上海市普陀区病原学阳性敏感肺结核患者家庭内密切接触者结核感染筛查情况及发病影响因素分析  

Screening of latent tuberculosis infection and analysis of morbidity influencing factors in household contacts of positive and sensitive pulmonary tuberculosis patients in Putuo District,Shanghai

作　　者：孙嘉轩 刘艳[2] 梁鹏飞 郑亦慧 胡屹 陈静[3] 徐飚 Sun Jiaxuan;Liu Yan;Liang Pengfei;Zheng Yihui;Hu Yi;Chen Jing;Xu Biao(Department of Epidemiology,School of Public Health,Fudan University,Shanghai 200032,China;Department of Chronic Communicable Disease,Shanghai Putuo Center for Disease Control and Prevention,Shanghai 200333,China;Tuberculosis and AIDS Prevention and Control Institute,Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,China)

机构地区：[1]复旦大学公共卫生学院流行病学教研室,上海200032 [2]上海市普陀区疾病预防控制中心慢性传染病预防控制科,上海200333 [3]上海市疾病预防控制中心结核病与艾滋病防治所,上海200336

出　　处：《中国防痨杂志》2024年第1期54-61,共8页Chinese Journal of Antituberculosis

基　　金：“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项——上海市大城市结核病综合防治模式研究(2018ZX10715012)。

摘　　要：目的:分析上海市普陀区病原学阳性敏感肺结核患者家庭内密切接触者结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)发病情况及其影响因素。方法:采用前瞻性研究方法,以2018—2021年上海市普陀区确诊的病原学阳性敏感肺结核患者及其家庭内密切接触者为研究对象,采用γ-干扰素释放试验对密切接触者开展结核感染筛查,并在首次调查后的3、6、12个月内向密切接触者提供自愿的LTBI检测,计算LTBI累计感染率;采用二分类logistic回归方法分析指示病例特征对家庭内密切接触者发生LTBI的影响,并通过结核病登记报告系统随访识别密切接触者中活动性肺结核发病情况,计算其近期(截至2022年12月31日)的人年发病密度。结果:2018—2021年共纳入确诊肺结核患者168例,识别家庭内密切接触者284名,首次筛查LTBI感染率为26.8%(76/284),一年内累计感染率为34.5%(98/284)。多因素分析结果显示,在第2个月末痰检结果仍为阳性的指示病例是家庭内密切接触者发生LTBI的危险因素(OR=7.167,95%CI:2.399~26.587,P=0.001)。284名家庭内密切接触者共观察了720.17人年,5例新发现肺结核患者近期发病密度为6.94/1000人年(5/720.17人年),LTBI阳性肺结核近期发病密度[15.76/1000人年(4/253.83人年)]与LTBI阴性肺结核[2.14/1000人年(1/466.34人年)]差异无统计学意义(χ^(2)=2.607,P=0.106)。结论:结核病患者家庭内密切接触者结核病感染风险高,尤其是第2个月末痰检结果仍为阳性的指示病例家庭内密切接触者发生LTBI的风险更高,应加强涂阳结核病患者的及时诊断和有效治疗,有效预防结核病在家庭内密切接触者中的传播。Objective:To analysed the screening of latent tuberculosis infection(LTBI)and the morbidity influencing factors in household contacts of positive and sensitive pulmonary tuberculosis(PTB)patients in Putuo District,Shanghai.Methods:This was a prospective study,the study subjects were the household contacts of positive and sensitive PTB patients who tested for Mycobacterium tuberculosis infection byγ-interferon release test in Putuo District from 2018 to 2021.After the first screen,the household contacts were followed up and tested for LTBI voluntarily within 3,6,12 months to calculate the cumulative infection rate.Binary logistic regression were used to analyze the risk factors of index cases on the LTBI of household contacts.The new cases were identified through the Tuberculosis Registration and Reporting System and short-term(end 202-12-03)incidence density of TB in household contacts were calculated.Results:From 2018 to 2021,a total of 168 PTB cases and 284 household contacts were enrolled in the study.The infection rate of the first screening test was 26.8%(76/284)and the cumulative infection rate was 34.5%(98/284)within one year.The results of multivariate analysis showed that the positive 2-month sputum examination of index cases was a risk factor for LTBI in household contacts(OR=7.167,95%CI:2.399-26.587,P=0.001).The short-term incidence density of 284 household contacts was 6.94/1000 person-years with 720.17 observation person-years.Five new cases were detected among and the short-term incidence density was 6.94/1000 person-years(5/720.17 person-years).There were no significant difference in the incidence density of PTB between LTBI household contacts(15.76/1000 person-years(4/253.83 person-years))and non-infected individuals(2.14/1000 person-years(1/466.34 person-years))(χ^(2)=2.607,P=0.106).Conclusion:The infection risk was high in household contacts of PTB patients.Index cases with positive 2-month sputum examination result had higher risks of generating LTBI.The timely diagnosis and effective treatme

关 键 词：结核 肺 潜伏性结核病 家庭 接触者追踪 多相筛查 流行病学研究 

分 类 号：R152[医药卫生—营养与食品卫生学] R183[医药卫生—公共卫生与预防医学]