学校肺结核疫情密切接触者基线筛查及随访队列研究  

Baseline screening and follow-up cohort study of close contacts of school tuberculosis epidemic

作　　者：周建伟 张松桃 李占辉 许兴军 张卫 赵红霞 Zhou Jianwei;Zhang Songtao;Li Zhanhui;Xu Xingjun;Zhang Wei;Zhao Hongxia(He’nan Yiyang County Center for Disease Control and Prevention,Yiyang 471600,China)

机构地区：[1]河南省宜阳县疾病预防控制中心,宜阳471600

出　　处：《结核与肺部疾病杂志》2023年第2期120-127,共8页Journal of Tuberculosis and Lung Disease

摘　　要：目的:调查学校肺结核患者密切接触者结核菌素皮肤试验(tuberculin skin test,TST)和活动性肺结核发病及新发患者特征情况,为学校结核病防控工作提供基础数据。方法:采用队列研究方法,以河南省洛阳市宜阳县某学校2019年3月至2021年5月疫情处置中的307名学生密切接触者(排除19名转学者)作为基线筛查研究对象,以300名学生密切接触者(排除基线筛查中发现的7例活动性肺结核患者)作为2年随访队列的研究对象,分析期间密切接触者的可疑症状筛查、TST检测和胸部X线摄片(简称“胸片”)检查结果,比较不同特征学生的TST检测结果和活动性肺结核发病情况。结果:2年随访队列调查期间共计发现TST强阳性者119名,基线筛查和5次随访筛查的TST强阳性率分别为26.06%(80/307)、33.45%(99/296)、39.64%(111/280)、40.71%(114/280)、42.09%(117/278)和43.12%(119/276);其中,基线筛查与前2次(即2019年9月紫外线环境消毒后2个月前)随访筛查的TST强阳性率的差异有统计学意义(χ^(2)=6.261,P=0.044)。5次随访筛查共发现TST阳转者75名,阳转率分别为18.92%(42/222)、9.47%(16/169)、4.05%(6/148)、4.20%(6/143)和3.73%(5/134),其中前2次随访筛查发现阳转率的差异有统计学意义(χ^(2)=5.097,P=0.024)。共发现活动性肺结核患者28例,发病率为5.00/100人年(28/560.22人年)。基线调查时77名TST强阳性者在随访期间诊断为肺结核患者的发病率(9.47/100人年,13/137.23人年)明显高于基线调查时214名TST阴性者的发病率(3.70/100人年,15/404.99人年),差异有统计学意义(χ^(2)=6.143,P=0.013);而单纯TST强阳性且完成全疗程预防性治疗的85名学生均未发病,与51名未接受预防性治疗(26名)和未完成全疗程预防性治疗(25名)的单纯TST强阳性者发病率(21.14/100人年,17/80.41人年)差异有统计学意义(χ^(2)=31.820,P=0.000)。结论:学校肺结核患者密切接触者存在较高的聚集性感染发病风险,需多Objective:By investigating the incidence and characteristics of tuberculin skin test(tuberculin skin test,TST)and active tuberculosis in close contacts of pulmonary tuberculosis patients in schools,to provide basic data for the prevention and control of tuberculosis in schools.Methods:In this paper,a cohort study was used to research 307 close contacts of students(excluding 19 transfer scholars)from a school in Yiyang County,Luoyang City,He’nan Province during the epidemic treatment from March 2019 to May 2021 as the subjects of baseline screening,and 300 close contacts of students(excluding 7 active tuberculosis patients found in the baseline screening)as the subjects of two-year follow-up cohort study,including suspicious symptom screening,TST test,and chest X-ray examination.The incidence rate of tuberculosis,the strong positive prevalence of TST and the strong positive conversion rate of TST were observed at different follow-up stages.Results:A total of 119 TST strongly positive patients were found during the 2-year follow-up cohort survey.The strong positive prevalence of TST were 26.06%(80/307),33.45%(99/296),39.64%(111/280),40.71%(114/280),42.09%(117/278)and 43.12%(119/276)with the baseline screening and five follow-up screening.The difference between the strong positive prevalence of TST for baseline screening and the previous two follow-up screenings(two months before ultraviolet disinfection in September 2019)was statistically significant(χ^(2)=6.261,P=0.044).A total of 75 students with strong positive conversion rate of TST were found in the five follow-up screenings,and the positive conversion rate was 18.92%(42/222),9.47%(16/169),4.05%(6/148),4.20%(6/143)and 3.73%(5/134),respectively,among which the difference in the positive conversion rate of the first and second follow-up screening was statistically significant(χ^(2)=5.097,P=0.024).A total of 28 patients with active pulmonary tuberculosis were found in the five follow-up screenings,and the incidence rate was 5.00/100 person years(28/560.22 per

关 键 词：学生 结核 肺 接触者追踪 队列研究 随访研究 

分 类 号：R521[医药卫生—内科学] R81[医药卫生—临床医学]