监测封闭社区结核病患者接触者结核感染状况二年的结果分析

doi:10.3969/j.issn.1000-6621.2019.08.015

摘要/Abstract

摘要：

目的监测封闭社区(强制隔离戒毒所)中结核病患者接触者(简称“接触者”)的结核感染状况,并初步分析可能对该社区接触者受结核感染的影响因素。方法采用结核菌素试验(PPD试验),对封闭社区中2016年10—11月确诊的5例结核病患者的所有接触者(共计792名)每6个月进行1次PPD试验,连续观察2年,其中有25名因各种原因未进行PPD试验,接受PPD试验者767名。依据《WS 288—2017 肺结核诊断》,有卡介苗接种卡痕者硬结平均直径≥10mm、无卡痕者硬结平均直径≥5mm判断为接触者结核感染。分析不同接触程度的767名接触者受MTB感染状况的变化情况。并用logistic回归模型进行社区接触者结核感染的危险因素分析。结果在调查的封闭社区中,接触者第一次PPD试验结果被判断为结核感染者444例,感染率为57.9%(444/767)。在后续2年的结核感染监测中,323名未感染者中有54例(占16.7%,54/323)接触者变为结核感染;2年中社区接触者受结核感染者共498例,感染率64.9%(498/767)。有54名社区接触者在2年中PPD试验硬结直径减小或消失,由受结核感染变为未感染状态,占10.8%(54/498)。年龄(Wald χ ²=10.942,P=0.001,OR=1.04, 95%CI为1.02~1.06)、接种卡介苗(Wald χ ²=4.533,P=0.033,OR=1.41, 95%CI 为1.03~1.93)、与患者密切接触(Wald χ ²=6.343,P=0.012,OR=1.68, 95%CI 为1.12~2.52),是导致社区接触者结核感染风险增加的相关因素。讨论封闭社区(强制隔离戒毒所)中结核病患者接触者MTB感染率较高,首次PPD试验筛查未感染者中有近1/6的接触者在2年间转为结核感染;有1/10结核感染者在2年间转为未感染状态。年龄增长、接种卡介苗、与结核病患者密切接触者受结核感染的比例增高。

关键词: 结核,肺, 接触者追踪, 结核菌素试验, 感染, 人群监测, 因素分析,统计学, 吸毒者

Abstract:

Objective To understand the prevalence of latent tuberculosis infection (LTBI) among TB contacts who were institutionalized for drugs in a compulsory rehabilitation center; further, to analyze the factors associated with risks of TB infection.Methods Five TB cases were detected during October to November, 2016. Tuberculosis skin test (TST) for TB infection were provided to all the institutionalized persons who had contacted the TB cases at the same period. Follow-up TSTs were given every 6 months to these contacts for two years. TST positivity is defined as an induration ≥10 mm for BCG-vaccinated (with a BCG scar), or ≥5 mm for people without a BCG scar, according to the WS 288-2017 Diagnosis for pulmonary tuberculosis. Prevalence of LTBI were measured, and logistic regression was applied for analyzing the factors associated with LTBI.Results Of the 792 TB contacts, 25 declined the TST. The prevalence of LTBI at the first TST examination was 57.9% (444 among the 767 contacts). During the follow-up, another 54 contacts who were negative at first became TST positive, led to an 16.7% (54/323) increment. In total, the 2-year positivity was 64.9% (498/767). Of the 498 TST positive cases, 54 had a diminished TST induration, which suggested a change to TST negative (10.8%, 54/498). Age (Wald χ ²=10.942,P=0.001,OR=1.04, 95%CI: 1.02-1.06), BCG vaccination (Wald χ ²=4.533,P=0.033,OR=1.41, 95%CI 1.03-1.93) and close contact to TB patients (Wald χ ²=6.343,P=0.012,OR=1.68, 95%CI: 1.12-2.52) were significantly associated with LTBI by TST in the study population. Conclusion The prevalence of LTBI is high among the institutionalized persons in the compulsory rehabilitation center. About one-sixth of non-infected by TST at the first testing could become LTBI positive while one of ten might change the LTBI status from positive to negative during a two-year period. Increased age, history of BCG vaccination and close contacts with TB patients had an increased possibility of TB infection by TST.

