浙江省常山县农村老年人结核分枝杆菌潜伏感染情况及影响因素

doi:10.19982/j.issn.1000-6621.20230399

摘要/Abstract

摘要：

目的：了解浙江省常山县农村老年人结核分枝杆菌潜伏感染(latent tuberculosis infection, LTBI)情况及相关影响因素,为制定针对性的干预措施提供科学依据。方法：从“中国疾病预防控制信息系统”的子系统“结核病管理信息系统”中,以2017—2021年近5年结核病报告发病率排序,选取浙江省衢州市常山县报告发病率最高乡镇的3个村庄全部常住农村老年人为调查对象,最终共纳入909名。收集研究对象的人口学特征、吸烟史和饮酒史等信息。采用γ-干扰素诱导蛋白-10 (IP-10) mRNA 释放试验检测LTBI的情况,采用多因素logistic回归分析其影响因素。结果：909名研究对象中,LTBI阳性375例(41.25%),阴性534名(58.75%)。多因素logistic回归分析显示,男性(OR=1.676,95%CI:1.170~2.401)相较于女性,面临更大的LTBI风险,而血清高密度脂蛋白水平较高(OR=0.607,95%CI:0.433~0.852)的人群,其LTBI风险则相对较小。结论：浙江省常山县农村老年人LTBI率较高,特别要关注男性和高密度脂蛋白水平偏低的人群。

关键词: 分枝杆菌,结核, 感染, 因素分析,统计学

Abstract:

Objective: To investigate the status of latent tuberculosis infection (LTBI) among elderly rural residents in Changshan County, Zhejiang Province, and its related influencing factors, so as to provide scientific basis for formulating targeted intervention measures. Methods: In the “Tuberculosis Management Information System”, a subsystem of the “China Disease Control Information System”, the towns were sorted by the reported incidence of tuberculosis in the past five years from 2017 to 2021, all the permanent elderly rural residents were selected as the investigation objects in the three villages with the highest reported incidence in Changshan County, Quzhou City, Zhejiang Province, and a total of 909 people were included. Demographic information, smoking history and drinking history were collected. LTBI was detected by interferon gamma-induced protein 10 (IP-10) mRNA release test, and its influencing factors were analyzed by multivariate logistic regression. Results: Among the 909 study subjects, 375 tested positive for LTBI (41.25%) and 534 tested negative (58.75%). Multivariable logistic regression analysis showed that male participants (OR=1.676,95%CI: 1.170-2.401) had a higher risk of LTBI than female participants, while those with higher levels of serum high-density lipoprotein (OR=0.607,95%CI: 0.433-0.852) had a relatively lower risk of LTBI. Conclusion: Elderly rural residents in Changshan County, Zhejiang Province have a high prevalence of LTBI, with particular attention should be paid to males and those with lower levels of high-density lipoprotein.

Key words: Mycobacterium tuberculosis, Infection, Factor analysis, statistics

中图分类号:

R521
R446.5

陈瑞麒, 张明五, 王伟, 陈松华, 柳正卫, 陈彬. 浙江省常山县农村老年人结核分枝杆菌潜伏感染情况及影响因素[J]. 中国防痨杂志, 2024, 46(4): 383-389. doi: 10.19982/j.issn.1000-6621.20230399

Chen Ruiqi, Zhang Mingwu, Wang Wei, Chen Songhua, Liu Zhengwei, Chen Bin. Prevalence and influencing factors of latent tuberculosis infection among elderly rural residents in Changshan County, Zhejiang Province[J]. Chinese Journal of Antituberculosis, 2024, 46(4): 383-389. doi: 10.19982/j.issn.1000-6621.20230399

