青岛市养老院老年人结核分枝杆菌潜伏感染状况及影响因素分析

doi:10.19982/j.issn.1000-6621.20250140

摘要/Abstract

摘要：

目的: 了解青岛市养老院入住老年人结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)情况,分析影响LTBI的相关因素,探讨养老院结核病防控措施及策略。方法: 采用现况调查方法,于2024年6—8月采取单纯随机抽样选取青岛市1个中心城区和1个郊区,根据养老院的规模及配合的意愿,共选取7家养老院的老年人,通过γ-干扰素释放试验、胸部X线摄片开展LTBI筛查;同时,收集调查对象的个人信息、养老院经营管理情况。结果: 共调查425名老年人,LTBI感染率为26.59%(113/425)。单因素分析结果显示,男性老年人LTBI感染率(30.53%,80/262)明显高于女性老年人(20.25%,33/163),差异有统计学意义(χ²=5.450,P=0.020);70~79岁组老年人的LTBI感染率最高(35.29%,42/119),并随年龄增加,感染率升高(OR=1.02,95%CI:1.00~1.04);郊区养老院老年人LTBI感染率(31.34%,63/201)明显高于城区养老院老年人(22.32%,50/224),差异有统计学意义(χ²=4.418, P=0.036);近10年曾发现结核病患者的养老院中老年人LTBI感染率(31.34%,63/201)明显高于未发现过结核病患者的养老院中的老年人(22.32%,50/224),差异有统计学意义(χ²=4.418,P=0.036);养老院中仅接受生活照护的老年人的LTBI感染率为31.34%(63/201),明显高于接受生活照护加医疗护理的老年人(22.32%,50/224),差异有统计学意义(χ²=4.418,P=0.036);老年人与护工人数之比为6~7的养老院的老年人LTBI感染率为17.97%(23/128),明显低于老年人与护工人数之比≥8的养老院的老年人(31.34%,63/201),差异有统计学意义(χ²=7.317,P=0.026)。多因素logistic回归分析结果显示,老年人与护工人数之比在6~7的养老院居住的老年人较老年人与护工人数之比≥8的养老院居住的老年人LTBI发生风险小(OR=0.50, 95%CI: 0.30~0.85)。结论: 青岛市养老院入住老年人LTBI水平较高,老年人与护工人数之比是影响养老院老年人发生LTBI的危险因素,养老院应合理配备护工,加强对结核病的预防控制。

关键词: 老年人, 分枝杆菌,结核, 感染, 因素分析,统计学

Abstract:

Objective: To assess the prevalence of latent tuberculosis infection (LTBI) among elderly residents of nursing homes in Qingdao, identify factors associated with LTBI, and propose targeted strategies for the prevention and control of tuberculosis in institutional settings. Methods: A cross-sectional study was conducted between June and August 2024 in Qingdao, China. One central urban district and one suburban district were selected using simple random sampling. Based on institutional size and willingness to participate, seven nursing homes were included. Elderly residents were screened for LTBI using interferon-gamma release assays (IGRA) and chest radiography. Demographic data of the participants and operational characteristics of the nursing homes were also collected. Results: Among 425 elderly residents surveyed, the prevalence of LTBI was 26.59% (113/425). Univariate analysis revealed a significantly higher LTBI prevalence among males (30.53%, 80/262) compared to females (20.25%, 33/163; χ²=5.450, P=0.020). The highest infection rate was observed in the 70-79-year age group (35.29%, 42/119), and the likelihood of LTBI increased with age (OR=1.02, 95%CI: 1.00-1.04). Residents of suburban nursing homes exhibited a significantly higher LTBI prevalence (31.34%, 63/201) than those in urban facilities (22.32%, 50/224; χ²=4.418, P=0.036). Similarly, individuals living in nursing homes where tuberculosis cases had been reported within the past decade showed a higher LTBI prevalence (31.34%, 63/201) than those in institutions without such history (22.32%, 50/224; χ²=4.418, P=0.036); the prevalence of LTBI among elderly individuals receiving only life care services was 31.34% (63/201), significantly higher than that among those receiving both life care and medical care (22.32%, 50/224; χ²=4.418, P=0.036). Residents in facilities with a caregiver-to-resident ratio of 6-7 had a significantly lower LTBI prevalence (17.97%, 23/128) compared to those in institutions with a ratio of ≥8 (31.32%, 63/201; χ²=7.317, P=0.026). Multivariate logistic regression analysis further indicated that a caregiver-to-resident ratio of 6-7 was independently associated with a reduced risk of LTBI (OR=0.50, 95%CI: 0.30-0.85). Conclusion: The prevalence of LTBI among elderly nursing home residents in Qingdao is notably high. A higher caregiver-to-resident ratio was identified as an independent risk factor for LTBI. Strengthening human resource allocation and optimizing staff-to-resident ratios in nursing homes may play a critical role in reducing tuberculosis transmission and improving infection control in institutional care settings.

