Investigation on latent infection of Mycobacterium tuberculosis among freshmen in Colleges and universities in Changping District of Beijing and analysis of preventive treatment effect of latent infection

doi:10.19983/j.issn.2096-8493.20220109

Abstract

Abstract:

Objective: To understand the status of latent tuberculosis infection (LTBI) among college freshmen in Changping District, Beijing, to provide preventive therapy and follow-up of TB incidence.in order to provide a basis for the development of strategies on tuberculosis (TB) prevention and control. Methods: From 2015 to 2018, 97648 freshmen from 9 colleges and universities in Changping District were tested with tuberculin skin test (TST) and chest radiography. The TST reagent used tuberculin purified protein derivative (PPD); 5769 patients with strong positive PPD were given preventive treatment; According to the results of PPD and preventive treatment, they were divided into 4 groups (PPD strongly positive preventive treatment group, PPD strongly positive non-preventive treatment group, PPD positive group, PPD negative group). The incidence of pulmonary tuberculosis was observed for 4 years. The rates between groups were compared by χ² test, and the influencing factors were analyzed by univariate and multivariate Cox regression analysis. Results: The strong positive rate of PPD among 97648 freshmen was 6.01% (5873/97648). The strong positive rates of PPD among freshmen from 2015 to 2018 were 7.68% (1919/24974), 6.08% (1422/23371), 5.64% (1420/25196) and 4.61% (1112/24107) respectively, showing a downward trend, and the difference was statistically significant (Z=-14.274, P<0.01). After 4 years of follow-up, the incidence rate of tuberculosis in the PPD strongly positive group without preventive treatment was 495.77/100000 (17/3429); The incidence rate of pulmonary tuberculosis in PPD strongly positive preventive treatment group was 85.47/100000 (2/2340); The incidence rate of tuberculosis in PPD positive group was 40.63/100000 (7/17230); The incidence rate of tuberculosis in PPD negative group was 29.52/100000 (22/74530). Strong positive PPD was a risk factor for tuberculosis (HR=16.83, 95%CI:8.94-31.70). Among PPD strongly positive students, preventive treatment was the protective factor of tuberculosis (HR=0.17, 95%CI:0.04-0.75). Conclusion: Preventive therapy of PPD strong response can effectively reduce the incidence of active TB, which is important for controlling the epidemic of TB in schools.

Key words: Tuberculosis, Incidence, Preventive and protective drugs, Students, Tuberculin skin test

CLC Number:

R521

Yang Zhen, Lei Nan, Zhao Fei, He Yanping, Lin Na, Zhang Zhiguo. Investigation on latent infection of Mycobacterium tuberculosis among freshmen in Colleges and universities in Changping District of Beijing and analysis of preventive treatment effect of latent infection[J]. Journal of Tuberculosis and Lung Disease , 2022, 3(4): 274-280. doi: 10.19983/j.issn.2096-8493.20220109

Figures/Tables 7

变量	β值	S $x ¯$	Wald χ²值	P值	HR(95%CI)值
性别	0.61	0.31	3.89	0.05	1.85(1.00~3.40)
年龄	0.21	0.19	1.22	0.27	1.23(0.85~1.77)
规律服药(是)	0.16	0.10	2.33	0.11	1.17(0.96~1.03)
完成疗程(是)	0.19	0.35	1.58	0.59	1.21(0.49~2.43)
不良反应(有)	0.94	1.05	1.55	0.37	2.56(0.32~1.22)
PPD
强阳性	2.41	0.31	59.38	<0.01	11.17(6.05~20.64)
阳性	0.32	0.43	0.54	0.46	1.38(0.59~3.22)
阴性	-
预防性治疗	0.57	0.72	0.62	0.43	1.77(0.43~7.29)

变量	β值	S $x ¯$	Wald χ²值	P值	HR(95%CI)值
PPD强阳性	2.82	0.32	76.44	<0.01	16.83(8.94~31.70)
PPD阳性	0.32	0.43	0.54	0.46	1.38(0.59~3.22)
PPD阴性	-
预防性治疗	-1.76	0.75	5.54	0.02	0.17(0.04~0.75)

