分级接触者筛查在一起大学生肺结核聚集性发病调查中的应用  

Applying stratified screening of contacts in an investigation of TB epidemic among students in a university

作　　者：张国钦[1] 张玉华[1] 陈盛玉 钟达[1] 傅衍勇 

机构地区：[1]天津市结核病控制中心,300041

出　　处：《中国学校卫生》2015年第5期735-738,共4页Chinese Journal of School Health

摘　　要：目的探讨分级接触者筛查方法在大学生肺结核聚集性发病调查中的应用效果,为有效控制聚焦性疾病蔓延提供依据。方法对天津市某大学首发肺结核病例的接触者分级筛查,开展流行病学调查、症状筛查、PPD试验、TBSA检测和胸部DR检查。结果本次调查逐步筛查了3级接触者,共934名师生。在1-3级接触者中,肺结核可疑症状发生率分别为7.1%,0.4%和0.2%,PPD强阳性率分别为62.5%,30.7%和26.7%,TB-SA阳性率分别为45.5%,22.3%和17.4%,DR胸片可疑阴影发生率分别为16.7%,4.4%和0.6%,各项检查的阳性率均呈递减（χ^2值分别为36.32,23.02,7.03,52.22,P值均〈0.05）。最终在接触者中确诊17例学生肺结核病例,从1-3级接触者的肺结核检出率分别为14.3%,3.1%和0.6%,差异有统计学意义（χ^2=43.97,P〈0.01）。在宿舍楼层分布上,女生43号楼3层的肺结核罹患率为11.6%,高于男生4层的2.0%及其他楼层的0.8%,差异有统计学意义（χ^2=45.97,P〈0.05）;专业分布上,10级动画专业、10级环艺专业和其他专业罹患率分别为18.9%,6.8%和0.6%,差异有统计学意义（χ^2=72.30,P〈0.05）。结论分级接触者筛查方法适用于学校内结核病疫情调查,可以明确疫情波及人群。调查发现病例间有流行病学关联,疫情主要在宿舍楼层及专业内传播。Objective To evaluate the application effect of stratified contacts screening in an investigation of TB epidemic among students. Methods Contacts of primary TB cases were stratified and underwent epidemiological survey, symptoms screening, PPD testing, TB-SA testing and chest X-ray examination in a university. Results Contacts were stratified to 3 classes, involving 934 students and teachers. From class 1 to class 3 contacts, proportions of suspect TB symptoms were 7.1%, 0.4% and 0.2% respectively, proportions of strongly positive PPD were 62.5%, 30.7% and 26.7% respectively, proportions of positive TB -SA were 45.5% ,22.3% and 17.4% respectively, proportion of abnormal chest X-ray were 16.7%, 4.4% and 0.6% respectively. Proportions of those positive results were all declined from class 1 to class 3 contacts（ P〈0.05 ）. Among class 1 to 3 contacts, 17 students were newly diagnosed as pulmonary TB patients, the attack rate of TB was 14.3 %, 3.1% and 0.6% respectively（ P〈0.05）. The attack rate in girls＂ 3rd floor of Dorm 43 was 11.6%, which was higher than 2.0% in boys＂ 4th floor of Dorm 32 where the primary case lived and 0.8% in other floors of Dorms, the difference was statistically significant （P〈0.05 ）. Attack rates were also different among classes, which were 18.9%, 6.8% and 0.6% respectively in Grade 10 Cartoon, Grade 10 Environment Art and other classes, the difference was also statistically significant （ P〈0.05 ）. Conclusion Screening of stratified contacts is applicable in the investigation of TB epidemic in schools, and can be used to understand the attack population. TB eases in this investigation are epidemiologically related, and are mainly transmitted via dormitory and class.

关 键 词：学生 发病率 卫生调查 结核 肺 

分 类 号：R195[医药卫生—卫生统计学] R521[医药卫生—卫生事业管理]