Key words: Aged, Mycobacterium tuberculosis, Infection, Factor analysis, statistical

中图分类号:

阎月明, 陈梦, 李学奎, 王忠东, 孙海燕, 代晓琦, 宋颂, 徐红红, 张梦涵, 王治, 吕坤政. 青岛市养老院老年人结核分枝杆菌潜伏感染状况及影响因素分析[J]. 中国防痨杂志, 2025, 47(9): 1148-1153. doi: 10.19982/j.issn.1000-6621.20250140

Yan Yueming, Chen Meng, Li Xuekui, Wang Zhongdong, Sun Haiyan, Dai Xiaoqi, Song Song, Xu Honghong, Zhang Menghan, Wang Zhi, Lyu Kunzheng. Prevalence and influencing factors of latent tuberculosis infection among elderly residents in nursing homes in Qingdao[J]. Chinese Journal of Antituberculosis, 2025, 47(9): 1148-1153. doi: 10.19982/j.issn.1000-6621.20250140

图/表 1

表1

不同特征老年人结核分枝杆菌潜伏感染情况及影响因素单因素分析

特征	人数[名 (构成比,%)]	LTBI者[例 (感染率,%)]	χ²值	P值	单因素分析
特征	人数[名 (构成比,%)]	LTBI者[例 (感染率,%)]	χ²值	P值	OR值	95%CI值	P值
性别			5.450	0.020
男性	262(61.65)	80(30.53)			1.73	1.09~2.75	0.020
女性	163(38.35)	33(20.25)			1.00
年龄组(岁)			9.999	0.040	1.02	1.00~1.04	0.049
50~59	82(19.29)	13(15.85)			1.00
60~69	97(22.82)	23(23.71)			1.65	0.78~3.51	0.194
70~79	119(28.00)	42(35.29)			2.90	1.44~5.84	0.003
80~89	96(22.59)	27(28.13)			2.08	0.99~4.36	0.053
90~99	31(7.30)	8(25.81)			1.85	0.68~5.01	0.229
入住养老院时间(年)			2.403	0.301	1.05	0.97~1.13	0.240
1~4	185(43.53)	45(24.32)			0.59	0.30~1.16	0.124
5~9	192(45.18)	51(26.56)			0.66	0.34~1.29	0.225
≥10	48(11.29)	17(35.42)			1.00
生活自理情况			2.487	0.288
自理	162(38.12)	37(22.84)			1.00
半自理	185(43.53)	56(30.27)			1.47	0.91~2.38	0.120
完全不能自理	78(18.35)	20(25.64)			1.17	0.62~2.18	0.633
失智情况			0.226	0.634
否	301(70.82)	82(27.24)			1.00
是	124(29.18)	31(25.00)			0.89	0.55~1.44	0.634
地域			4.418	0.036
郊区(平度市)	201(47.29)	63(31.34)			1.59	1.03~2.45	0.036
城区(李沧区)	224(52.71)	50(22.32)			1.00
养老院近10年是否发现过结核病患者			4.418	0.036
是	201(47.29)	63(31.34)			1.59	1.03~2.45	0.036
否	224(52.71)	50(22.32)			1.00
养老院经营形式			5.003	0.082
公办	64(15.06)	12(18.75)			1.00
民营	160(37.65)	38(23.75)			1.35	0.65~2.79	0.418
公办民营	201(47.29)	63(31.34)			1.98	0.99~3.96	0.054
养老院床位规模(张)			3.517	0.319
≥500	243(57.18)	71(29.22)			1.70	0.78~3.70	0.183
300~499	39(9.18)	7(17.95)			0.90	0.30~2.69	0.849
100~299	97(22.82)	26(26.80)			1.51	0.64~3.54	0.349
<100	46(10.82)	9(19.57)			1.00
养老院每床建筑面积(m²)			6.937	0.074
≥40	201(47.29)	63(31.34)			1.17	0.67~2.03	0.579
30~<40	113(26.59)	21(18.58)			0.58	0.30~1.13	0.112
25~<30	22(5.18)	4(18.18)			0.57	0.18~1.85	0.348
<25	89(20.94)	25(28.09)			1.00
养老院照护类型			4.418	0.036
生活照护	201(47.29)	63(31.34)			1.59	1.03~2.45	0.036
生活照护+医疗护理	224(52.71)	50(22.32)			1.00
养老院老人与护工人数之比			7.317	0.026
≥8	201(47.29)	63(31.34)			1.17	0.68~1.99	0.573
6~7	128(30.12)	23(17.97)			0.56	0.30~1.06	0.073
4~5	96(22.59)	27(28.13)			1.00

