浙江省长兴县农村老年人群结核分枝杆菌潜伏感染现状及变化的相关因素分析

doi:10.19982/j.issn.1000-6621.20250333

摘要/Abstract

摘要：

目的: 探讨农村老年人结核分枝杆菌潜伏感染(latent tuberculosis infection, LTBI)现状、一年随访期末的感染状态转阳情况及相关因素,为基层结核病精准防控提供科学数据。方法: 依托浙江省湖州市长兴县老年健康体检队列,采用双时点γ-干扰素释放试验(interferon-gamma release assay, IGRA)检测LTBI状态。通过多因素logistic回归分析基线LTBI状态及一年随访期末感染转阳的独立影响因素。结果: 农村老年人群基线LTBI率为9.49%(97/1022),基线阴性人群(925名)中764名完成1年随访,发生感染转阳51例,年感染转阳率为6.68%(51/764)。对51例感染转阳者1年后再次随访,实际随访到46例,IGRA检测转阴率为69.57%(32/46),持续阳性率为28.26%(13/46)。基线感染多因素分析显示:X线胸片异常(OR=1.539,95%CI:1.008~2.350)、男性(OR=1.700,95%CI:1.111~2.601)老年人群的LTBI比例较高。1年末感染转阳多因素分析显示:随着血红蛋白水平升高,感染转阳风险也增加(OR=1.026,95%CI:1.006~1.047)。结论: 浙江省湖州市长兴县农村老年人群基线LTBI率较低,且感染转阳者的感染状态波动性较强,因此对社区老年人LTBI者实施预防性干预前,需综合评估其暴露发病风险。

关键词: 分枝杆菌,结核, 感染, 农村人口, 老年人, 危险因素

Abstract:

Objective: To investigate the prevalence of latent tuberculosis infection (LTBI) among rural elderly individuals, the rate of LTBI conversion after one-year follow-up, and related factors, providing scientific data for precise tuberculosis prevention and control in primary healthcare settings. Methods: Utilizing the elderly health examination cohort in Changxing County, Zhejiang Province, a two-time-point interferon-gamma release assay (IGRA) was performed to detect LTBI status. Multivariable logistic regression analysis was employed to identify independent factors influencing baseline LTBI status and LTBI conversion at the one-year follow-up. Results: The baseline LTBI prevalence in the rural elderly population was 9.49% (97/1022). Among 925 baseline-negative individuals, 764 completed one-year follow-up, with 51 cases of LTBI conversion, yielding an annual conversion rate of 6.68% (51/764). A follow-up assessment was conducted one year later on the 51 individuals who had converted to positive, with 46 participants successfully evaluated. The IGRA reversion rate was 69.57% (32/46), and the persistent positivity rate was 28.26% (13/46). Multivariable analysis identified two baseline LTBI predictors: abnormal chest X-ray findings (OR=1.539, 95%CI: 1.008-2.350)and male gender (OR=1.700, 95%CI: 1.111-2.601). Higher hemoglobin levels increased conversion risk (OR=1.026, 95%CI: 1.006-1.047). Conclusion: The rural elderly population in Changxing County, Huzhou City, Zhejiang Province exhibits a relatively low baseline LTBI rate, and infection status among converters shows significant fluctuation. Therefore, a comprehensive assessment of exposure and disease progression risks is essential before implementing preventive interventions for elderly community-dwelling individuals with LTBI.

Key words: Mycobacterium tuberculosis, Infection, Rural population, Aged, Risk factors

中图分类号:

R52
R197.62

张健, 陈彬, 张明五, 秦家胜, 宋玉芳, 李雪静, 王伟. 浙江省长兴县农村老年人群结核分枝杆菌潜伏感染现状及变化的相关因素分析[J]. 中国防痨杂志, 2026, 48(3): 405-412. doi: 10.19982/j.issn.1000-6621.20250333

Zhang Jian, Chen Bin, Zhang Mingwu, Qin Jiasheng, Song Yufang, Li Xuejing, Wang Wei. Analysis of the dynamics and influencing factors of latent tuberculosis infection in a rural elderly population in Changxing County[J]. Chinese Journal of Antituberculosis, 2026, 48(3): 405-412. doi: 10.19982/j.issn.1000-6621.20250333

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分类	TB1-Nil		TB2-Nil
分类	2023年	2024年	2023年	2024年
<0.2IU/ml[名,构成比(%)]	42(82.35)	1(1.96)	33(64.71)	0(0.00)
0.2~0.35IU/ml[名,构成比(%)]	9(17.65)	11(21.57)	18(35.29)	3(5.88)
0.35~0.7IU/ml[名,构成比(%)]	0(0.00)	28(54.90)	0(0.00)	32(62.75)
>0.7IU/ml[名,构成比(%)]	0(0.00)	11(21.57)	0(0.00)	16(31.37)
M(Q₁,Q₃)	0.05(0.00,0.16)	0.42(0.35,0.63)	0.16(0.11,0.23)	0.49(0.42,0.77)
检验值与P值	Z=6.154, P<0.001		Z=6.205, P<0.001

