采用分子流行病学和传统调查相结合分析嘉祥县某中学结核病聚集性疫情  

The analysis of TB aggregation epidemic of a tuberculosis outbreak in a middle school through combination methods of molecular epidemiology and traditional survey

作　　者：李建翠 汪延举 史衍席 王秀珍[1] 李学政[3] 王海英[3] 

机构地区：[1]山东省济宁市结核病防治所,270100 [2]山东省嘉祥县疾病预防控制中心结核病防治科 [3]山东省胸科医院汉光国际感染性疾病研究中心

出　　处：《中国防痨杂志》2012年第10期655-658,共4页Chinese Journal of Antituberculosis

基　　金：山东省科学技术发展计划(2007GG20002029)

摘　　要：目的分析2007—2008年山东省济宁市嘉祥县某中学一起结核病聚集性疫情的情况。方法以线索病例为依据,对该校3254名学生进行PPD试验和症状筛查。对分离培养的Mtb进行24位点分枝杆菌散在重复单位—可变数目串联重复序列(Mycobacterial interspersed repetitive unit-variable number tandem repeat,MIRU-VNTR)基因分型分析。采用logistic回归分析法,分析菌阳患者暴露程度和确诊为活动性结核病患者(active tu-berculosis,ATB)或潜伏感染者(LTBI)的关系。结果筛查该中学学生的Mtb潜伏感染率为28.8%,共确诊10例活动性肺结核患者,其中3例培养阳性。24位点MIRU-VNTR基因分型3株菌株结果显示,2株菌株基因型成簇,1株菌株位点Mutub4、Mtub21和QUB-26拷贝数不同。logistic回归分析结果显示与菌阳患者同班级或同年级是被诊断为ATB或LTBI的危险因素。结论该次结核疫情中,3位菌阳患者在学校引起了一定程度的传播,可能导致了另外7例ATB的暴发。因此对学生结核病患者的及时确诊和有效治疗,以及对学生及时进行结核病筛查对控制学校结核病暴发具有重要意义。Objective To analyze the TB aggregation epidemic situation of a school TB outbreak in Ji＇ning city of Shandong.Methods We performed tuberculin skin test and symptom screening to 3254 students for detecting latent and active TB in the school.The M.tuberculosis isolates were genotyped by 24-locus MIRU-VNTR.Using the logistic regression analysis,we analyzed the relationship between exposure levels to the culture positive cases and the possibility of being diagnosed as latent or active TB.Results The rate of latent tuberculosis infection was 28.8% in the middle school students,a total of 10 active cases were diagnosed,among which 3 of them were culture positive.The results of 24 points MIRU-VNTR genotyping showed that two isolates were clustered.One isolate had three different hyper-variable loci： Mutub4,Mtub21 and QUB-26.The logistic regression analysis indicated that being the same class or the same grade with the three culture positive cases are risk factors for both latent and active TB.Conclusion The three culture positive cases may caused certain level of transmissions,which may lead to the outbreak of the other seven active TB cases.Therefore,the timely diagnosis and effective treatment of student cases and timely TB screening are important to control the TB outbreaks in schools.

关 键 词：结核 肺/流行病学 疾病暴发流行 结核 肺/传播 基因型 流行病学 分子 流行病学研究 

分 类 号：R52[医药卫生—内科学] R181.8[医药卫生—临床医学]