特尼秩和检验,差异有统计学意义(Z值分别为-14.20、-14.63,P值均<0.01)。(4)1103例结核病组患者中,T-SPOT.TB检测阳性率以淋巴结结核(87.50%,14/16)为最高,随后依次为多组织器官结核(87.33%,317/363)、肺结核(86.54%,482/557)、结核性胸膜炎(74.77%,80/107),脑结核(57.14%,4/7)和骨关节结核(50.98%,26/51)相对较低。(5)T-SPOT.TB检测阳性的NTM感染患者的平均年龄[(53.61±18.43)岁]较T-SPOT.TB检测阳性的确诊结核病患者[(44.98±18.88)岁]高,差异有统计学意义(t=-2.63,P=0.009)。结论 T-SPOT.TB检测结果受结核病诊断依据、痰菌量、既往结核病史或肺部陈旧性结核病灶、NTM感染、结核病灶存在的部位等多种因素的影响;T-SPOT.TB检测用于指导结核病诊断时,需综合考虑各项因素。     

Childhood tuberculosis in a low-income Paris suburb: lessons from a resurgence brought under control.

SETTING: Few series of paediatric tuberculosis (TB) have been reported in the last 20 years. OBJECTIVE: To describe diagnostic and treatment practices in children with TB living in Seine-Saint-Denis, a low-income Paris suburb. METHODS: Local TB incidence in 1998 was 34.2/100,000 overall and 10.2/100,000 in children. Between September 1996 and December 1997, the hospitals and prevention units serving the area's paediatric population were sent questionnaires to identify TB cases in children aged under 15 living in Seine-Saint-Denis and treated with at least one anti-tuberculosis drug. RESULTS: Of 92 cases identified, 60 (65%) had been diagnosed during contact tracing; for 52 patients (60%), the index case had been found. The reason for anti-tuberculosis treatment was active TB in 26 (28.3%), latent TB in 46 (50%), and prophylaxis in 20 (21.8%). Forty per cent (37/92) of the patients were aged under 5. Only 15 of the 35 notified cases met the criteria for mandatory notification (at least three anti-tuberculosis drugs). CONCLUSION: TB remains a public health problem in Seine-Saint-Denis. The high proportion of cases identified by contact tracing attests to the efficacy of the local contact-tracing programme. The criteria for mandatory notification in France were too restrictive to ensure effective surveillance of childhood TB. Since 2002, notification has included cases of tuberculous infection in children.     

531例住院儿童结核病情况分析

目的　分析25年间531例住院儿童结核病情况,评价儿童结核病的防治效果。方法 对25年间住院的儿童结核病例进行全面的调查分析。结果 25年间共收治儿童结核病531例,占同期住院病人总数的3.8%,其中原发性肺结核和结核性脑膜炎297例,占儿童结核病总数的55.9%。死亡率由3.6%下降为0。结论 由于新生儿卡介苗的普遍接种,结核病防治工作的深入开展,住院原发性结核病呈明显下降趋势。     

Is the BCG test of diagnostic value in tuberculosis?

Setting: In developing countries including Turkey, tuberculosis is still a major problem. Rapid diagnosis and early medical intervention are the two most important considerations in preventing the spread of the disease.Objective: This study was carried out to determine the diagnostic value of BCG test in childhood tuberculosis and compare it with tuberculin test in this regard.Design: 50 patients and 20 healthy children without any evidence of previous BCG vaccination and aged 80 days-15 years were simultaneously tested with purified protein derivative (PPD) and BCG vaccine.Results: In pulmonary tuberculosis BCG test was positive in 100% of cases and the PPD test in 44.5%. Similarly, BCG test was positive in 100% of miliary tuberculosis and tuberculous meningitis cases but PPD test was negative in all of them. Out of 22 patients with malnutrition 18 (82%) had positive BCG test and 4 had positive PPD test. BCG test showed uniformly high positivity in all grades of malnutrition.Conclusion: BCG is more reliable and sensitive than the tuberculin test in the diagnosis of tuberculosis. It is still valuable in the diagnosis of tuberculosis especially in developing countries where the disease is still a major public health problem and where sophisticated methods such as rapid culture with BACTEC and demonstration of bacilli with DNA probes are not widely available.     

