住院儿童结核分枝杆菌潜伏感染筛查情况分析

doi:10.3969/j.issn.1000-6621.2021.07.003

摘要/Abstract

摘要： 目的分析罹患不同系统疾病儿童结核分枝杆菌潜伏感染(LTBI)筛查情况。方法采用回顾性研究方法,搜集2013年1月至2015年12月于首都医科大学附属北京儿童医院住院且行结核菌素皮肤试验(tuberculin skin test, TST)和γ-干扰素释放试验(interferon-gamma release assay, IGRA)的19093例患儿的临床资料进行分析。根据临床诊断对患儿疾病进行分类,包括呼吸系统疾病、风湿免疫系统疾病、血液系统/肿瘤疾病、泌尿系统疾病。分析TST和IGRA在不同系统疾病患儿中的筛查阳性情况、筛查结果的一致性及影响一致性的因素。结果在不同系统疾病患儿中,以TST筛查LTBI时,筛查阳性率由高至低依次为:风湿免疫系统疾病患儿(4.56%,205/4492)、泌尿系统疾病患儿(3.01%,41/1361)、呼吸系统疾病患儿(2.82%,170/6039)和血液系统/肿瘤疾病患儿(1.78%,19/1070),差异有统计学意义(χ ²=34.383,P<0.01);以IGRA筛查LTBI时,筛查阳性率由高至低依次为:血液系统/肿瘤疾病患儿(1.13%,36/3191)、风湿免疫系统疾病患儿(1.06%,66/6215)、泌尿系统疾病患儿(0.93%,19/2039)和呼吸系统疾病患儿(0.90%,69/7648),差异无统计学意义(χ ²=1.608,P=0.658)。在各系统疾病患儿中,TST和IGRA筛查结果的一致性均较差(呼吸系统疾病患儿:一致率为96.92%(5853/6039),Kappa=0.193;风湿免疫系统疾病患儿:一致率为95.19%(4276/4492),Kappa=0.165;血液系统/肿瘤疾病患儿:一致率为97.48%(1043/1070),Kappa=0.169;泌尿系统疾病患儿:一致率为96.77%(1317/1361),Kappa=0.173)。结论相对于呼吸系统疾病患儿,罹患风湿免疫系统疾病、血液系统/肿瘤疾病、泌尿系统疾病儿童的LTBI感染率更高,且应用TST和IGRA筛查LTBI的结果不一致率也更高。在此类患儿中,建议同时采用TST联合IGRA进行LTBI筛查。

关键词: 儿童, 分枝杆菌, 结核, 传染病潜伏期, 诊断技术和方法

Abstract: Objective To analyze the screening of latent tuberculosis infection (LTBI) in children with diseases of different systems. Methods Clinical information of 19093 children hospitalized in Beijing Children’s Hospital, Capital Medical University and tested by tuberculin skin test (TST) or interferon-gamma release assay (IGRA) between January 2013 and December 2015 were retrospectively analyzed. The diseases were classified according to clinical diagnosis, including respiratory diseases, rheumatic and immune diseases, hematologic/tumor diseases and renal diseases. The positive rate, consistency and the risk factors of the consistency of TST and IGRA were analyzed in children with diseases of different systems. Results Among children with diseases of different systems, when using TST to screen LTBI, the positive rates were 4.56% (205/4492), 3.01% (41/1361), 2.82% (170/6039) and 1.78% (19/1070) in children with rheumatic and immune diseases, renal diseases, respiratory diseases and hematologic/tumor diseases, respectively, the difference was statistically significant (χ ²=34.383, P<0.01). When using IGRA to screen LTBI, the positive rates were 1.13% (36/3191), 1.06% (66/6215), 0.93% (19/2039) and 0.90% (69/7648) in children with hematologic/tumor systemic diseases, rheumatic and immune diseases, renal diseases and respiratory diseases, respectively. However, the difference was not statistically significant (χ ²=1.608, P=0.658). The consistency between test results of TST and IGRA was poor in children with diseases of different systems (respiratory diseases: consistency rate was 96.92% (5853/6039), Kappa=0.193; rheumatic and immune diseases: consistency rate was 95.19% (4276/4492),Kappa=0.165; hematologic/tumor systemic diseases: consistency rate was 97.48% (1043/1070), Kappa=0.169;renal diseases: consistency rate was 96.77% (1317/1361), Kappa=0.173). Conclusion Compared to children with respiratory diseases, the rates of LTBI and the inconsistent results of TST and IGRA were higher in children with rheumatic and immune diseases, renal diseases and hematologic/tumor diseases. The combination of TST and IGRA was suggested to be used to screen LTBI in children with respiratory diseases.

