儿童重症结核病3例临床特点及宏基因组二代测序结果分析  

Clinical characteristics of 3 children with severe tuberculosis and analysis of the results of metagenomic next-generation sequencing

作　　者：许愿愿 王昶 童文佳 段袁园 吴优 金丹群 Xu Yuanyuan;Wang Chang;Tong Wenjia;Duan Yuanyuan;Wu You;Jin Danqun(Pediatric Intensive Care Unit,Anhui Provincial Children′s Hospital,Hefei 230051,China;Imaging Center,Anhui Provincial Children′s Hospital,Hefei 230051,China)

机构地区：[1]安徽省儿童医院儿童重症监护病房,合肥230051 [2]安徽省儿童医院影像中心,合肥230051

出　　处：《中华实用儿科临床杂志》2021年第15期1187-1190,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：安徽省重点研究与开发计划项目(201904a07020101)。

摘　　要：目的探讨儿童重症监护病房(PICU)重症结核病(TB)患儿的临床特点和宏基因组二代测序(mNGS)在诊断中的可行性。方法回顾性分析2018年1月至2020年12月安徽省儿童医院PICU收治的3例重症TB患儿的临床资料和mNGS检测结果,并在中国知网、万方、维普和PubMed数据库中检索应用mNGS诊断的儿童TB,检索时间均为建库至2021年3月,复习相关文献。结果1.在3例患儿中,男2例,女1例。3例均有发热。1例患有X-连锁重症联合免疫缺陷病(X-SCID)。3例患儿抗酸染色、结核菌素纯蛋白衍生物(PPD)皮肤试验和结核感染T细胞斑点试验(T-SPOT.TB)均阴性,经mNGS早期诊断。2例转专科抗结核治疗好转出院。2.共检索到3篇文献,报道7例TB患儿。1例X-SCID男婴患卡介苗相关噬血细胞综合征,6例结核性脑膜炎,均采用mNGS早期检出结核分枝杆菌复合群协助诊断。结论mNGS在儿童重症TB,尤其是免疫抑制患儿的快速病原诊断方面具有一定应用前景,有助于优化早期诊断和抢先治疗,以改善预后。Objective To explore the clinical characteristics of children with severe tuberculosis(TB)in pediatric intensive care unit(PICU)and the diagnostic viability of metagenomic next-generation sequencing(mNGS).Methods The clinical data and mNGS results of 3 children with severe TB admitted to PICU of Anhui Provincial Children′s Hospital from January 2018 to December 2020 were retrospectively analyzed.The literature reporting children with TB diagnosed by applying mNGS were searched in China National Knowledge Infrastructure,Wanfang data,VIP and PubMed data bases,all of which were searched from the establishment of the database to March 2021,and the relevant literature was reviewed.Results(1)All of 3 cases,including 2 males and 1 female,all had fever.One case was diagnosed with X-linked severe combined immunodeficiency(X-SCID).Acid-fast stain tests of body fluid,purified protein derivative(PPD)tests and T-cell spot tests of tuberculosis infection(T-SPOT.TB)were conducted in 3 cases,with the test results being negative,and the early diagnosis was confirmed with mNGS.Two cases were discharged from the hospital after being switched to special anti-TB treatment.(2)A total of 3 articles were retrieved,in which 7 children were reported.One male with X-SCID combined with bacillus Calmette-Guérin-associated hemophagocytic syndrome and 6 children with tuberculous meningitis were subject to early diagnosis with mNGS(detection of Mycobacterium tuberculosis complex).Conclusions It is promising for the application of mNGS in rapid pathogen diagnosis of children with severe TB,especially in children with immunodeficiency.It could optimize early diagnosis and treatment to improve prognosis.

关 键 词：宏基因组二代测序 结核病 儿童重症监护病房 诊断 

分 类 号：R529.9[医药卫生—内科学]