Tuberculin Response in Infants Six Months after an Intradermal Bacille Calmette-Guérin Vaccination

初生兒接種卡介苗預防注射六個月後之皮膚結核菌素反應

沈仲敏(Chung-Min Shen) ； 宋文舉(Wen-Jue Soong) ； 鄭枚枝(Mei-Jy Jeng) ； 黃碧桃(Betau Hwang)

《輔仁醫學期刊》 5卷3期 (2007/09) Pp. 115-121

摘要

初生兒施行卡介苗疫苗預防注射，在台灣施行已久，由於近來結核病的死灰復燃，便以此篇研究評估卡介苗預防注射在台灣的有效性及注射後之皮膚反應。本研究收集自2001年5月至2001年10月中在本院出生之健康新生兒，由家長填寫同意書後接受CBC、DC及CXR之檢查，並於出生48小時內注射卡介苗，個案須於出生第1、第4、第8、第12 及第24 週返診，返診時由專人做身體理學檢查並紀錄注射處皮膚的變化，此外第24週返診時需重複檢查CBC、DC、CXR，及接受皮膚結核菌素測驗，並在48至72小時後檢查反應。結果共收集了150個個案，其中109人完成實驗，皮膚結核菌素測驗呈陽性者佔68.2%，其中有一人注射處皮膚完全沒有反應但皮膚結核菌素測驗卻呈陽性。皮膚結核菌素測驗轉陽性和注射處是否形成疤痕組織沒有相關性，卻和注射處是否曾化膿有相關。因此以是否有疤痕組織之形成來研判卡介苗預防注射之有效性並不準確，但能否以注射處是否曾化膿來評估尚需要更多之研究來證實。

關鍵字

結核病 ； 卡介苗預防注射 ； 皮膚結核菌素測驗

並列摘要

Background and Purpose: We evaluated the effectiveness of a bacille Calmette-Guérin (BCG) vaccination in term infants by looking at the following criteria: (1) the percentage of infants with scarring; (2) the percentage of infants experiencing tuberculin conversion 6 months after the vaccination; and (3) the number of complications from the vaccination. Materials and Methods: From May to October 2001, healthy full-term infants born at our hospital whose parents provided informed consent were enrolled. They received a BCG vaccination within 48 h of birth, and the vaccination site was examined when the infants were 1, 4, 8, 12, and 24weeks old. They were given a purified protein derivative (PPD) skin test at 6 months old, and the reaction was checked 48~72h later. Results: In total, 150 term infants were enrolled, among which 109 infants completed the course. The PPD test was positive (induration ≥5mm) in 75 (68.2%) of the infants. One infant had no visible BCG vaccination lesion, but the PPD skin test was positive. There was no correlation between the rate of scarring and tuberculin conversion in these infants. There was a significant correlation between sterile abscess formation and tuberculin conversion. Conclusions: Although the tuberculin response after the BCG vaccination could not be predicted by scar formation, it was correlated with abscess formation.

並列關鍵字

BCG vaccine ； tuberculin test ； tuberculosis