结核菌素皮肤试验诊断结核分枝杆菌潜伏感染学校人群预防性服药临界值的确定  

Determination of the critical value of prophylactic medication in school population for the diagnosis of latent tuberculosis infection by tuberculin skin test

作　　者：卢鹏 王荣[2] 刘家松[3] 刘巧[1] 丁晓艳[1] 陆伟[1] 竺丽梅[1] Lu Peng;Wang Rong;Liu Jiasong;Liu Qiao;Ding Xiaoyan;Lu Wei;Zhu Limei(Department of Chronic Communicable Disease,Center for Disease Control and Prevention of Jiangsu Province,Jiangsu Province,Nanjing 210009,China;Department of Chronic Communicable Disease,Center for Disease Control and Prevention of Nanjing City,Jiangsu Province,Nanjing 210003,China;Department of Chronic Communicable Disease,Center for Disease Control and Prevention of Huaian City,Jiangsu Province,Huaian 223003,China)

机构地区：[1]江苏省疾病预防控制中心慢性传染病防制所,南京210009 [2]南京市疾病预防控制中心慢性传染病防制所,南京210003 [3]江苏省淮安市疾病预防控制中心慢性传染病防制所,淮安223003

出　　处：《中国防痨杂志》2022年第8期797-801,共5页Chinese Journal of Antituberculosis

基　　金：江苏省卫生健康委科研重点项目(ZD2021052,ZDA2020022)。

摘　　要：目的:探寻在学校结核病疫情处置中应用结核菌素皮肤试验(tuberculin skin testing,TST)诊断需要预防性服药的结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)者的硬结平均直径临界值。方法:于2020年10月至2021年10月,选取江苏省发生3例及以上病例学校结核病疫情的2所学校的学生和老师作为研究对象,共纳入163名。对研究对象同时进行TST和QuantiFERON-TB gold in-tube(QFT)检测,以QFT检测结果为参照标准,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)来确定TST检测学校人群中需要预防性服药的LTBI者的硬结平均直径临界值。结果:163名受试者中,QFT检测阳性者79例(48.5%),QFT检测阴性者84名(51.5%)。TST中度阳性者132名(81.0%),其中,QFT检测阳性者62例,阳性率为47.0%(95%CI:38.3%~55.6%)。在163名研究对象中,以QFT检测结果为参照标准,TST检测硬结平均直径为12.5 mm时诊断需要预防性服药的LTBI者的价值最高,敏感度为38.0%(95%CI:27.3%~49.6%),特异度为82.1%(95%CI:72.3%~89.6%),曲线下面积(AUC)为0.621(95%CI:0.542~0.696);在132名TST中度阳性者中,以QFT检测结果为参照标准,TST检测硬结平均直径为12.5 mm时诊断需要预防性服药的LTBI者的价值最高,敏感度为25.8%(95%CI:15.5%~38.5%),特异度为87.1%(95%CI:77.0%~93.9%),AUC为0.572(95%CI:0.483~0.657)。结论:在学校结核病疫情处置中,如果在一个班级发生3例及以上结核病病例或者TST中度阳性率或者强阳性率远高于本地区正常范围时,应该重视TST中度阳性的人群。Objective:To explore the critical value of mean diameter of induration tuberculin by skin test(TST)for the diagnosis of late tuberculosis infection(LTBI)that needs preventive medication in the treatment of tuberculosis epidemic in school.Methods:From October 2020 to October 2021,163 students and teachers from two schools with three or more student tuberculosis patients in Jiangsu Province were selected.All the subjects were tested by TST and QuantiFERON-TB gold in-tube(QFT).Using the QFT results as the reference standard,the receiver operating characteristic curve(ROC)was used to determine the critical value of mean diameter of induration tuberculin,to diagnosis LTBI students and teachers who needed to have preventive treatment.Results:Of the 163 individuals,79(48.5%)were positive and 84(51.5%)were negative in QFT.Among 132 individuals with moderate positive in TST,62 were QFT positive(47.0%(95%CI:38.3%-55.6%)).Of the 163 individuals,using the QFT results as the reference standard,TST had the highest diagnostic value when the induration diameter of TST was 12.5 mm,with a sensitivity of 38.0%(95%CI:27.3%-49.6%)and a specificity of 82.1%(95%CI:72.3%-89.6%).The area under the curve(AUC)was 0.621(95%CI:0.542-0.696).Among 132 individuals with moderate positive TST,using the QFT results as the reference standard,TST had the highest diagnostic value when the induration diameter of TST was 12.5 mm,with a sensitivity of 25.8%(95%CI:15.5%-38.5%)and a specificity of 87.1%(95%CI:77.0%-93.9%),and the AUC was 0.572(95%CI:0.483-0.657).Conclusion:In the treatment of tuberculosis epidemic in school if there are three or more tuberculosis cases in a class or the moderate or strong positive rate of TST is much higher than the normal range in the region,attention should be paid to the population with moderate positive TST results.

关 键 词：结核 学生 疾病暴发流行 诊断 预防和防护用药 

分 类 号：R183[医药卫生—流行病学] R52[医药卫生—公共卫生与预防医学]