References 19

[1]	中华人民共和国国家卫生健康委办公厅, 中华人民共和国教育部办公厅.中国学校结核病防控指南(2020年版).国卫办疾控函〔2020〕910号.2020-10-16.
[2]	屠德华, 刘玉清, 张立兴, 等. 大学生预防性治疗的结核菌素反应强度标准研究. 中国防痨杂志, 2006, 28(5): 265-268.
[3]	中华人民共和国卫生部.WS 288—2008 肺结核诊断标准2008-01-16.
[4]	中华人民共和国国家卫生和计划生育委员会.WS 288—2017肺结核诊断.2017-11-09.
[5]	北京市卫生局. 北京市卫生局关于印发《北京市结核病防治工作规范(2013年版).》的通知京卫疾控字〔2013〕39号.2013-05-08.
[6]	中国医学科学院病原生物学研究所, 中国疾病预防控制中心, 中国科学院地理科学与资源研究所. 全国结核分枝杆菌潜伏感染率估算专家共识. 中国防痨杂志, 2022, 44(1):4-8. doi: 10.19982/j.issn.1000-6621.20210662. doi: 10.19982/j.issn.1000-6621.20210662
[7]	刘曦, 李婕. 2011—2015年北京市海淀区高校本科入学新生结核病筛查及随访情况. 结核与肺部疾病杂志, 2020, 1(1): 49-54. doi: 10.3969/j.issn.2096-8493.2020.01.011. doi: 10.3969/j.issn.2096-8493.2020.01.011
[8]	高磊, 金奇. 关口前移:结核潜伏感染及其控制. 中国防痨杂志, 2018, 40(8):791-795. doi: 10.3969/j.issn.1000-6621.2018.08.003. doi: 10.3969/j.issn.1000-6621.2018.08.003
[9]	全国结核病流行病学抽样调查技术指导组, 全国结核病流行病学抽样调查办公室. 2000年全国结核病流行病学抽样调查报告. 中国防痨杂志, 2002, 24(2):65-108.
[10]	任哲雯, 成君, 徐彩红, 等. 肺结核患者密切接触者潜伏性结核感染预防性治疗研究进展. 中国防痨杂志, 2019, 41(9): 1021-1024. doi: 10.3969/j.issn.1000-6621.2019.09.020. doi: 10.3969/j.issn.1000-6621.2019.09.020
[11]	肖桂珍. 分析某高校新生PPD结果及意义. 现代预防医学. 2008, 35(11):2126-2127.
[12]	肖承康, 朱俊芳, 刘柏辉, 等. 大中专院校学生结核感染发病情况调查分析. 临床肺科杂志, 2007, 12(1):77-78. doi: 10.3969/j.issn.1009-6663.2007.01.046. doi: 10.3969/j.issn.1009-6663.2007.01.046
[13]	戴景涛, 卓玛. 结核潜伏性感染预防性治疗效果分析. 医药前沿, 2018, 8(31):219-220.
[14]	杨奎, 陈伟. 学生结核分枝杆菌潜伏感染筛查和预防性治疗研究进展. 结核与肺部疾病杂志, 2021, 2(4): 361-365. doi: 10.19983/j.issn.2096-8493.20210141. doi: 10.19983/j.issn.2096-8493.20210141
[15]	林培歆, 张晨晨. 学生人群潜伏性结核感染现况及干预进展. 结核与肺部疾病杂志, 2020, 1(2): 170-173. doi: 10.3969/j.issn.2096-8493.2020.02.016. doi: 10.3969/j.issn.2096-8493.2020.02.016
[16]	World Health Organization. Guidelines on the management of latent tuberculosis infection. Geneva:World Health Organization, 2015.
[17]	梁瑞英, 徐伟, 吴春萍. 北京市朝阳区2013—2015年高校新生结核菌潜伏感染现状及发病情况. 中国学校卫生. 2019, 40(9):1373-1375. doi: 10.16835/j.cnki.1000-9817.2019.09.026. doi: 10.16835/j.cnki.1000-9817.2019.09.026
[18]	王倪, 张慧, 黄飞, 等. 在中学开展结核菌潜伏感染者预防性治疗的可行性研究. 疾病监测, 2017, 32(1): 43-47. doi: 10.3784/j.issn.1003-9961.2017.01.012. doi: 10.3784/j.issn.1003-9961.2017.01.012
[19]	王玉红, 邢华燕, 田野, 等. 郑州市部分大中专院校2005—2012 年新生结核菌普查分析. 中国卫生统计,2014, 31 (4):674-677.

变量	赋值
性别	0=男;1=女
年龄(岁)	连续性变量
TST结果	1=强阳性;2=阳性;3=阴性
是否预防性治疗	0=未预防性治疗;1=预防性治疗
是否规律服药	0=规律服药;1=未规律服药
是否完成疗程	0=完成疗程;1=未完成疗程
有无不良反应	0=有不良反应;1=无不良反应
随访时长(年)	连续性变量
是否发病	0=未发病;1=发病

年份	PPD皮肤试验学生数 (名)	肺结核患者 (例)	阴性				阳性				强阳性
年份	PPD皮肤试验学生数 (名)	肺结核患者 (例)	学生数 (名)	率 (%)	患肺结核者 (例)	检出率 (/10万)	学生数 (名)	率 (%)	肺结核患者 (例)	检出率 (/10万)	学生数 (名)	率 (%)^a	肺结核患者 (例)	检出率 (/10万)
2015	24974	32	18004	72.09	2	11.11	5051	20.23	1	19.8	1919	7.68	29	1511.20
2016	23371	14	17450	74.67	0	0.00	4499	19.25	1	22.23	1422	6.08	13	914.21
2017	25196	9	19595	77.77	0	0.00	4181	16.59	0	0.00	1420	5.64	9	633.80
2018	24107	9	19490	80.85	2	10.26	3505	14.54	0	0.00	1112	4.61	7	629.50
合计	97648	64	74539	76.33	4	5.37	17236	17.65	2	11.60	5873	6.01	58	987.57

	服药组(构成比,%)	未服药组(构成比,%)	χ²值	P值
性别			71.532	<0.01
男性	1204(51.45)	2148(62.64)
女性	1136(48.55)	1281(37.36)
年龄(岁)			2.856	0.24
18	1864(79.66)	2786(81.25)
19	301(12.86)	392(11.43)
20	175(7.48)	251(7.32)

组别	随访第1年			随访第2年			随访第3年			随访第4年
组别	学生数 (名)	发病例数	发病率 (/10万)	学生数 (名)	发病例数	发病率 (/10万)	学生数 (名)	发病例数	发病率 (/10万)	学生数 (名)	发病例数	发病率 (/10万)
PPD阴性组	74530	2	2.68	74528	9	12.08	74519	5	6.71	74514	6	8.05
PPD阳性组	17230	2	11.61	17228	2	11.61	17226	1	5.81	17225	2	11.61
PPD强阳性预防性治疗组	2340	0	0.00	2340	0	0.00	2340	1	42.74	2339	1	42.75
PPD强阳性未预防性治疗组	3429	5	145.82	3424	7	204.44	3417	4	117.06	3413	1	29.30
合计	97529	9	9.23	97520	18	18.46	97502	11	11.28	97491	10	10.26