图/表 5

表1

表2

表3

表4

表5

老年人发生结核分枝杆菌潜伏感染影响因素的多因素logistic回归分析

影响因素	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
性别
女性					1.000
男性	0.516	0.183	7.924	0.005	1.676(1.170~2.401)
吸烟情况
从不吸烟					1.000
当前吸烟	-0.033	0.214	0.024	0.877	0.967(0.636~1.471)
曾经吸烟(已戒烟)	-0.065	0.239	0.074	0.937	0.937(0.586~1.498)
实验室检查
白细胞	0.072	0.046	2.464	0.116	1.075(0.982~1.175)
空腹血糖	0.088	0.059	2.250	0.134	1.092(0.973~1.226)
高密度脂蛋白	-0.499	0.173	8.314	0.004	0.607(0.433~0.852)

表5

参考文献 25

[1]	World Health Organization. Global tuberculosis report 2023. Geneva: World Health Organization, 2023.
[2]	Bouzeyen R, Javid B. Therapeutic Vaccines for Tuberculosis: An Overview. Front Immunol, 2022, 13:878471. doi:10.3389/fimmu.2022.878471.
[3]	Cohen A, Mathiasen VD, Schön T, et al. The global prevalence of latent tuberculosis: a systematic review and meta-analysis. Eur Respir J, 2019, 54(3):1900655. doi:10.1183/13993003.00655-2019.
[4]	Houben RM, Dodd PJ. The Global Burden of Latent Tuberculosis Infection: A Reesti-mation Using Mathematical Modelling. PLoS Med, 2016, 13(10):e1002152. doi:10.1371/journal.pmed.1002152.
[5]	Bagcchi S. WHO’s Global Tuberculosis Report 2022. Lancet Microbe, 2023, 4(1):e20. doi:10.1016/S2666-5247(22)00359-7.
[6]	Pagaduan JV, Altawallbeh G. Advances in TB testing. Adv Clin Chem, 2023, 115:33-62. doi:10.1016/bs.acc.2023.03.003. pmid: 37673521
[7]	Zellweger JP, Sotgiu G, Corradi M, et al. The diagnosis of latent tuberculosis infection (LTBI): currently available tests, future developments, and perspectives to eliminate tuberculosis (TB). Med Lav, 2020, 111(3):170-183. doi:10.23749/mdl.v111i3.9983. pmid: 32624559
[8]	Gao L, Bai L, Liu J, et al. LATENTTB-NSTM study team. Annual risk of tuberculosis infection in rural China: a population-based prospective study. Eur Respir J, 2016, 48(1):168-178. doi:10.1183/13993003.00235-2016. pmid: 27230438
[9]	王前, 李涛, 杜昕, 等. 2015—2019年全国肺结核报告发病情况分析. 中国防痨杂志, 2021, 43(2):107-112. doi:10.3969/j.issn.1000-6621.2021.02.002.
[10]	吴倩, 张钰, 刘魁, 等. 2016—2020年浙江省肺结核流行特征分析. 预防医学, 2022, 34(5):487-491. doi:10.19485/j.cnki.issn2096-5087.2022.05.013.
[11]	Ault R, Dwivedi V, Koivisto E, et al. Altered monocyte phenotypes but not impaired peripheral T cell immunity may explain susceptibility of the elderly to develop tuberculosis. Exp Gerontol, 2018, 111:35-44. doi:10.1016/j.exger.2018.06.029. pmid: 29991459
