肺结核密切接触者结核分枝杆菌潜伏感染情况及影响因素分析  

Analysis of latent tuberculosis infection and related factors in close contacts of pulmonary tuberculosis patients

作　　者：蒋骏[1] 李云[1] 姜伟[2] 张晓龙[1] Jiang Jun;Li Yun;Jiang Wei;Zhang Xiaolong(Institute of Tuberculosis Prevention and Control,Suzhou Center for Disease Control and Prevention,Suzhou 215004,China;Department of Tuberculosis,Zhangjiagang Center for Disease Control and Prevention,Suzhou 215600,China)

机构地区：[1]苏州市疾病预防控制中心结核病防制所,苏州215004 [2]张家港市疾病预防控制中心结核科,苏州215600

出　　处：《结核与肺部疾病杂志》2023年第4期318-322,共5页Journal of Tuberculosis and Lung Disease

基　　金：苏州市重大疾病、传染病预防和控制关键技术(研究)项目(GWZX202001)。

摘　　要：目的:分析肺结核密切接触者结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)情况及影响因素。方法:以苏州地区张家港市2021年1月1日至12月31日期间登记管理的肺结核患者(76例)及其密切接触者(498名)为研究对象,调查研究对象人口学特征和接触方式等信息,采用结核菌素皮肤试验判定LTBI者。应用非条件的Binary Logistic逐步回归模型筛选肺结核密切接触者发生LTBI的影响因素,绘制森林图。结果:498名肺结核密切接触者中,LTBI者179例,潜伏感染率为35.94%。病原学阳性患者密切接触者LTBI发生率(37.64%,172/457)明显高于病原学阴性者(17.07%,7/41),差异有统计学意义(χ^(2)=6.910,P<0.001)。多因素分析显示,以年龄最低三分位(<20岁)为参考,肺结核密切接触者(20~39岁和≥40岁)发生LTBI风险的OR(95%CI)值分别为1.768(1.132~2.763)和2.020(1.093~3.733),呈现随年龄增加,感染风险上升的趋势(χ_(趋势)^(2)=15.743,P<0.001);社会密切接触者发生LTBI的风险是家庭密切接触者的2.892(95%CI:1.673~4.999)倍。结论:苏州地区张家港市肺结核密切接触者LTBI发生率较高,病原学阳性患者密切接触者、年龄≥40岁密切接触者和社会密切接触者是发生LTBI的高风险人群,应进行针对性开展预防性服药干预。Objective:To analyze latent tuberculosis infection(LTBI)and related factors in close contacts of pulmonary tuberculosis patients.Methods:Tuberculosis patients(76 cases)and their close contacts(498 cases)registered and managed in Zhangjiagang City of Suzhou area from January 1 to December 31,2021 were taken as research objects.The demographic characteristics and contact approaches of the research objects were investigated,and LTBI was determined by tuberculin skin test.The non-conditioned Binary Logistic stepwise regression model was used to screen the influencing factors of LTBI among close contacts of tuberculosis patients,and a forest plot was drawn.Results:Among 498 subjects,there were 179 cases of LTBI,resulting in an infection rate of 35.94%.The LTBI rate of close contacts of etiologically positive patients(37.64%,172/457)was significantly higher than that of etiologically negative patients(17.07%,7/41;χ^(2)=6.910,P<0.001).Multivariable analysis showed that compared with the lowest three quartiles of age(<20 years)as the reference,the OR(95%CI)values of the risk of LTBI among close contacts of tuberculosis patients aged 20-39 years and≥40 years were 1.768(1.132-2.763)and 2.020(1.093-3.733),respectively,showing an increasing trend of infection risk with increasing age(χ_(trend)^(2)=15.743,P<0.001).The infection risk of LTBI among non-family close contacts was 2.892(95%CI:1.673-4.999)times of that of family close contacts.Conclusion:The LTBI rate among close contacts of tuberculosis patients in Zhangjiagang City,Suzhou area was relatively high.Close contacts of patients with etiologically positive pulmonary tuberculosis,close contacts aged 40 years and older,and non-family close contacts were at high risk of LTBI,and targeted preventive medication interventions should be carried out.

关 键 词：结核 肺 接触者追踪 结核菌素 皮肤试验 因素分析 统计学 

分 类 号：R521[医药卫生—内科学]