小儿垂直传播结核感染9例临床分析

Clinical analysis of 9 children with vertical infection of tuberculosis

目的探讨孕期患活动性结核病（TB）母亲结核垂直传播（VTRTB）所致新生儿期先天性结核感染（CLTBI）罹患活动性TB的风险、诊断、治疗及预后。方法回顾南京医科大学附属儿童医院随访1-6年的7例CLTBI患儿的临床资料及2例文献资料，分为CLTBI组5例、活动性TB组4例；结合母亲病史，分析其流行病学、临床特点、治疗、预后及相关因素。结果8例母亲孕期均有活动性TB，早产率及低出生体质量率均为55．56％（5／9例）。9例患儿的结核菌纯蛋白衍生物试验（PPD）、抗酸杆菌涂片（AFB）和结核杆菌培养的转阳率分别为6／9例、0／9例、1／9例。3例结核感染T淋巴细胞酶联免疫斑点试验（T-SPOT-TB）阳性、3例荧光定量聚合酶链反应技术检测结核分枝杆菌DNA（FQ-TB-DNA）阳性（各有l例出生后即阳性）。其中5例口服异烟肼或合用利福平预防干预，随访1-6年情况良好；3例影像学见肺门或纵隔淋巴结大，3例肺部弥散性点状、结节状影或大片状高密度影；以病原学及免疫学等实验室检查为依据，本组9例患儿的VTRTB率为88．89％（8／9例），婴幼儿期罹患活动性TB风险接近50％；婴幼儿期活动性TB的发生率从未预防干预的100％（4／4例），下降到预防干预后0（0／5例）。结论结核杆菌相关的病原学、免疫学、影像学检查及临床疗效，可提示活动性TB并回顾性诊断的CLTBI，其中T-SPOT-TB及FQ-TB-DNA有一定的早期诊断价值；抗结核预防可降低CLTBI进展为活动性TB。

Objective To explore the risk, diagnosis,treatment and prognosis of newborns suffering from con- genital latent tuberculosis infection （CLTBI） by vertical transfer of mycobacterium tuberculosis （VTRTB） from mothers with active tuberculosis （TB） mothers during pregnancy. Methods The clinical data of 7 children with CLTBI follow- up of 1 -6 years in Children＇s Hospital of Nanjing Medical University and 2 cases from literatures were re- viewed, and they were divided into simple CLTBI group （n = 5 ） and active TB group （n = 4 ）. Combined with the mater- nal history, the epidemiology, clinical features, treatment, prognosis and relative factors of the children were analyzed. Results Eight mothers had active TB during pregnancy, and premature delivery rate and low birth weight rate were 55.56% （5/9 cases） respectively. The positive conversion rates of purified protein derivative tests （PPD）,acid- fast bacilli （AFB） and TB culture were 6/9 cases, 0/9 cases and 1/9 cases, respectively. Positive results of T cell enzyme - linked immunospot tuberculous test （ T - SPOT. TB） and TB - DNA by fluorescent quantitative polymerase chain reaction （ FQ - TB - DNA） were detected in 4 cases respectively, 1 of 3 patients with T - SPOT. TB and 1 of 3 patients with FQ - TB - DNA were positive. There were 5 cases with chemoprophylaxis of anti - TB drugs for 1 - 6 years with isonicid or rifampicin;3 cases with pulmonary hilar or mediastiual lymph nodes enlargement, and 3 cases with pulmonary diffuse punctate, nodular or patchy high density shadow in 3 cases;the rate of VTRTB in 9 cases was 8/9 （88.89%） based on laboratory examination of etiology and immunology, and the risk of active TB in infants and early childhood was close to 50% in neonates with CLTBI;the incidence of active TB was reduced from 100% （4/4 cases） of non - intervention down to 0 （0/5 case） of intervention. Conclusions Etiology, immunology, imaging examination of TB and clinical efficacy, can prompt active TB and retrospective diagnosis of CLTBI, and application of T - SPOT. TB and FQ - TB - DNA for early diagnosis of CLTBI has a higher applied value ; prophylactic and treatment of anti - tuber- culosis drugs can reduce the progression of CLTBI to active TB and improve outcomes.