Use of an interferon-gamma release assay to diagnose latent tuberculosis infection in foreign-born patients

BACKGROUND: The tuberculin skin test (TST) has a low specificity in the setting of bacille Calmette-Guérin (BCG) vaccination. Interferon-gamma release assays (IGRAs) appear to be more specific but have not been validated in this population under routine clinical conditions. We sought to validate the routine clinical use of the T-SPOT.TB test (Oxford Immunotec; Oxford, UK), an IGRA, in a predominantly foreign-born population with a high rate of BCG vaccination. METHODS: We compared the TST and the T-SPOT.TB test in 96 subjects at a New York City Department of Health tuberculosis clinic. We aimed to determine which test better predicted being a close contact of a case of active tuberculosis, a surrogate for latent tuberculosis infection. RESULTS: A positive T-SPOT.TB test result was strongly associated with being a close contact of a case of active tuberculosis after adjustment for potential confounders (adjusted odds ratio, 2.9; 95% confidence interval, 1.1 to 7.3; p = 0.03). A positive TST result was associated with being a contact only in subjects without BCG vaccination (p = 0.02). The T-SPOT.TB test was more specific for being a close contact than the TST (p < 0.001). Specificity in BCG-vaccinated subjects was 3% for the TST compared with 70% for the T-SPOT.TB test (p < 0.001). CONCLUSIONS: The T-SPOT.TB test is superior in routine clinical use to the TST for identifying high-risk individuals among foreign-born populations with high rates of BCG vaccination.     

Contact tracing using a new T-cell-based test: better correlation with tuberculosis exposure than the tuberculin skin test.

SETTING: Residential institution for alcoholics in Switzerland. OBJECTIVE: To compare the results of the tuberculin skin test (TST) and the new T-cell-based test for tuberculosis infection (T-SPOT.TB) in subjects exposed to a case of smear-positive pulmonary TB (PTB). DESIGN: After the notification of smear-positive PTB in a resident of an institution for alcoholics, contacts underwent TST and determination of Mycobacterium tuberculosis specific T-cells in blood by T-SPOT.TB. Results were analysed according to age, history of BCG vaccination, and level of exposure to the index case. RESULTS: There was no correlation between the level of exposure and the TST results, but the T-SPOT.TB results were significantly correlated with the level of exposure (P = 0.029, OR 5.00, 95%CI 1.05-23.86). Contacts who had been previously BCG-vaccinated were significantly more likely to have a positive TST than unvaccinated contacts (52% vs. 0%, P = 0.0003), but there was no influence of prior BCG vaccination on T-SPOT.TB results. CONCLUSIONS: T-SPOT.TB test results correlated better than TST with level of exposure to M. tuberculosis and were not confounded by prior BCG vaccination. This test allows better selection of contacts who should receive treatment for latent TB infection.     

Identifying Predictors of Interferon-γ Release Assay Results in Pediatric Latent Tuberculosis: A Protective Role of Bacillus Calmette-Guerin?: A pTB-NET Collaborative Study

Rationale: Interferon-γ (IFN-γ) release assays are widely used to diagnose latent infection with Mycobacterium tuberculosis in adults, but their performance in children remains incompletely evaluated to date. Objectives: To investigate factors influencing results of IFN-γ release assays in children using a large European data set. Methods: The Pediatric Tuberculosis Network European Trials group pooled and analyzed data from five sites across Europe comprising 1,128 children who were all investigated for latent tuberculosis infection by tuberculin skin test and at least one IFN-γ release assay. Multivariate analyses examined age, bacillus Calmette-Guérin (BCG) vaccination status, and sex as predictor variables of results. Subgroup analyses included children who were household contacts. Measurements and Main Results: A total of 1,093 children had a QuantiFERON-TB Gold In-Tube assay and 382 had a T-SPOT.TB IFN-γ release assay. Age was positively correlated with a positive blood result (QuantiFERON-TB Gold In-Tube: odds ratio [OR], 1.08 per year increasing age [P < 0.0001]; T-SPOT.TB: OR, 1.14 per year increasing age [P < 0.001]). A positive QuantiFERON-TB Gold In-Tube result was shown by 5.5% of children with a tuberculin skin test result less than 5 mm, by 14.8% if less than 10 mm, and by 20.2% if less than 15 mm. Prior BCG vaccination was associated with a negative IFN-γ release assay result (QuantiFERON-TB Gold In-Tube: OR, 0.41 [P < 0.001]; T-SPOT.TB: OR, 0.41 [P < 0.001]). Young age was a predictor of indeterminate IFN-γ release assay results, but indeterminate rates were low (3.6% in children < 5 yr, 1% in children > 5 yr). Conclusions: Our data show that BCG vaccination may be effective in protecting children against Mycobacterium tuberculosis infection. To restrict use of IFN-γ release assays to children with positive skin tests risks underestimating latent infection.     