变量	总人数 (名)	结核分枝杆菌潜伏感染		检验值	P值
变量	总人数 (名)	阳性	阴性	检验值	P值
性别[名,构成比(%)]				χ²=6.294	0.012
男性	477	57(11.95)	420(88.05)
女性	545	40(7.34)	505(92.66)
年龄组[名,构成比(%)]				χ²=1.832	0.400
65~75岁	699	72(10.30)	627(89.70)
75~84岁	275	22(8.00)	253(92.00)
≥85岁	48	3(6.25)	45(93.75)
糖尿病史[名,构成比(%)]				χ²=4.092	0.043
无	920	93(10.11)	827(89.89)
有	102	4(3.92)	98(96.08)
吸烟史[名,构成比(%)]				χ²=5.363	0.021
无	791	66(8.34)	725(91.66)
有	231	31(13.42)	200(86.58)
胸部X线片[名,构成比(%)]				χ²=4.245	0.039
正常	544	42(7.72)	502(92.28)
异常^a	478	55(11.51)	423(88.49)
BMI[名,构成比(%)]				χ²=4.220	0.239
<18.5kg/m²	49	8(16.33)	41(83.67)
18.5~23.9kg/m²	563	50(8.88)	513(91.12)
24.0~27.9kg/m²	329	34(10.33)	295(89.67)
≥28kg/m²	81	5(6.17)	76(93.83)
血红蛋白[g/L,M(Q₁,Q₃)]	1022	137.00 (128.00,148.00)	134.00 (124.00,144.00)	Z=-1.968^b	0.049
LDL-C/HDL-C[M(Q₁,Q₃)]	1022	1.85(1.34,2.34)	1.88(1.45,2.44)	Z=-0.929^b	0.353
淋巴细胞计数[×10⁹/L,M(Q₁,Q₃)]	1022	1.60(1.30,1.90)	1.50(1.20,1.90)	Z=-1.500^b	0.134

变量	基线阴性人数(名)	随访期末LTBI状态		检验值	P值
变量	基线阴性人数(名)	持续阴性人数	感染转阳人数	检验值	P值
性别[名,构成比(%)]				χ²=1.204	0.273
男性	348	321(92.24)	27(7.76)
女性	416	392(94.23)	24(5.77)
年龄组[名,构成比(%)]				χ²=2.666	0.264
65~75岁	530	496(93.58)	34(6.42)
75~84岁	208	191(91.83)	17(8.17)
≥85岁	26	26(100.00)	0(0.00)
糖尿病史[名,构成比(%)]				χ²=0.014	0.905
无	678	633(93.36)	45(6.64)
有	86	80(93.02)	6(6.98)
吸烟史[名,构成比(%)]				χ²=2.896	0.089
无	597	562(94.14)	35(5.86)
有	167	151(90.42)	16(9.58)
胸部X线片[名,构成比(%)]				χ²=1.247	0.264
正常	417	393(94.24)	24(5.76)
异常^a	347	320(92.22)	27(7.78)
BMI[名,构成比(%)]				χ²=1.598	0.660
<18.5kg/m²	33	32(96.97)	1(3.03)
18.5~23.9kg/m²	424	397(93.63)	27(6.37)
24~27.9kg/m²	242	225(92.98)	17(7.02)
≥28kg/m²	65	59(90.77)	6(9.23)
血红蛋白[g/L,M(Q₁,Q₃)]	764	134.00 (125.00,143.00)	142.00 (130.50,150.00)	Z=-2.979^b	0.003
LDL-C/HDL-C[M(Q₁,Q₃)]	764	1.86(1.48,2.41)	1.84(1.34,2.39)	Z=-0.519^b	0.604
淋巴细胞计数[×10⁹/L,M(Q₁,Q₃)]	764	1.50(1.20,1.90)	1.50(1.20,1.75)	Z=-1.154^b	0.248

因变量	自变量^a	类别	β值	s $\bar{x}$值	Wald χ²	P值	OR(95%CI)值
基线LTBI	性别	女性(参照组)					1.000
		男性	0.531	0.217	5.977	0.014	1.700(1.111~2.601)
	X线胸片	正常(参照组)					1.000
		异常^b	0.431	0.216	3.987	0.046	1.539(1.008~2.350)
一年随访期末新发LTBI	血红蛋白水平	连续变量(1g/L)	0.026	0.010	6.567	0.010	1.026(1.006~1.047)