胸腺淋巴体质患儿接种疫苗诱发死亡报告1例及国内其他同类病例报告分析

目的了解胸腺淋巴体质患儿接种疫苗后猝死的相关特征,有效预防该类患儿因正常的预防接种导致的死亡。方法对2010年发生于北京市丰台区的胸腺淋巴体质接种疫苗诱发死亡的病例进行详细的报告并通过医学文献检索对1986年到2010年近25年间中国期刊总库中收录的所有接种疫苗诱发猝死的报告进行逐一的分析,找出与该病例同类的胸腺淋巴体质患儿接种后死亡的病例,对相关特点进行描述性分析。结果加上本病例,1986至2010年共发现同类报告9例:男性6例,女性3例;年龄最小3个月,最大2岁11个月;同时接种两种及以上疫苗的3人,5人次接种百日咳、白喉、破伤风类毒素混合疫苗,接种到死亡时间最短约1 h,最长达19 h;尸检结果表现为不同程度的胸腺增大,淋巴组织增生,多脏器水肿和淤血。结论胸腺淋巴体质所导致的猝死,生前不易诊断,一般为死后尸解确诊。尸解常见胸腺肥大,淋巴组织增生,肾上腺萎缩,内脏器官组织淤血及滤泡增生。建议放射科和儿科医师在阅读小儿垂直胸部X线摄片时用心-胸腺-胸廓比值方法测量胸腺大小,如有异常将其列入预防接种的禁忌,以减少预防接种导致死亡的风险。

Report of a case with status thymicolymphaticus died after vaccination and similar reports in China

Objective To understand the characteristics of status thymicolymphaticus cases sudden death after vaccination and provide advice for its prevention and control. Methods Sudden death of cases with status thymicolymphaticus happened in Fengtai 2010 are reported and after searching for all the sudden deaths associated with vaccination from 1986 to 2010 nearly 25 years in China published in journals, all the cases were carefully analyzed for related characteristics. Results Besides this case, there were totally 9 cases reported during 1986~2010, 6 boys and 3 girls. The youngest was 3 months and the oldest was 2 years and 11 months. Three cases were vaccinated with 2 or more vaccines and 5 cases were vaccinated with DPT vaccines. The shortest time between vaccination and death was about 1 hour, the longest was 19 hours. Autopsy results showed different extents of thymus enlargement, lymphoproliferation, many had visceral edema and congestion. Conclusion The diagnosis of status thymicolymphaticus is difficult, and usually confirmed after the death of patients. Pediatricians and radiologists should be careful in reading pediatric vertical chest X-ray taken for the thymus, and use the heart-thymus-thorax ratio to measure the size of the thymus. If there is any abnormality in the ratio, the child should be contraindicated for vaccination in order to reduce deaths possibly associated with vaccination.