67例婴幼儿肺结核临床诊断分析

目的分析婴幼儿肺结核的临床诊断特点。方法对67例婴幼儿肺结核的卡介苗接种情况、结核接触史、临床表现、实验室检查、胸部影像学特点、PPD试验结果进行回顾性分析。结果67例患儿中未接种卡介苗20例(29.9%);有结核接触史31例(46.3%),外来人口26例(38.8%);发热51例(76.1%),有呼吸道症状者59例(88.1%),有神经系统症状者15例(22.4%);PPD(-)14例(20.9%),CRP升高50例,ESR升高45例(67.1%)血常规检查示白细胞升高45例(67.2%),白细胞分类中性粒为主者49例(73.1%);67例行X线胸片检查,其中16例(23.9%)仅见两肺纹理增多增粗、未见实质性病灶,CT检查58例,其中2例未见明显异常。最后诊断为原发型肺结核40例,占59.7%,血行播散性肺结核14例,占20.9%;继发性肺结核5例,占7.5%;结核性胸膜炎8例,占11.9%。结论婴幼儿肺结核有一定的临床特点,临床应注意早期诊断;同时应该加强外来流动人口的结核病防治工作,普及外来人口儿童的卡介苗接种率。     

北京市学龄前儿童结核菌自然感染的研究

北京市从１９７８年成功实施现代结核病控制措施，结核病疫情明显好转，为掌握结核自然感染率及其在现代结核病控制措施下的下降趋势。在对新生儿及儿童采取一系列保护性预防措施的情况下，自１９８８年７月１５日于顺义县开始停止新生儿卡介苗接种。１９９５年对首批未接种卡介苗的６～７岁即１９８８～１９８９年出生的队列进入小学一年级的学生采用国际标准ＰＰＤ及国际标准结素试验技术进行结核菌素试验。１９９５年顺义县６～７岁儿童的结核感染率为１．３５％，估算年结核感染率为０．２１％，说明现代结核病控制措施对结核病感染的显著影响。顺义县１９８８～１９９５年０～４岁未接种卡介苗的儿童中结核性脑膜炎的发生继续减少。研究结果为评价现代结核病控制措施的效果及在不同结核病流行病学条件下修订卡介苗接种政策提供科学依据。     

Tuberculous meningitis in Japanese children between 1980-1991]

We evaluated the clinical and laboratory findings of tuberculous meningitis admitted to Tokyo Metropolitan Children's Hospital from 1980 through 1991 retrospectively. They consisted of 26 patients (14 boys and 12 girls), and their age ranged from 4 months to 11 years. Seventeen patients were under 3 years of age. Mortality rate was 4% (1/26), and there were 13 patients with sequelae on discharge from the hospital, and 12 patients without any sequelae. The period to recover normal CSF findings was relatively long. Some cases which did not seem to respond well to chemotherapy at the initial stage, recovered from meningitis without sequelae. This suggests that it is not necessary to change the chemotherapy at the initial few weeks of therapy. The risk factors of poor prognosis were; age less than 2 years, decreased level of consciousness on admission, convulsion, CSF protein more than 70 mg/dl, and CSF glucose less than 20 mg/dl. Tryptophan reaction was not always positive. Chloride in CSF was not so important to diagnose tuberculous meningitis in children. For the proper diagnosis of tuberculous meningitis in children one should consider several factors such as tuberculin skin test, family history, chest X-ray findings and CSF study. BCG was inoculated in six children (three patients were under one year old and the rests were older than 4 years). In three patients under one year old BCG was seemed to be inoculated after Mycobacterium tuberculosis infection, and apparently not effective to prevent tuberculosis meningitis. We conclude that BCG vaccination is necessary in early infancy to prevent tuberculous meningitis.