[12]	Niki M, Yoshiyama T, Nagai H, et al. Nutritional status positively impacts humoral immunity against its Mycobacterium tuberculosis, disease progression, and vaccine development. PLoS One, 2020, 15(8):e0237062. doi:10.1371/journal.pone.0237062.
[13]	Jamal A, Phillips E, Gentzke AS, et al. Current Cigarette Smoking Among Adults-United States, 2016. MMWR Morb Mortal Wkly Rep, 2018, 67(2):53-59. doi:10.15585/mmwr.mm6702a1.
[14]	Jeon KH, Han K, Jeong SM, et al. Changes in Alcohol Consumption and Risk of Dementia in a Nationwide Cohort in South Korea. JAMA Netw Open, 2023, 6(2):e2254771. doi:10.1001/jamanetworkopen.2022.54771.
[15]	高磊, 张慧, 胡茂桂, 等. 基于多中心调查数据和空间统计模型的全国结核分枝杆菌潜伏感染率估算. 中国防痨杂志, 2022, 44(1): 54-59. doi:10.19982/j.issn.1000-6621.20210661.
[16]	World Health Organization. Guidelines on the management of latent tuberculosis infection. Geneva: World Health Organization, 2015.
[17]	Uplekar M, Weil D, Lonnroth K, et al. WHO’s new end TB strategy. Lancet, 2015, 385(9979):1799-1801. doi:10.1016/S0140-6736(15)60570-0. pmid: 25814376
[18]	Gao L, Lu W, Bai L, et al. Latent tuberculosis infection in rural China: baseline results of a population-based, multicentre, prospective cohort study. Lancet Infect Dis, 2015, 15(3):310-319. doi:10.1016/S1473-3099(14)71085-0. pmid: 25681063
[19]	雷蓉蓉, 张婷, 吴成果, 等. 南川区居民结核潜伏感染调查. 预防医学, 2022, 34(4): 371-374. doi:10.19485/j.cnki.issn2096-5087.2022.04.010.
[20]	Lwin TT, Apidechkul T, Saising J, et al. Prevalence and determinants of TB infection in a rural population in northeastern Myanmar. BMC Infect Dis, 2020, 20(1):904. doi:10.1186/s12879-020-05646-8. pmid: 33256645
[21]	Chen C, Zhu T, Wang Z, et al. High Latent TB Infection Rate and Associated Risk Factors in the Eastern China of Low TB Incidence. PLoS One, 2015, 10(10):e0141511. doi:10.1371/journal.pone.0141511.
[22]	Chan ED, Kinney WH, Honda JR, et al. Tobacco exposure and susceptibility to tuberculosis: is there a smoking gun? Tuberculosis (Edinb), 2014, 94(6):544-550. doi:10.1016/j.tube.2014.08.010.
[23]	Bates MN, Khalakdina A, Pai M, et al. Risk of tuberculosis from exposure to tobacco smoke: a systematic review and meta-analysis. Arch Intern Med, 2007, 167(4):335-342. doi:10.1001/archinte.167.4.335. pmid: 17325294
[24]	张春景, 马路一, 高蓓. 高密度脂蛋白在抗感染中的作用. 社区医学杂志, 2015, 13(6): 67-70.
[25]	Alsayed Hasanain AF, El-Maghraby KM, H Zayed AA, et al. Latent tuberculosis infection among patients with coronary artery stenosis: A case-Control study. Int J Mycobacteriol, 2018, 7(2):143-147. doi:10.4103/ijmy.ijmy_34_18. pmid: 29900890

