Analysis of the dynamics and influencing factors of latent tuberculosis infection in a rural elderly population in Changxing County

doi:10.19982/j.issn.1000-6621.20250333

Abstract

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

CLC Number:

R52
R197.62

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

Figures/Tables 5

References 24

[1]	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.
[2]	Houben RM, Dodd PJ. The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical Modelling. PLoS Med, 2016, 13(10):e1002152. doi:10.1371/journal.pmed.1002152.
[3]	Zellweger JP, Sotgiu G, Corradi M, et al. The diagnosis of latent tuberculosis infection (LTBI): currently available tests, future developments, and perspectives to eliminate tuberculosis (TB). Med Lav, 2020, 111(3):170-183. doi:10.23749/mdl.v111i3.9983. pmid: 32624559
[4]	张灿有, 陈卉, 张慧, 等. 2011―2020年全国65岁及以上老年人肺结核报告发病情况分析. 中华疾病控制杂志, 2022, 26(11):1252-1258. doi:10.16462/j.cnki.zhjbkz.2022.11.003.
[5]	陈静, 肖筱, 吴哲渊, 等. 上海市徐汇区和长宁区老年2型糖尿病患者结核分枝杆菌潜伏感染筛查情况及影响因素分析. 中国防痨杂志, 2022, 44(2):181-186. doi:10.19982/j.issn.1000-6621.20210579.
[6]	Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J, 2020:41(1):111-188. doi:10.1093/eurheartj/ehz455.
[7]	《中国成人超重和肥胖预防控制指南》修订委员会. 中国成人超重和肥胖预防控制指南. 北京: 人民卫生出版社, 2021.
[8]	Wang W, Chen X, Chen S, et al. The burden and predictors of latent tuberculosis infection among elder adults in high epidemic rural area of tuberculosis in Zhejiang, China. Front Cell Infect Microbiol, 2022, 12:990197. doi:10.3389/fcimb.2022.990197.
[9]	高磊, 张慧, 胡茂桂, 等. 基于多中心调查数据和空间统计模型的全国结核分枝杆菌潜伏感染率估算. 中国防痨杂志, 2022, 44(1):54-59. doi:10.19982/j.issn.1000-6621.2022.01.005.
[10]	雷蓉蓉, 张婷, 吴成果, 等. 南川区居民结核潜伏感染调查. 预防医学, 2022, 34(4):371-374. doi:10.19485/j.cnki.issn2096-5087.2022.04.010.
[11]	金玫华, 王子怡, 任飞林, 等. 2014—2023年湖州市肺结核流行特征. 预防医学, 2024, 36(10):856-860. doi:10.19485/j.cnki.issn2096-5087.2024.10.007.
[12]	Lee CK, Wong SHV, Lui G, et al. A Prospective Study to Monitor for Tuberculosis During Anti-tumour Necrosis Factor Therapy in Patients With Inflammatory Bowel Disease and Immune-mediated Inflammatory Diseases. J Crohns Colitis, 2018, 12(8):954-962. doi:10.1093/ecco-jcc/jjy057 pmid: 29757355
[13]	Gao L, Lu W, Bai L, et al. Latent tuberculosis infection in rural China: baseline results of a population-based, multicentre, prospective cohort study. Lancet Infect Dis, 2015, 15(3):310-319. doi:10.1016/S1473-3099(14)71085-0. pmid: 25681063
[14]	Zhu Z, Shen W, Hu J, et al. Risk factors for latent tuberculosis infection clustering among the elderly: a population-based cross-sectional study in Eastern China. BMC Infect Dis, 2025, 25(1):368. doi:10.1186/s12879-025-10743-7.
[15]	吕平欣, 贺伟, 吕岩, 等. 基于影像学特征把握非活动性肺结核的影像学诊断要点. 中国防痨杂志, 2022, 44(4):305-309. doi:10.19982/j.issn.1000-6621.20220002.
[16]	王丽, 杨恩卓, 沙巍, 等. 结核病免疫治疗的研究进展. 中国防痨杂志, 2022, 44(10):1079-1084. doi:10.19982/j.issn.1000-6621.20220194.
[17]	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.
[18]	Lwin TT, Apidechkul T, Saising J, et al. Prevalence and determinants of TB infection in a rural population in northeastern Myanmar. BMC Infect Dis, 2020, 20(1):904. doi:10.1186/s12879-020-05646-8. pmid: 33256645
[19]	Lee MR, Huang YP, Kuo YT, et al. Diabetes Mellitus and Latent Tuberculosis Infection: A Systematic Review and Metaanalysis. Clin Infect Dis, 2017, 64(6):719-727. doi:10.1093/cid/ciw836.
[20]	李百远, 李元军, 高非凡, 等. 二甲双胍辅助抗结核的作用机制及临床价值. 临床荟萃, 2021, 36(2):179-183. doi:CNKI:SUN:LCFC.0.2021-02-017.
[21]	陈禹, 李晓睿, 王妙然, 等. 金属离子在结核病中的作用研究进展. 结核与肺部疾病杂志, 2025, 6(1):102-112. doi:10.19983/j.issn.2096-8493.20250006.
[22]	Dai Y, Zhu C, Xiao W, et al. Mycobacterium tuberculosis hijacks host TRIM21- and NCOA4-dependent ferritinophagy to enhance intracellular growth. J Clin Invest, 2023, 133(8):e159941. doi:10.1172/JCI159941
[23]	Luo M, Liu M, Wu X, et al. Impact of anemia on prognosis in tuberculosis patients. Ann Transl Med, 2022, 10(6):329. doi:10.21037/atm-22-679. pmid: 35433932
[24]	郭同磊, 辛赫男, 高磊, 等. 《世界卫生组织结核病整合指南模块1:结核病预防性治疗》解读. 中国防痨杂志, 2023, 45(8):723-727. doi:10.19982/j.issn.1000-6621.20230199.

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)