免疫功能低下儿童和青少年的结核病:儿童结核病网络 欧洲试验组 多中心病例控制研究
Paula Rodríguez-Molino1,2,3,4, Marc Tebruegge5,6,7, Antoni Noguera-Julian8,9,10
1General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain.
概括
在欧洲,患有免疫性损害 (IC) 和结核病 (TB) 的儿童面临更严重的疾病和长期问题. 对结核病的标准免疫检测在这些脆弱的儿童中效果较差.
科学领域:
- 儿童传染病 儿童传染病
- 免疫学 免疫学 免疫学
- 公共卫生 公共卫生
背景情况:
- 在高资源环境中,免疫受损 (IC) 儿童的存活率增加.
- 儿童群体中免疫抑制疗法的使用越来越多.
- 结核病 (TB) 仍然是免疫力低下儿童的一个重大问题.
研究的目的:
- 研究欧洲儿童结核病的临床特征.
- 评估结核病测试在IC儿科患者的诊断性能.
- 为了确定结核病在IC儿童的结核病结局,与非IC儿童相比.
主要方法:
- 多中心,匹配病例控制研究.
- 包括2000年至2020年期间诊断的结核病例 (<18岁).
- 139名IC儿童与278名非IC儿童的比较.
主要成果:
- 免疫功能低下的儿童患非呼吸性结核病 (32.4% vs 21.2%) 和严重疾病 (57.6% vs 38.5%) 的比率更高.
- 结核素皮肤试验和QuantiFERON-TB Gold试验在IC儿童中显示出更高的假阴性率 (分别为31.9%和30.0%).
- 尽管微生物学确认率相似,但IC儿童的长期后果明显更高 (14.8%与6.1%相比).
结论:
- 欧洲的IC和结核病儿童表现出非呼吸结核病的增加,严重的疾病和长期的后果.
- 目前的基于免疫的结核病测试表明,在免疫功能低下的儿科患者中,结核病的敏感性较差.
- 未来的研究应该优先开发改进的免疫结核病测试,并了解后果,以告知预防策略.
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