先天性和产后结核病婴儿的临床表现、诊断和结局：儿科结核病网络欧洲试验组（ptbnet）的一项多中心队列研究

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe Pub Date : 2025-04-19 DOI:10.1016/j.lanepe.2025.101303

Florian Götzinger , Alejandra Alonso Caprile , Antoni Noguera-Julian , Andrea Lo Vecchio , Fernando Baquero-Artigao , Teresa del Rosal , Folke Brinkmann , Françoise Mouchet , Svetlana Velizarova , Karsten Kötz , Nicole Ritz , Danilo Buonsenso , Rinn Song , Robindra Basu Roy , Tea Nieminen , Cornelius Rau , Vira Chechenieva , Steven Welch , Petra Kaiser-Labusch , Marieke Emonts , Nuria Martinez-Alier

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引用次数: 0

摘要

据估计，全球每年有20多万孕妇患结核病。尽管如此，关于围产期结核病的数据仍然很少。本研究旨在描述围产期结核病，包括先天性（cTB）和产后（pTB）结核病，在欧洲设置。方法通过欧洲儿科结核病网络试验组（ptbnet）进行回顾性队列研究，收集并比较1995年至2019年104家参与欧洲医疗机构诊断的cTB和pTB病例。结果20个中心报告的46例病例被纳入最终分析(cTB, n = 27；pTB, n = 19)。cTB患者出现症状的中位年龄为1周（IQR: 0-1周），pTB患者为12周（IQR: 5-18周）。早产在cTB患者中比pTB患者更常见[57.9% (11/19)；95% CI: 36.3-76.9% vs. 21.1% (4/19)；95% ci: 8.5-43.3%；P = 0.049]，平均出生体重显著降低[1680 g]；IQR: 932-2805 g vs. 2890 g；IQR: 2461-3400 g；p = 0.0043]。大多数患者获得微生物学确认[85.2% (23/27)]；95% CI: 67.5-94.1% vs. 78.9% (15/19)；95% ci: 56.7-91.5%；p = 0.70]。两组患者干扰素释放试验敏感性均较差[25.0% (3/12)95% CI: 8.9-53.2% vs. 35.7% (5/14) 95% CI: 16.3-61.2%；p = 0.68]；相比之下，肺结核患者结核菌素皮肤试验（5 mm截止点）的敏感性显著更高[16.7% (2/12)95% CI: 4.7-44.8% vs. 66.7% (10/15)；95% ci: 41.7-84.8%；p = 0.0185]。大约一半的患者需要重症监护支持[51.9% (14/27)95% CI: 34.0-69.3% vs. 47.4% (9/19)；95% ci: 27.3-68.3%；p比;0.99]。四(4/46;8.7%的患者死亡，4例(4/46；8.7%)有严重的长期后遗症。尽管在高资源环境下，该患者队列中仍有大量的死亡率和发病率。cTB与早产和低出生体重有关。与微生物测试相比，免疫测试在围产期结核病方面表现不佳，因此不应用作排除测试。资金：没有研究专项资金。

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Clinical presentation, diagnostics, and outcomes of infants with congenital and postnatal tuberculosis: a multicentre cohort study of the Paediatric Tuberculosis Network European Trials Group (ptbnet)

Background

According to estimates, globally more than 200,000 pregnant women develop tuberculosis (TB) annually. Despite this, data on perinatal TB remain scarce. This study aimed to describe perinatal TB, comprising congenital (cTB) and postnatal (pTB) TB, in a European setting.

Methods

Retrospective cohort study via the Paediatric Tuberculosis Network European Trials Group (ptbnet) capturing and comparing cases of cTB and pTB diagnosed at 104 participating European healthcare institutions between 1995 and 2019.

Findings

Forty-six cases reported by 20 centres were included in the final analysis (cTB, n = 27; pTB, n = 19). Median age at symptom onset was one week in cTB (IQR: 0–1 weeks), and 12 weeks in pTB patients (IQR: 5–18 weeks). Prematurity was more common in cTB than pTB patients [57.9% (11/19); 95% CI: 36.3–76.9% vs. 21.1% (4/19); 95% CI: 8.5–43.3%; p = 0.049], and the average birth weight was significantly lower [1680 g; IQR: 932–2805 g vs. 2890 g; IQR: 2461–3400 g; p = 0.0043]. Microbiological confirmation was achieved in most patients [85.2% (23/27); 95% CI: 67.5–94.1% vs. 78.9% (15/19); 95% CI: 56.7–91.5%; p = 0.70]. The sensitivity of interferon-gamma release assays was poor in both groups [25.0% (3/12) 95% CI: 8.9–53.2% vs. 35.7% (5/14) 95% CI: 16.3–61.2%; p = 0.68]; in contrast, the sensitivity of the tuberculin skin tests (at 5 mm cut-off) was significantly higher in pTB patients [16.7% (2/12) 95% CI: 4.7–44.8% vs. 66.7% (10/15); 95% CI: 41.7–84.8%; p = 0.0185]. Approximately half of the patients required intensive care support [51.9% (14/27) 95% CI: 34.0–69.3% vs. 47.4% (9/19); 95% CI: 27.3–68.3%; p > 0.99]. Four (4/46; 8.7%) patients died, and four (4/46; 8.7%) had severe long-term sequelae.

Interpretation

There was substantial mortality and morbidity in this patient cohort, despite the high-resource setting. cTB was associated with premature birth and low birth weight. In contrast to microbiological tests, immunological tests perform poorly in perinatal TB, and should therefore not be used as rule-out tests.

Funding

No study-specific funding.

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.