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中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (8): 1124-1129.doi: 10.19982/j.issn.1000-6621.20260209

• 论著 • 上一篇    下一篇

结核菌素皮肤试验反应程度与高中学生肺结核发病风险的关联

廖文平1, 张理翌2, 吕娟1, 辛玉1, 苏倩3(), 张文1()   

  1. 1 重庆市结核病防治所医教科, 重庆 400050
    2 重庆市结核病防治所党务办公室, 重庆 400050
    3 重庆市结核病防治所综合防治科, 重庆 400050
  • 收稿日期:2026-04-15 出版日期:2026-08-01 发布日期:2026-07-30
  • 通信作者: 苏倩,Email:23527986@qq.com;张文,Email:zhanghenwen@163.com
  • 基金资助:
    重庆市科卫联合医学科研项目(2022MSXM018);重庆市疾控局疾控科研项目(2026JKXM037);重庆市九龙坡区科技计划项目(2024-04-023-Y);重庆市九龙坡区科技计划项目(2024-04-002-Z);重庆市首批公共卫生重点学科(专科)建设经费

Association between magnitude of tuberculin skin test reactions and risk of pulmonary tuberculosis among senior high school students

Liao Wenping1, Zhang Liyi2, Lyu Juan1, Xin Yu1, Su Qian3(), Zhang Wen1()   

  1. 1 Department of Medical Education, Chongqing Tuberculosis Control and Prevention Institution, Chongqing 400050, China
    2 Party Affairs Office, Chongqing Tuberculosis Control and Prevention Institution, Chongqing 400050, China
    3 Department of Comprehensive Prevention and Control, Chongqing Tuberculosis Control and Prevention Institution, Chongqing 400050, China
  • Received:2026-04-15 Online:2026-08-01 Published:2026-07-30
  • Contact: Su Qian, Email:23527986@qq.com; Zhang Wen, Email:zhanghenwen@163.com
  • Supported by:
    Joint Medical Research Project of Chongqing Science and Health Commission(2022MSXM018);Chongqing Center for Disease Control and Prevention Scientific Research Project(2026JKXM037);Jiulongpo District Science and Technology Program of Chongqing(2024-04-023-Y);Jiulongpo District Science and Technology Program of Chongqing(2024-04-002-Z);Funding for the First Batch Key Public Health Disciplines (Specialties) Construction of Chongqing

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摘要：

目的: 探讨不同结核菌素皮肤试验(tuberculin skin test,TST)反应程度与高中学生肺结核发病风险的关联,为优化学校肺结核筛查策略提供科学依据。方法: 采用前瞻性队列研究方法,于2022年9—12月在重庆市15个行政区采用分层随机整群抽样方法选取27339名高中一、二年级学生建立研究队列,观察2年内活动性肺结核发病情况。采用Cox比例风险回归模型分析TST反应程度与发病风险的关联及剂量-反应关系。结果: 27339名研究对象中TST阴性者有15641名(57.21%)、一般阳性者有3352名(12.26%)、中度阳性者有4455名(16.30%)、强阳性者有3891名(14.23%)。总观察人年数为54663人年,新发活动性肺结核35例,总发病密度为64.03/10万人年,2年累积发病率为128.02/10万。随着TST反应程度增强,发病密度与2年累积发病率均呈明显升高。不同性别、学校属性及区域疫情等级学生的TST反应程度构成均存在明显差异(χ2值分别为32.928、146.846、318.985,P值均<0.001)。TST强阳性组学生(3891名)中,男性占49.78%(1937名),女性占50.22%(1954名);来自公办学校者占55.69%(2167名),来自民办学校者占44.31%(1724名);来自高疫情地区者占48.34%(1881名),来自中疫情地区者占51.66%(2010名)。从发病时间上看,强阳性组与中度阳性组发病高峰集中在观察第1年[发病率分别为179.90/10万(7/3891)和112.23/10万(5/4455)],阴性组与一般阳性组高峰在第2年[发病率分别为70.33/10万(11/15641)和149.16/10万(5/3352)]。多因素Cox回归分析显示,TST强阳性组发病风险为阴性组的2.470(95%CI:1.065~5.736)倍;硬结平均直径每增加1mm,发病风险升高5.1%(HR=1.051,95%CI:1.018~1.086)。分层分析显示,中疫情地区亚组中TST强阳性与肺结核发病风险关联最强(HR=4.983,95%CI:1.115~22.266)。结论: TST强阳性是高中学生肺结核发病的独立危险因素,存在明确剂量-反应关系与发病时间分布特征。建议对不同TST反应程度的学生人群实施分级分类管理策略。

关键词: 皮肤试验, 学生, 结核,肺, 发病率, 因素分析,统计学

Abstract:

Objective: To explore the association between the magnitude of tuberculin skin test (TST) reactions and the risk of active pulmonary tuberculosis (PTB) among senior high school students, so as to provide scientific evidence for optimizing school-based PTB screening strategies. Methods: A prospective cohort study was conducted. From September to December 2022, stratified random cluster sampling was adopted to recruit 27339 Grade 1 and Grade 2 senior high school students from 15 administrative districts of Chongqing to establish the study cohort. All participants were followed up for 2 years to monitor incident active PTB. Cox proportional hazards regression models were used to analyze the association and dose-response relationship between TST reaction intensity and PTB risk. Results: Among the 27339 participants, 15641 (57.21%) had negative TST results, 3352 (12.26%) mild positive reactions, 4455 (16.30%) moderate positive reactions, and 3891 (14.23%) strong positive reactions. The total person-years of observation were 54663. A total of 35 new active PTB cases were identified, with an overall incidence density of 64.03/100000 person-years and a 2-year cumulative incidence of 128.02/100000. Both incidence density and 2-year cumulative incidence rose markedly as TST reaction intensity increased. Significant differences were observed in the distribution of TST reaction grades across subgroups stratified by gender, school type and regional epidemic level (χ2=32.928, 146.846, 318.985, all P<0.001). Among the 3891 students with strong TST positivity, males accounted for 49.78% (1937 students) and females 50.22% (1954 students); 55.69% (2167 students) attended public schools and 44.31% (1724 students) private schools; 48.34% (1881 students) resided in high-burden areas and 51.66% (2010 students) in medium-burden areas. In terms of disease onset timing, the peak incidence in the strong-positive and moderate-positive groups occurred within the first year of follow-up (179.90/100000 (7/3891) and 112.23/100000 (5/4455), respectively), while the peak for the negative and mild-positive groups appeared in the second year (70.33/100000 (11/15641) and 149.16/100000 (5/3352), respectively). Multivariate Cox regression revealed that students with strong TST positivity had a 2.470 (95%CI: 1.065-5.736)-fold higher risk of developing PTB compared with TST-negative students. Each 1 mm increase in the mean induration diameter corresponded to a 5.1% elevation in disease risk (HR=1.051, 95%CI: 1.018-1.086). Stratified analysis demonstrated that the strongest association between strong TST positivity and PTB risk was found in the medium epidemic burden subgroup (HR=4.983, 95%CI: 1.115-22.266). Conclusion: Strong TST positivity is an independent risk factor for active PTB among senior high school students, with a clear dose-response relationship and distinct temporal distribution of disease onset. Tiered and categorized management strategies are recommended for students with varying TST reaction intensities.

Key words: Skin tests, Students, Tuberculosis, pulmonary, Incidence, Factor analysis, statistical

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