Key words: Tuberculosis,pulmonary, Contact tracing, Tuberculin test, Infection, Population surveillance, Factor analysis,statistical, Drug user

房宏霞,解志民,秦玉宝,罗志理,赖铿,余秀齐,王艳,郑开巧,刘昌伟,陈智聪. 监测封闭社区结核病患者接触者结核感染状况二年的结果分析[J]. 中国防痨杂志, 2019, 41(8): 887-891. doi: 10.3969/j.issn.1000-6621.2019.08.015

Hong-xia FANG,Zhi-min XIE,Yu-bao QIN,Zhi-li LUO,Keng LAI,Xiu-qi YU,Yan WANG,Kai-qiao ZHENG,Chang-wei LIU,Zhi-cong CHEN. A two-year follow-up study on latent tuberculosis infection among contacts of tuberculosis patients in an institutionalized population[J]. Chinese Journal of Antituberculosis, 2019, 41(8): 887-891. doi: 10.3969/j.issn.1000-6621.2019.08.015

图/表 4

表1

表2

表3

影响本封闭社区767名(例)接触者结核感染定量因素的单因素分析

因素	感染	未感染	统计学检验值	P值	OR值	95%CI值
年龄(岁, $x ˉ$ ±s)	37.7±7.469	35.6±7.363	t=3.913	<0.001	2.20	1.10~3.31
BMI [M(Q₁,Q₃)]	22.2(20.8,24.7)	22.7(20.8,24.9)	Z=-1.172	0.241	0.98	0.95~1.00
吸毒时间[年, M(Q₁,Q₃)]	7(4,11)	5(3,10)	Z=-3.132	0.002	1.04	1.02~1.07
戒毒次数[次, M(Q₁,Q₃)]	2(1,3)	2(1,2)	Z=-2.299	0.022	1.24	1.06~1.46

表3

表4

影响本封闭社区767名(例)接触者结核感染的多因素logistic回归分析

因素	β值	s $x ˉ$ 值	Waldχ²值	P值	OR(95.0%CI)值
卡介苗接种史	0.342	0.161	4.533	0.033	1.41(1.03~1.93)
接触程度	0.519	0.206	6.343	0.012	1.68(1.12~2.52)
年龄	0.035	0.011	10.942	0.001	1.04(1.02~1.06)
常数项	-0.997	0.396	6.342	0.012	0.369

表4

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变量名称	变量赋值	变量名称	变量赋值
感染	无=0;有=1	年龄	-
卡介苗接种史	无=0;有=1	吸毒时间	-
既往结核病病史	无=0;有=1	戒毒次数	-
肺结核可疑症状	无=0;有=1	BMI	-
接触程度	一般接触=0;密切接触=1

因素	感染(498例)		未感染(269名)		合计 (767例或名)	χ²值	P值	OR值	95%CI值
因素	例数	构成比 (%)	人数	构成比 (%)	合计 (767例或名)	χ²值	P值	OR值	95%CI值
卡介苗接种史						6.831	0.009	1.51	1.11~2.05
无	155	58.7	109	41.3	264
有	343	68.2	160	31.8	503
肺结核可疑症状						0.721	0.396	1.27	0.73~2.19
无	452	64.5	249	35.5	701
有	46	69.7	20	30.3	66
既往结核病病史						-	0.066^a	6.50	0.78~47.14
无	487	64.5	268	35.5	755
有	11	91.7	1	8.3	12
接触程度						7.705	0.006	1.75	1.18~2.61
一般接触	384	62.5	230	37.5	614
密切接触	114	74.5	39	25.5	153