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中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (8): 854-859.doi: 10.3969/j.issn.1000-6621.2018.08.014

• 论著 • 上一篇    下一篇



  1. 430030 武汉,华中科技大学同济医学院公共卫生学院流行病与卫生统计学系
  • 收稿日期:2018-02-28 出版日期:2018-08-10 发布日期:2018-09-09
  • 通信作者: 许奕华
  • 基金资助:

Study on the infection risk and model of students in close contact with senile tuberculosis patients

Da-jie ZHANG,Jia-yu HUANG,Xu-hui LI,Meng-yu LI,Yan-shu CHEN,Ying ZHANG,Yi-hua XU()   

  1. Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  • Received:2018-02-28 Online:2018-08-10 Published:2018-09-09
  • Contact: Yi-hua XU


目的 通过老年结核病患者(以下称“指示病例”)对家庭成员中的高危易感人群——学生的密切接触者的感染风险及模型研究,为学生结核病密切接触者感染结核病的早期发现提供科学依据。方法 选取武汉市结核病防治机构2016年5月至2017年11月登记的244例新发老年结核病患者,通过自我推荐并根据纳入和排除标准,最终纳入209名学生密切接触者,对密切接触者进行问卷调查以及PPD试验。利用单因素分析和多元logistic回归模型,筛选老年结核病学生密切接触者结核病感染的风险因素,并研究得出关键风险因素及建立决策树模型。结果 209名学生密切接触者PPD试验阳性率为77.51%(162/209)。logistic逐步回归分析显示,学生密切接触者与指示病例接触的时间(OR=29.17,95%CI:4.65~183.04)、场所通风情况(OR=5.79,95%CI:2.14~15.67)、自我防护意识(OR=3.56,95%CI:1.24~10.22)在PPD试验结果阳性者与阴性者之间的分布差异具有统计学意义。利用logistic回归分析的结果,建立的决策树模型共3层,7个结节点。与指示病例接触的时间长短对密切接触者结核感染风险影响最大,接触时间≥2h的阳性率为97.30%(72/74),高于<2h的阳性率[66.67%(90/135)]。接触指示病例时密切接触者的自我防护意识是次级影响因素,在接触时间<2h结节点下,没有自我防护意识的密切接触者阳性率为94.12%(48/51),高于有自我防护意识的阳性率[50.00%(42/84)]。而有自我防护意识这一结节点下,接触场所通风条件好的阳性率为25.00%(12/48),低于接触场所通风条件中等或差等的阳性率[83.33%(30/36)]。结论 决策树模型提示与指示病例接触的时间长短、接触地点的通风情况及自我防护意识是学生密切接触者结核感染的重要影响因素,同时揭示了各个因素的影响程度:与指示病例接触时间>自我防护意识>接触地点的通风情况。

关键词: 结核, 肺, 老年人, 接触者追踪, 学生, 决策树, 比例危险度模型


Objective To provide scientific basis for the early detection of tuberculosis (TB) infection in close contacts though investigating the infection risk and model of students (the high-risk and susceptible family members) who were in close contact with elderly TB cases (referred to as indicator cases).Methods A total of 244 newly diagnosed elderly TB patients were registered in the Tuberculosis Prevention and Treatment Center in Wuhan from May 2016 to November 2017. By self-recommendation and according to the inclusion and exclusion criteria, 209 student close contacts were enrolled. A questionnaire survey and a purified protein derivative (PPD) test were conducted. Univariate analysis and multivariate logistic regression models were used to screen the risk factors for TB infection in student close contacts of senile tuberculosis and to study the key risk factors and establish a decision tree model.Results The positive rate of PPD test among the 209 student close contacts was 77.51% (162/209). Logistic stepwise regression analysis showed that the duration of contact with the indicator cases (OR=29.17, 95%CI: 4.65-183.04), site ventilation (OR=5.79, 95%CI: 2.14-15.67), and self-protection awareness (OR=3.56, 95%CI: 1.24-10.22) had statistically significant differences between the students with positive and negative PPD test results. Using the results of logistic regression analysis, the decision tree model was built with 3 layers and 7 nodes. The duration of exposure to the indicator cases had the greatest impact on the risk of TB infection in close contacts. The positive rate of student with a contact time of ≥2 h was 97.30% (72/74), which was higher than that of students with a contact time of <2 h (66.67% (90/135)). The self-protection awareness of close contacts was a secondary influence factor when exposed to indicator cases. Under the contact time <2 h node, the positive rate of close contacts without self-protection awareness was 94.12% (48/51), which was higher than that of contacts with self-protection consciousness (50.00% (42/84)). In the self-protection awareness node, the positive rate of contacts in good ventilation condition at the site of exposure was 25.00% (12/48), lower than that of contacts in moderate or poor ventilation condition at the site of exposure (83.33% (30/36)).Conclusion The decision tree model indicates the duration of contact with the indicator cases, the ventilation at the contact sites and the self-protection awareness as important influencing factors of TB infection among students close contacts. The degree of influence of each factor was as follows: contact time > self-protection awareness > contact point ventilation.

Key words: Tuberculosis, pulmonary, Aged, Contact tracing, Students, Decision trees, Proportional hazards models