耐药肺结核患者密切接触者结核分枝杆菌潜伏感染危险因素分析  

Risk factors of latent tuberculosis infection among close contacts of drug-resistant pulmonary tuberculosis patients

作　　者：叶新春 刘赛朵 程芳 蒋贤高[1] 宁洪叶[1] 吴正兴[1] 周月影 邱超超 潘宁 施伎蝉[1] Ye Xinchun;Liu Saiduo;Cheng Fang;Jiang Xiangao;Ning Hongye;Wu Zhengxing;Zhou Yueying;Qiu Chaochao;Pan Ning;Shi Jichan(Department of Infectious Disease,Wenzhou Central Hospital/Theorem Clinical College of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学定理临床医院/温州市中心医院感染科,温州325000

出　　处：《中国防痨杂志》2024年第5期525-530,共6页Chinese Journal of Antituberculosis

基　　金：耐多药结核病患者密切接触者观察性研究(Y20211148)。

摘　　要：目的:探究耐药肺结核患者密切接触者结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)情况及危险因素。方法:采用前瞻性研究方法,选取2020年7月至2022年1月于温州市中心医院收治的154例耐药肺结核(包括单耐利福平肺结核、耐多药肺结核)患者的306名密切接触者作为研究对象。收集研究对象社会人口学特征、卡介苗接种史、疾病史,以及与指示病例的接触情况等信息;并进行HIV抗体筛查、胸部CT扫描、结核感染T细胞斑点试验和(或)结核菌素皮肤试验(PPD试验)等。调查研究对象LTBI情况,并采用logistic回归模型分析其发生LTBI的影响因素。结果:研究对象结核分枝杆菌潜伏感染率为18.6%(57/306)。多因素分析结果表明,年龄≥40岁、女性、体力劳动者、指示病例为复治患者,以及指示病例有咳嗽、咳痰等临床症状的密切接触者发生LTBI的风险更高[OR(95%CI)值分别为6.501(1.371~30.827)、2.961(1.472~5.956)、2.716(1.368~5.391)、3.100(1.278~7.521)、3.065(1.336~7.031)];而家庭月收入≥5000元是密切接触者发生LTBI的保护因素[OR(95%CI)=0.308(0.156~0.607)]。结论:耐药肺结核患者密切接触者结核分枝杆菌潜伏感染率较高,高龄、女性、体力劳动者、低收入,以及与复治耐药肺结核患者和具有咳嗽、咳痰等临床症状耐药肺结核患者的密切接触者是发生LTBI的高危人群。Objective:To explore the situation and risk factors of latent tuberculosis infection(LTBI)in close contacts of drug-resistant pulmonary tuberculosis patients.Methods:Using a prospective research method,306 close contacts of 154 drug-resistant pulmonary tuberculosis(including rifampicin resistant pulmonary tuberculosis and multidrug-resistant pulmonary tuberculosis)patients admitted to the Wenzhou Central Hospital from July 2020 to January 2022 were selected as the study subjects.Collected information included the sociodemographic characteristics,history of BCG vaccination,disease history,and contact with indicated cases of the research subjects;in addition,HIV antibody screening,chest CT scan,T-SPOT.TB and/or PPD test,etc.were conducted.The LTBI situation of the research subjects was investigated,and logistic regression models were used to analyze the influencing factors of their occurrence of LTBI.Results:The LTBI rate among the study subjects was 18.6%(57/306).The results of multivariate analysis showed that,for the close contacts,aged≥40 years,female,physical workers,and those with clinical symptoms such as cough and sputum in the indication case were at a higher risk of developing LTBI(OR(95%CI)values of 6.501(1.371-30.827),2.961(1.472-5.956),2.716(1.368-5.391),3.100(1.278-7.521),and 3.065(1.336-7.031),respectively);family monthly income≥RMB 5000 yuan was a protective factor for close contacts to develop LTBI(OR(95%CI)=0.308(0.156-0.607)).Conclusion:Close contacts of drug-resistant pulmonary tuberculosis patients have a higher LTBI rate.Elderly,female,physically active workers,low-income individuals,as well as close contacts with relapsed drug-resistant pulmonary tuberculosis patients and drug-resistant pulmonary tuberculosis patients with clinical symptoms such as cough and sputum,are high-risk population for latent infection.

关 键 词：结核 肺 抗药性 细菌 接触者追踪 感染 因素分析 统计学 

分 类 号：R521[医药卫生—内科学]