中国实用儿科杂志

中国实用儿科杂志 ›› 2026, Vol. 41 ›› Issue (3): 246-251.DOI: 10.19538/j.ek2026030614

• 论著 • 上一篇    下一篇

免疫功能低下儿童结核病的临床特征和预后分析

  

  1. 1.国家儿童医学中心  首都医科大学附属北京儿童医院呼吸中心临床部二病区，北京  100045；2.北京市昌平区妇幼保健院儿科，北京  102200
  • 出版日期:2026-03-06 发布日期:2026-04-23
  • 通讯作者: 李惠民，电子信箱：lihuimindoc@163.com

Clinical characteristics and prognosis analysis of immunocompromised children with tuberculosis

  1. *Department No.2 of Respiratory Medicine，Beijing Children’s Hospital，Capital Medical University，National Center for Children’s Health，Beijing  100045，China
  • Online:2026-03-06 Published:2026-04-23

摘要： 目的　总结免疫功能低下儿童结核病的临床特征，探讨影响其预后的相关因素。方法　回顾性分析2017年1月至2022年12月期间北京儿童医院呼吸中心住院确诊结核病患儿的临床资料，同时随访其预后情况，对影响预后的危险因素进行回归分析。结果　269例儿童结核病中，免疫功能低下组58例（21.56%），40例（68.97%）存在原发性免疫缺陷疾病，其中慢性肉芽肿病多见（15例，37.50%），免疫功能正常对照组211例（78.44%）。免疫功能低下组易并发肺外结核（P<0.05），多无结核接触史（84.48%），接种卡介苗后卡疤阳性率偏低（66.67% vs. 81.55%），易诊断延迟（P<0.01）。免疫功能低下组更易出现呼吸困难、淋巴结肿大、肝脾增大以及严重结核病（P<0.05）；且其结核菌素皮肤试验、γ-干扰素释放试验以及结核分枝杆菌DNA检测阳性率均低于免疫功能正常对照组；其 CD4+T淋巴细胞百分比明显减低（P<0.01）。免疫功能低下组加用二线治疗占62.07%（36/58），高于对照组42.65%（90/211）（P<0.05），抗结核药物治疗时长26（18，31）个月明显长于对照组18（16，24）个月（P<0.01），抗结核相关药物不良反应发生率更高（78.85% vs. 53.37%，P<0.01）。免疫功能低下儿童结核病预后欠佳者33例（63.46%），其中死亡者13例（25.00%），其预后危险因素为存在原发性免疫缺陷疾病（OR值为4.050，P=0.030）、疾病严重程度分度（OR值为5.000，P=0.012）。结论　免疫功能低下儿童合并结核病时多无结核接触史，临床症状不典型，易发生严重结核病及并发肺外结核；免疫学试验和病原学检测阳性率低，需要结合多种检测方式以诊断，治疗方面需要更强的化疗方案和更长的疗程，其预后多较差，病死率较高。

关键词:

Abstract: Objective　To summarize the clinical characteristics of tuberculosis in immunocompromised children and to investigate the factors influencing their prognosis. Methods　A retrospective analysis was conducted on the clinical data of pediatric tuberculosis patients admitted to the Respiratory Center of Beijing Children’s Hospital between January 2017 and December 2022. The prognosis of these children was followed up，and a regression analysis was performed on the risk factors affecting the prognosis. Results　Among the 269 children with tuberculosis，58（21.56%） were in the immunocompromised group，of which 40（68.97%） had primary immunodeficiency diseases，with chronic granulomatous disease being the most common（15 cases，37.50%）. The control group with normal immune function comprised 211 cases（78.44%）. The immunocompromised group was more prone to extrapulmonary tuberculosis（P<0.05），and had a lower rate of tuberculosis contact history（84.48%），a lower rate of positive BCG scar after BCG vaccination（66.67% vs. 81.55%），and a higher rate of delayed diagnosis（P<0.01）. The immunocompromised group was more likely to present with dyspnea，lymphadenopathy，hepatosplenomegaly，and severe tuberculosis（P<0.05）；the positive rates of tuberculin skin test，interferon-γ release assay，and Mycobacterium tuberculosis DNA detection were all lower than those in the normal immune function control group；and the percentage of CD4+ T lymphocytes was significantly lower（P<0.01）. The proportion of children in the immunocompromised group who received second-line treatment was 62.07%（36/58），which was higher than 42.65%（90/211） in the control group（P<0.05）. The duration of anti-tuberculosis drug treatment was 26（18，31） months，which was significantly longer than 18（16，24） months in the control group（P<0.01），and the incidence of adverse reactions to anti-tuberculosis drugs was higher（78.85% vs. 53.37%，P<0.01）. Among the 58 children in the immunocompromised group，33（63.46%） had a poor prognosis，including 13 deaths（25.00%）. The risk factors for poor prognosis were the presence of primary immunodeficiency diseases（OR：4.050，P= 0.030） and the severity of the disease（OR：5.000，P=0.012）. Conclusion　Immunocompriomised children with tuberculosis often have no history of tuberculosis contact，the clinical symptoms are atypical，and they are prone to severe tuberculosis and extrapulmonary tuberculosis. The positive rates of immunological tests and pathogen detection are low，and multiple detection methods need to be combined for diagnosis. In terms of treatment，a stronger chemotherapy regimen and a longer course of treatment are required，and the prognosis is often poor with a higher mortality rate.

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