Key words: Child, Mycobacterium tuberculosis, Infectious disease incubation period, Diagnostic techniques and procedures

祁雪, 吴喜蓉, 郭雅洁, 王咏红, 马琦, 陈玉莹, 孙琳, 申阿东. 住院儿童结核分枝杆菌潜伏感染筛查情况分析[J]. 中国防痨杂志, 2021, 43(7): 653-658. doi: 10.3969/j.issn.1000-6621.2021.07.003

QI Xue, WU Xi-rong, GUO Ya-jie, WANG Yong-hong, MA Qi, CHEN Yu-ying, SUN Lin, SHEN A-dong. Analysis of screening of latent tuberculosis infection in hospitalized children[J]. Chinese Journal of Antituberculosis, 2021, 43(7): 653-658. doi: 10.3969/j.issn.1000-6621.2021.07.003

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参考文献 17

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临床特征	呼吸系统疾病	泌尿系统疾病	风湿免疫系统疾病	血液系统/肿瘤疾病	合计
性别
男性	4615(60.34)	1370(67.19)	3343(53.79)	1901(59.57)	11229(58.81)
女性	3033(39.66)	669(32.81)	2872(46.21)	1290(40.43)	7864(41.19)
年龄组(岁)
<5	4285(56.03)	787(38.60)	896(14.42)	1956(61.30)	7924(41.50)
≥5	3363(43.97)	1252(61.40)	5319(85.58)	1235(38.70)	11169(58.50)
卡痕
有	7245(94.73)	1968(96.52)	5756(92.61)	3112(97.52)	18081(94.70)
无	403(5.27)	71(3.48)	459(7.39)	79(2.48)	1012(5.30)
肺结核接触史
有	237(3.10)	32(1.57)	105(1.69)	40(1.25)	414(2.17)
无	7411(96.90)	2007(98.43)	6110(98.31)	3151(98.75)	18679(97.83)
应用激素或免疫抑制剂
是	411(5.37)	317(15.55)	905(14.56)	377(11.81)	2010(10.53)
否	7237(94.63)	1722(84.45)	5310(85.44)	2814(88.19)	17083(89.47)
合计	7648(40.06)	2039(10.68)	6215(32.55)	3191(16.71)	19093(100.00)

影响因素	TST(+)/IGRA(+)和 TST(-)/IGRA(-)	TST(+)/IGRA(-)和 TST(-)/IGRA(+)	χ²值	P值
性别			0.591	0.442
男性	7298(96.46)	268(3.54)
女性	5191(96.20)	205(3.80)
年龄组(岁)			17.460	<0.01
<5	4860(97.22)	139(2.78)
≥5	7629(95.81)	334(4.19)
卡痕			2.906	0.088
有	11785(96.28)	455(3.72)
无	704(97.51)	18(2.49)
肺结核接触史			14.215	<0.01
有	293(92.43)	24(7.57)
无	12196(96.45)	449(3.55)

影响因素	TST(+)/IGRA(+)和 TST(-)/IGRA(-)	TST(+)/IGRA(-)和 TST(-)/IGRA(+)	χ²值	P值
应用激素或免疫抑制剂			2.509	0.113
是	1313(97.12)	39(2.88)
否	11176(96.26)	434(3.74)
疾病分类			27.265	<0.01
呼吸系统疾病	5853(96.92)	186(3.08)
泌尿系统疾病	1317(96.77)	44(3.23)
风湿免疫系统疾病	4276(95.19)	216(4.81)
血液系统/肿瘤疾病	1043(97.48)	27(2.52)