学校肺结核密切接触者感染暴露对疫情风险预测的影响  

The impact of infection exposure among close contacts of tuberculosis cases in school on epidemic risk prediction

作　　者：张晓龙[1] 崔彩岩 傅颖 王斐娴 李云[1] 蒋骏[1] ZHANG Xiaolong;CUI Caiyan;FU Ying;WANG Feixian;LI Yun;JIANG Jun(Department of Tuberculosis Control,Suzhou Center for Disease Control and Prevention,Suzhou 215137,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215137

出　　处：《中华疾病控制杂志》2025年第1期108-110,116,共4页Chinese Journal of Disease Control & Prevention

基　　金：苏州市重大疾病、传染病预防和控制关键技术(GWZX202001);苏州市卫生青年骨干人才“全国导师制”培训项目(QNGG2022031)。

摘　　要：目的探讨学校肺结核(pulmonary tuberculosis,PTB)疫情中密切接触者结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)率对疫情风险的预测效能,分析暴露水平与疫情风险间的关系。方法基于630起学校PTB疫情,收集630例指示病例及37522例密切接触者的筛查数据。采用非条件logistic回归分析模型分析LTBI率与PTB疫情聚集风险的关联,使用限制性立方样条(restricted cubic splines,RCS)探讨其与疫情风险的非线性关系,并通过受试者工作特征(receiver operating characteristic,ROC)曲线评估LTBI率对疫情聚集风险的预测能力。结果RCS分析表明,当病原学阴性患者密切接触者LTBI率>2.48%或病原学阳性患者密切接触者LTBI率>6.92%时,PTB疫情风险随LTBI率的增加呈上升趋势。多因素校正后,LTBI率每增加1%,疫情发生聚集风险的OR值为1.235(95%CI:1.175~1.297)。按照LTBI率三分位分析,与LTBI率<5%相比,LTBI率为5%~<9%时,疫情发生聚集风险的OR值为3.906(95%CI:1.427~10.692);LTBI率≥10%时,疫情发生聚集风险的OR值为19.195(95%CI:8.588~42.902)。ROC进一步揭示,LTBI率为13.81%是预测学校PTB疫情聚集风险的最佳判定值,ROC曲线下面积(area under curve,AUC)为0.87(95%CI:0.81~0.93)。结论密切接触者LTBI率升高是学校PTB疫情发生聚集风险的重要预警指标。Objective To investigate the predictive efficacy of latent tuberculosis infection(LTBI)rate among close contacts in school pulmonary tuberculosis(PTB)epidemic,and analyze the relationship between exposure level and epidemic risk.Methods Based on 630 school PTB outbreaks,screening data were collected from 630 index cases and 37522 close contacts.Unconditional logistic regression was used to analyze the association between LTBI rate and PTB outbreak clustering risk.Restricted cubic splines(RCS)were employed to explore their non-linear relationship,and receiver operating characteristic(ROC)curve was used to evaluate the predictive ability of LTBI rate for outbreak clustering risk.Results RCS analysis revealed that the risk of a PTB outbreak increased as the LTBI rate rose when the LTBI rate among close contacts of bacteriologically negative patients exceeded 2.48%or among bacteriologically positive patients exceeded 6.92%.After multivariate adjustment,for every 1%increase in the LTBI rate,the odds ratio(OR)for the risk of outbreak clustering was 1.235(95%CI:1.175-1.297).Analyzed by LTBI rate tertiles,compared with LTBI rate of<5%,the OR=3.906(95%CI:1.427-10.692)when LTBI rate was 5%-<9%and the OR=19.195(95%CI:8.588-42.902)when LTBI rate was≥10%.The ROC further revealed that an LTBI rate of 13.81%was the optimal threshold value for predicting the clustering risk of school PTB outbreaks,with ROC area under the curve(AUC)of 0.87(95%CI:0.81-0.93).Conclusions An elevated LTBI rate among close contacts is an important early warning indicator for the clustering risk of PTB outbreaks in schools.

关 键 词：肺结核 学校 密切接触者 结核分枝杆菌 

分 类 号：R521[医药卫生—内科学] R181.88[医药卫生—临床医学]