“TST-IGRA”两步法在三起高中学校结核病密切接触者筛查中的应用  

Application of the TST-IGRA two-step method in screening close contacts of active tuberculosis patients among three high schools

作　　者：张瑞 郝艳星 王中林[1] 朱建明[1] 朱士玉[1] ZHANG Rui;HAO Yanxing;WANG Zhonglin;ZHU Jianming;ZHU Shiyu(Department of STD and TB Control,Jinshan Center for Disease Prevention and Control,Shanghai 201599,China)

机构地区：[1]上海市金山区疾病预防控制中心性病结核病防制科,上海201599

出　　处：《公共卫生与预防医学》2023年第5期60-63,共4页Journal of Public Health and Preventive Medicine

基　　金：上海市金山区卫生健康专项科研课题(JSKJ-KTGW-2020-07)。

摘　　要：目的 探索“TST-IGRA”两步法在学校结核病密切接触者筛查中的应用,为辖区学校结核病防控工作提供证据支持。方法 纳入2020—2021年金山区内发生的3起学校结核病疫情,在排除活动性肺结核后,对密切接触者采用结核菌素皮肤试验和γ-干扰素释放试验(IGRA)进行结核分枝杆菌潜伏感染筛查,分析两步法的必要性。结果 三起疫情共筛查密切接触者362人,接受TST检测的人数为350人。比较不同类别密切接触者TST和IGRA检测结果发现,教职员工TST中强阳性率高于学生(54.84%vs 20.38%,P<0.05);肺结核高负担地区来沪学生的TST中强阳性率高于本地学生(24.7%vs 18.8%,P<0.05)。对TST检测结果中强阳性者进行IGRA检测,结果显示中强阳性者“TST-IGRA”两步法阳性率仅为17.7%,Kappa值为0.3。结论 学校结核病防控应加强教职员工年度体检工作,出现异常及时就医。合理增加结核病高负担地区来沪学生的筛查频率,收集学生既往结核病接触史。在进行密切接触者筛查时,建议排除活动性结核病后,采取TST和IGRA联合判断结核杆菌潜伏感染,实现精准干预。Objective To explore the application of the TST-IGRA two-step method in the screening of close contacts of active tuberculosis patients among three high schools in Jinshan District in 2020-2021,and to provide evidence for improving the prevention and control of tuberculosis in schools.Methods Three school tuberculosis outbreaks in Jingshan District from 2020 to 2021 were included in the present study.After excluding active tuberculosis,tuberculin skin test andγ-interferon release assay(IGRA)were conducted to screen latent infection of Mycobacterium tuberculosis in close contacts,and the necessity of the two-step method was analyzed.Results A total of 362 close contacts were screened in the three outbreaks,and 350 people were tested by TST.Comparing the results of TST and IGRA among different types of close contacts,it was found that the positive rate of TST in teachers was higher than that in students(54.84%vs 20.38%,P<0.05).The positive rate of TST among students from high-burden areas of pulmonary tuberculosis in Shanghai was higher than that of local students(24.71%vs 18.80%,P<0.05).IGRA detection was performed on those with moderate and strong positive TST results,and the results showed that the positive rate of IGRA in those with strong positive TST results was only 17.7%,with Kappa value of 0.3.Conclusion The prevention and control of tuberculosis in school should strengthen the annual health examination of teachers and staff,promote timely medical treatment for suspected tuberculosis symptoms,reasonably increase the screening frequency of students in high-burden areas of tuberculosis in Shanghai,and collect students′previous history of tuberculosis exposure.When screening close contacts,after excluding active tuberculosis,it is recommended that TST and IGRA should be combined to determine latent Mycobacterium tuberculosis infection and achieve accurate intervention.

关 键 词：学生 结核杆菌 潜伏感染 

分 类 号：R183[医药卫生—流行病学]