化疗对卡介苗接种致腋下淋巴结强阳性反应患儿手术切除后免疫功能的影响

目的 探讨化疗对新生儿卡介苗接种后腋下淋巴结强阳性反应手术切除后免疫功能的影响.方法 选择2008年1月至2012年8月在兰州大学第一医院、甘肃省人民医院、甘肃省妇幼保健医院因接种卡介苗引起淋巴结反应的足月正常新生儿40例为研究对象,患儿入院后均行腋下淋巴结手术切除一期缝合,将40例患儿应用计算机随机分为两组,化疗组20例术后1周开始口服利福平、异烟肼治疗,疗程为6周;对照组术后不做处理.两组患儿分别于术后2、8周行外周血T细胞亚群及免疫球蛋白检测.结果 术后2周化疗组CD4＋、CD4＋/CD8＋、IgG分别为（35.96 ±4.62）％、1.90±0.15、（4.54±0.27） ng/L,对照组分别为（28.04±4.24）％、1.73±0.84、（2.10±0.35） ng/L,两组比较差异均有统计学意义（t值分别为3.343、2.017、2.017,P均＜0.05）;术后8周两组各指标差异均无统计学意义（P均＞0.05）.对照组术后2周与术后8周比较仅CD4＋差异有统计学意义[（28.04±4.24）％、（34.99±1.72）％,t =3.212,P＜o.05];而化疗组各对应参数差异均无统计学意义（P均＞0.05）.随访1年行超声检查两组均无腋下淋巴结肿大.结论 新生儿接种卡介苗腋下淋巴结强阳性反应手术切除后早期化疗会提高机体免疫,但远期对免疫无影响,不增加复发,考虑到化疗药物的副作用临床不建议进行抗结核治疗.

Effect of chemotherapy on immune function of resection of axillary lymph node positive reaction induced by BCG vaccination

Objective To investigate the effect of chemotherapy on immune function of resection of axillary lymph node positive reaction induced by BCG vaccination.Methods Forty cases with axillary lymph node positive reaction induced by BCG vaccination and underwent resection were selected as our subjects.Those all hospitalized from the first clinical medical college of Lanzhou University,Gansu Provincial Hospital and Gansu Provincial Maternal and Child Health Hospital from January 2008 to August 2012 and randomly divided into chemotherapy group （group A） and observation group （group B）.Patients in group A were given oral rifampicin,isoniazid for 6 weeks at 1 week after operation.Patients in group B were with only surgery.Peripheral blood T lymphocyte subsets and immunoglobulin were measured at the 2nd and 8th week after operation.Results CD4 ＋,CD4 ＋/CD8 ＋,IgG in group A at 2 weeks after chemotherapy were （35.96 ± 4.62） ％,（1.90 ±0.15）,（4.54 ±0.27） ng/L respectively,higher than that of group B（（28.04 ±4.24）％,（1.73 ±0.84）,（2.10 ± 0.35） ng/L,P ＜ 0.05）,and there were significant differences between the two groups in terms of CD4＋,CD4＋/CD8＋,IgG（t =3.343,2.017,2.017 respectively,P ＜0.05）.No significant difference was seen at 8 weeks after chemotherapy.In group B,CD4＋ level was （28.04 ±4.24）％ at 2 week after chemotherapy and （34.99 ± 1.72） ％ at 8 week after chemotherapy,the difference was significant （t =3.212,P ＜ 0.05）,while there was no significant difference in group A.Ultrasound examination was showed no swollen of axillary lymph node in two groups after 1 year after surgery.Conclusion Early chemotherapy can improve immune function of patient with axillary lymph node surgery induced by neonatal BCG vaccination.No further improvement after surgery for long time.Considering the side effect of chemotherapy,it is not recommended for anti-tuberculosis treatment.