播散性卡介菌病23例分析

Clinical analysis of 23 cases of disseminated bacillus Calmette-Guerin disease

目的探讨播散性卡介菌病的临床特点、诊断、治疗和预后。t方法收集2006年3月至201i年6月在上海市公共卫生临床中心诊断的播散性卡介菌病患儿23例，评价诊断标准，分析临床特点、免疫缺陷、治疗和预后。结果23例患儿中，男13例，女10例。首诊年龄为2个月～5岁，中位年龄14．5个月。临床表现发热23例、盗汗15例。23例患儿均进行胸腹部CT检查，均发现肺内实质浸润或粟粒样病灶伴肺门、纵隔和腹腔淋巴结肿大。结核菌素皮肤试验阳性率为60．9％（14／23）；13例行7干扰素释放试验，阳性3例。14例诊断原发免疫缺陷。23例播散性卡介菌病患儿中，14例合并感染。23例患儿均给予2～4种抗结核药物治疗及免疫治疗，其中12例病情危重的患儿加用利奈唑胺治疗，16例患儿加用胸腺肽。随访期间23例患儿中有7例死亡。结论播散性卡介菌病诊断标准应完善；播散性卡介菌病多发生于免疫缺陷患儿，预后不良，治疗方案有待进一步完善。

Objective To explore the clinical characteristics, diagnosis, treatment and prognosis of disseminated bacillus Calmette-Guerin （BCG） disease. Methods A retrospective study was performed on 23 children diagnosed with disseminated BCG disease at Shanghai Public Health Clinical Center from March 2006 to June 2011. The diagnosis, clinical features, underlying immunodeficiency, treatment and prognosis were evaluated. Results Among the 23 children, 13 were male and 10 were female. The age of patients was from 2 months to 5 years old when diagnosed （median age, 14. 5 months）. Clinical manifestations included fever in 23 cases, night sweats in 15. Thoracic and abdominal computed tomography of the 23 cases showed infiltrations or miliary lesion of the lungs with hilar, mediastinal and abdominal lymphadenopathy. Tuberculin skin tests （TST） were positive in 60.9% （14/23）, and interferon gamma release assay （IGRA） was positive in 23. l% （3/13）. Among the 23 cases, 14 cases were diagnosed with primary combined immunodeficiency disease. Co-infections were observed in 14 out of 23 patients. All patients were given 2--4 antituberculous agents, including 12 severe cases with additional linezolid, and 16 cases with thymosin. During follow-up, there were 7 deaths （30.4%）. Conclusions Clinical diagnostic criteria of disseminated BCG disease needs to be advised. Disseminated BCG disease tends to occur in children with immunodeficiency. The prognosis is poor and treatment options is limited at present.