特征	人数(名)	构成比(%)
年龄组(岁)
65~69	287	31.57
70~74	278	30.58
75~79	192	21.12
80~84	79	8.70
≥85	73	8.03
性别
男性	482	53.03
女性	427	46.97
体质量指数
<18.5	91	10.01
18.5~23.9	517	56.88
24.0~27.9	246	27.06
≥28.0	55	6.05
吸烟情况
从未吸烟	603	66.34
当前吸烟	186	20.46
曾经吸烟(已戒烟)	120	13.20
饮酒情况
从不饮酒	638	70.19
当前饮酒	230	25.30
曾经饮酒(已戒酒)	41	4.51
锻炼情况
不锻炼	540	59.41
偶尔锻炼	165	18.15
经常锻炼	45	4.95
每天锻炼	159	17.49
胸部X线摄片结果
正常	758	83.39
异常	151	16.61
合并糖尿病
是	60	6.60
否	849	93.40

特征	合计 (例/名)	阳性[例 (构成比,%)]	阴性[名 (构成比,%)]	χ²值	P值
年龄组(岁)				1.169	0.280
65~69	287	118(41.11)	169(58.89)
70~74	278	102(36.69)	176(63.31)
75~79	192	87(45.31)	105(54.69)
80~84	79	37(46.84)	42(53.16)
≥85	73	31(42.47)	42(57.53)
性别				11.531	<0.001
男性	482	224(46.47)	258(53.53)
女性	427	151(35.36)	276(64.64)
体质量指数				3.443	0.328
<18.5	91	30(32.97)	61(67.03)
18.5~23.9	517	223(43.13)	294(56.87)
24.0~27.9	246	99(40.24)	147(59.76)
≥28.0	55	23(41.82)	32(58.18)
吸烟情况				6.508	0.039
从未吸烟	603	233(38.64)	370(61.36)
当前吸烟	186	87(46.77)	99(53.23)
曾经吸烟(已戒烟)	120	55(45.83)	65(54.17)
饮酒情况				1.699	0.192
从不喝酒	638	255(40.03)	382(59.97)
当前喝酒	230	100(43.29)	131(56.71)
曾经喝酒(已戒酒)	41	20(48.78)	21(51.22)
锻炼情况				5.721	0.126
不锻炼	540	228(42.22)	312(57.78)
偶尔锻炼	165	61(36.97)	104(63.03)
经常锻炼	45	13(28.89)	32(71.11)
每天锻炼	159	73(45.91)	86(54.09)
胸部X线摄片结果				1.067	0.302
正常	758	307(40.50)	451(59.50)
异常	151	68(45.03)	83(54.97)
合并糖尿病				2.874	0.090
是	60	31(51.67)	29(48.33)
否	849	344(40.52)	505(59.48)

指标	阳性(375例)	阴性(534名)	Z值	P值
血常规
白细胞[×10⁹/L,M(Q₁,Q₃)]	5.70(4.80,6.70)	5.50(4.60,6.40)	-2.655	0.008
血红蛋白[g/L,M(Q₁,Q₃)]	132.00(122.00,144.00)	131.00(122.00,141.00)	-1.097	0.273
血小板[×10⁹/L,M(Q₁,Q₃)]	169.00(137.00,211.00)	167.00(134.00,207.00)	-0.988	0.323
血糖水平
空腹血糖[mmol/L,M(Q₁,Q₃)]	5.14(4.71,5.65)	4.97(4.61,5.48)	-2.897	0.004
肝功能
谷丙转氨酶[U/L,M(Q₁,Q₃)]	18.00(13.00,26.00)	17.50(13.00,23.00)	-0.522	0.601
谷草转氨酶[U/L,M(Q₁,Q₃)]	25.00(21.00,31.00)	26.00(22.00,31.00)	-1.252	0.210
总胆红素[μmol/L,M(Q₁,Q₃)]	11.50(8.80,15.10)	11.90(9.10,15.38)	-1.052	0.293
肾功能
血清肌酐[μmol/L,M(Q₁,Q₃)]	74.00(62.00,85.00)	72.00(62.00,86.00)	-1.393	0.164
血尿素[mmol/L,M(Q₁,Q₃)]	6.01(5.03,7.61)	6.20(5.13,7.27)	-0.037	0.971
血脂水平
总胆固醇[mmol/L,M(Q₁,Q₃)]	4.87(4.21,5.53)	5.00(4.29,5.69)	-1.340	0.180
甘油三酯[mmol/L,M(Q₁,Q₃)]	1.33(0.97,2.03)	1.31(0.97,1.84)	-0.894	0.371
血清低密度脂蛋白[mmol/L,M(Q₁,Q₃)]	2.67(2.11,3.20)	2.70(2.11,3.32)	-0.719	0.472
血清高密度脂蛋白[mmol/L,M(Q₁,Q₃)]	1.41(1.16,1.67)	1.50(1.24,1.82)	-3.577	<0.001

变量	赋值	变量	赋值
性别	0=女;1=男	吸烟情况	0=从未吸烟;1=当前吸烟;2=曾经吸烟(已戒烟)
白细胞	原值代入	高密度脂蛋白	原值代入
空腹血糖	原值代入