表1

参考文献 17

[1]	徐彩红, 赵雁林. 中国结核病预防性治疗指南. 北京: 人民卫生出版社, 2023.
[2]	中国医学科学院病原生物学研究所, 中国疾病预防控制中心, 中国科学院地理科学与资源研究所. 全国结核分枝杆菌潜伏感染率估算专家共识. 中国防痨杂志, 2022, 44(1): 4-8. doi:10.19982/j.issn.1000-6621.20210662.
[3]	全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告. 中国防痨杂志, 2012, 34(8):485-508. doi:10.19982/j.issn.1000-6621.2012.08.001.
[4]	Khan A, Rebhan A, Seminara D, et al. Enduring Challenge of Latent Tuberculosis in Older Nursing Home Residents: A Brief Review. J Clin Med Res, 2019, 11(6): 385-390. doi:10.14740/jocmr3763. pmid: 31143304
[5]	民政部, 全国老龄办. 2023年度国家老龄事业发展公报[EB/OL].[2025-04-05]. https://www.gov.cn/lianbo/bumen/202410/content_6979487.htm.
[6]	陈静, 饶立歆, 肖筱, 等. 上海市部分养老机构结核病防控相关措施实施情况调查. 中国防痨杂志, 2022, 44(6):617-624. doi:10.19982/j.issn.1000-6621.20220039.
[7]	Lin SY, Chien JY, Chiang HT, et al. Ambulatory independence is associated with higher incidence of latent tuberculosis infection in long-term care facilities in Taiwan. J Microbiol Immunol Infect, 2021, 54(2): 319-326. doi:10.1016/j.jmii.2019.07.008.
[8]	宋红焕, 陆伟, 竺丽梅, 等. 江苏省丹阳市65岁以上老年人结核菌素皮肤试验和γ干扰素体外释放试验检测结果分析. 实用老年医学, 2019, 33(2):174-176, 181. doi:10.3969/j.issn.1003-9198.2019.02.017.
[9]	陈瑞麒, 张明五, 王伟, 等. 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. 中国防痨杂志, 2024, 46(4): 383-389. doi:10.19982/j.issn.1000-6621.20230399.
[10]	Liu Y, Huang S, Jiang H, et al. The prevalence of latent tuberculosis infection in rural Jiangsu, China. Public Health, 2017, 146:39-45. doi:10.1016/j.puhe.2017.01.008. pmid: 28404472
[11]	Alshowair A, Assiri AM, Balfas AH, et al. Magnitude and Determinants of Latent Tuberculosis Among Inmates of Saudi Correctional Facilities: A Cross-Sectional Study. Int J Gen Med, 2024, 17: 4475-4483. doi:10.2147/IJGM.S472710. pmid: 39372131
[12]	胡鑫洋, 高静韬. 世界卫生组织《2024年全球结核病报告》解读. 结核与肺部疾病杂志, 2024, 5(6): 500-504. doi:10.19983/j.issn.2096-8493.2024164.
[13]	Dabitao D, Bishai WR. Sex and Gender Differences in Tuberculosis Pathogenesis and Treatment Outcomes. Curr Top Microbiol Immunol, 2023, 441: 139-183. doi:10.1007/978-3-031-35139-6_6. pmid: 37695428
[14]	Kim HW, Min J, Choi JY, et al. Prevalence of latent tuberculosis infection among participants of the national LTBI screening program in South Korea-A problem of low coverage rate with current LTBI strategy. Front Public Health, 2023, 10:1066269. doi:10.3389/fpubh.2022.1066269.
[15]	王雪晴, 王荣, 苗瑞芬, 等. 2022年南京市高中新生结核潜伏感染状况及影响因素分析. 职业与健康, 2024, 40(21): 2982-2987. doi:10.13329/j.cnki.zyyjk.2024.0539.
[16]	中华人民共和国国家质量监督检验检疫总局, 中国国家标准化管理委员会. GB/T 35796—2017养老机构服务质量基本规范. 2017-12-29.
[17]	中国人民共和国民政部. MZ/T 187—2021 养老机构岗位设置及人员配备规范. 2021-12-10.