卡介苗接种异常反应儿童淋巴细胞亚群与临床特征分析  

Analysis of lymphocyte subsets and clinical characteristics in children with abnormal reaction to Bacillus Calmette-Guérin vaccination

作　　者：王义[1] 田家豪 郭张妍 赵玉娟 李华[1] Wang Yi;Tian Jiahao;Guo Zhangyan;Zhao Yujuan;Li Hua(The Paediatric Intensive Care Unit of the Children′s Hospital Affiliated to Xi′an Jiaotong University,Xi′an 710003,China)

机构地区：[1]西安交通大学附属儿童医院重症医学科,710003 [2]西安交通大学医学部基础医学院,710061

出　　处：《国际儿科学杂志》2022年第9期635-639,共5页International Journal of Pediatrics

基　　金：陕西省科技厅-自然科学基础研究计划面上项目(2021JM-560);西安市科技局-医学研究项目(21YXYJ0009)。

摘　　要：目的探讨接种卡介苗出现异常反应儿童的淋巴细胞亚群与临床特征。方法采用回顾性研究的方法,选择2013年1月至2019年12月于西安交通大学附属儿童医院确诊的35例卡介苗接种异常反应患儿研究为对象,将疫苗注射后发生局部强反应的单纯淋巴结炎的患儿作为局限组,将淋巴结炎合并远隔器官受累的患儿为播散组。比较两组患儿临床感染指标、人口学基线资料、淋巴细胞亚群、治疗及预后的差异。结果纳入确诊患儿35例,其中局限组25例,播散组10例;男性患儿20例,女性15例;与局限组比较,播散组在咳嗽、发热、生长迟缓方面等发生率均升高,差异具有统计学意义(P<0.05);播散组比局限组在淋巴细胞比率[(61.14±18.61)%比(39.64±31.45)%]、T细胞[CD3^(+)(×10^(6)/L):(1821±487)比(1065±539)]、辅助/诱导T细胞[CD3^(+)CD4^(+)(×10^(6)/L):(1058±357)比(445±140)]、双阳性T细胞[CD3^(+)CD4^(+)CD8^(+)(×10^(6)/L):(24.07±7.17)比(14.10±8.89)]、CD4^(+)/CD8^(+)比值[CD4^(+)/CD8^(+)(%):(1.65±0.73)比(1.00±0.25)]、NK细胞[CD16^(+)CD56^(+)(×10^(6)/L):(19.70±2.34)比(12.76±7.01)]均降低,差异具有统计学意义(P<0.05)。播散组随访期内6例确诊免疫缺陷病,7例死亡;局限组均痊愈。结论儿童卡介苗反应多数预后良好,播散性患儿多数合并原发性免疫功能缺陷,预后不良,早期淋巴细胞亚群分析对卡介苗病筛查有效。Objective To investigate the lymphocyte subsets and clinical characteristics of children with abnormal reaction to Bacillus Calmette-Guérin(BCG)vaccination.Methods A total of 35 children with BCG disease diagnosed in the Children′s Hospital Affiliated to Xi′an Jiaotong University from January 2013 to December 2019 were enrolled retrospectively.Patients with strong local reaction and lymphadenitis after vaccine injection were selected as the localized group,and with lymphadenitis complicated with distant organ involvement were classified as the disseminated group.The differences in clinical infection indicators,demographic data,lymphocyte subsets and prognosis between the two groups were compared.Results There are 25 cases in the localized group and 10 cases in the disseminated group,male 20 cases and female 15 cases.Compared with the localized group,the incidence of cough,fever and growth retardation all increased in the disseminated group,with statistical significance(all P<0.05).Lymphocyte ratio[(61.14±18.61)%vs.(39.64±31.45)%],T lymphocytes[CD3^(+)(×10^(6)/L):(1821±487)vs.(1065±539)],helper/inducible T lymphocytes[CD3^(+)CD4^(+)(×10^(6)/L):(1058±357)vs.(445±140)],double positive T lymphocytes[CD3^(+)CD4^(+)CD8^(+)(×10^(6)/L):(24.07±7.17)vs.(14.10±8.89)],CD4^(+)/CD8^(+)ratio[CD4^(+)/CD8^(+)(%):(1.65±0.73)vs.(1.00±0.25)],natural killer cells[CD16^(+)CD56^(+)(×10^(6)/L):(19.70±2.34)vs.(12.76±7.01)]were lower in the disseminated group than those in the localized group and the differences were significant(all P<0.05).In the disseminated group,6 cases were diagnosed with immunodeficiency disease and 7 cases died during the follow-up period.All the children in the localized group were cured.Conclusion Most BCG reaction have a good prognosis,while disseminated children combined with primary immune deficiency have worst prognosis.Early lymphocyte subsets analysis is effective for BCG disease screening.

关 键 词：儿童 卡介苗病 免疫缺陷病 淋巴细胞亚群 

分 类 号：R725.5[医药卫生—儿科] R186[医药卫生—临床医学]