两步法在大学新生结核潜伏感染检测中的应用  

Application on two-step method in detecting latent tuberculosis infection among college freshmen

作　　者：李银萍[1] 尹立[1] 李飞[1] 陶然 王新丽[1] 刘京辉[1] 许雅馨 徐计宏 LI Yin-ping;YIN Li;LI Fei;TAO Ran;WANG Xin-li;LIU Jing-hui;XU Ya-xin;XU Kei-hong(Prevention and Health Care and Health Monitoring Center,Taiyuan City Center for Disease Prevention and Control,Shanxi 030000,China;Tuberculosis Department,Taiyuan City Center for Disease Control and Prevention;Department of Public Health,Taiyuan City Center for Disease Control and Prevention;Office of Taiyuan City Center for Disease Control and Prevention)

机构地区：[1]太原市疾病预防控制中心预防保健及健康监护中心,山西030000 [2]太原市疾病预防控制中心结核科 [3]太原市疾病预防控制中心公卫科 [4]太原市疾病预防控制中心办公室

出　　处：《预防医学论坛》2025年第1期21-24,共4页Preventive Medicine Tribune

基　　金：山西省卫生健康委员会立项课题(2020108)。

摘　　要：目的探讨两步法在太原市大学新生结核潜伏感染检测中的应用,为大学结核病防治工作提供依据。方法采用随机整群抽样选择太原市两所大学2022年录取的大一本科新生。成立专家小组参照学校结核病防控工作规范设计调查问卷,并经过预实验及时修改调查表的内容。对研究对象进行结核菌素试验(TST),对TST阳性者进行γ-干扰素释放试验。TST皮肤硬结平均直径>10mm或γ-干扰素释放试验检测阳性者,经病史询问、胸部X线检查、体格检查、痰检等排除活动性结核病的可能,则为结核潜伏感染。采用SPSS 22.0统计软件分析数据,计数资料比较采用χ^(2)检验,多因素logistics回归分析γ干扰素释放试验的影响因素。结果两所大学大一新生进行TST 15246名,阳性3738名,阳性率24.22%;中、强阳性3026名,潜伏感染率为19.85%。对TST阳性者进一步进行γ-干扰素释放试验检测153名,阳性35名,阳性率为22.87%;推算潜伏感染854名,潜伏感染率5.61%。TST反应越强,γ-干扰素释放试验阳性率越高,差异有统计学意义(χ^(2)=22.603,P<0.05)。γ-干扰素释放试验阳性与卡介苗接种史、糖尿病家族史、TST结果、近三年内结核病密切接触史有关(χ^(2)值分别为12.413、3.862、22.623、7.783,P<0.05)。多因素logistics回归分析结果显示,卡介苗接种史是γ-干扰素释放试验结果的影响因素(OR=0.710,95%CI:0.100~0.540,P<0.05)。结论采用两步法可更精准地界定结核潜伏感染者,卡介苗接种史对γ-干扰素释放试验结果有一定影响。Objective To explore the application of the two-step method in detecting latent tuberculosis infection(LTBI)among freshmen in Taiyuan city,so as to provide evidence for tuberculosis(TB)prevention and control in universities.Methods A random cluster sampling method was used to select first-year undergraduate students enrolled in 2universities in Taiyuan city in 2022.An expert panel designed a questionnaire based on the school TB prevention and control guidelines,and the content was revised after a pilot study.Tuberculin skin tests(TST)were conducted on the participants,and those with positive TST results underwent interferon-gamma release assays(IGRAs).Individuals with a TST induration diameter>10mm or a positive IGRA result were further evaluated for active TB through medical history inquiry,chest Xray,physical examination,and sputum testing.If active TB was excluded,they were classified as having latent TB infection.Data were analyzed using SPSS 22.0.Categorical data were compared using the chi-square test,and multivariate logistic regression was used to analyze factors influencing IGRA results.Results Among the 15246freshmen who underwent TST,3738tested positive,yielding apositive rate of 24.22%.Among these,3026had moderate or strong positive reactions,resulting in a latent infection rate of 19.85%.Further IGRA testing was performed on 153TST-positive individuals,with 35testing positive(positive rate:22.87%).The estimated number of latent infections was 854,with a latent infection rate of 5.61%.The stronger the TST reaction,the higher the IGRA positive rate,and the difference was statistically significant(χ^(2)=22.603,P<0.05).IGRA positivity was associated with a history of BCG vaccination,family history of diabetes,TST results,and close contact with TB patients within the past three years(χ^(2)=12.413,3.862,22.623,and 7.783,respectively;P<0.05).Multivariate logistic regression analysis showed that a history of BCG vaccination was a significant factor influencing IGRA results(OR=0.710,95%CI:0.100-0.540,P<0.05

关 键 词：大学新生 结核 潜伏感染 结核菌素试验 

分 类 号：R186.2[医药卫生—流行病学] R52[医药卫生—公共卫生与预防医学]