结核病与肺部健康杂志 ›› 2015, Vol. 4 ›› Issue (1): 18-22.doi: 10.3969/j.issn.2095-3755.2015.01.004

• 论著 • 上一篇    下一篇

校园结核潜伏感染者预防性治疗管理方式的研究

齐怡,杨连军,王雪梅,杨蕴轶,路希维   

  1. 116033 大连市结核病医院
  • 收稿日期:2015-01-06 出版日期:2015-03-14 发布日期:2015-03-14
  • 通信作者: 路希维,Email:yiluxiwei@126.com

The study of preventive treatment management strategy for people with latent Mycobacterium tuberculosis infections in school

QI Yi, YANG Lian-jun, WANG Xue-mei, YANG Yun-yi, LU Xi-wei   

  1. Tuberculosis Hospital of Dalian, Dalian 116033, China
  • Received:2015-01-06 Online:2015-03-14 Published:2015-03-14
  • Contact: LU Xi-wei, Email: yiluxiwei@126.com

摘要: 目的 改进校园结核潜伏感染者预防性治疗管理模式,探讨提高潜伏感染者对药物预防性治疗的依从性和规范治疗的新手段。方法 搜集2010年至2014年发生在东软信息学院、大连海洋大学的2起结核病暴发事件中密切接触者292名,其中潜伏感染者130例,采用DOT管理方式推进潜伏感染者预防性治疗(DOT组);大连理工大学和大连交通大学的2起结核病暴发事件中密切接触者244名,共有潜伏感染者91例,采用全程管理模式进行服药管理(全程管理组)。分别观察两组的治疗依从性、规则服药率及有效干预率,同时对中断治疗原因进行调查。采用SPSS 19.0软件进行统计学分析,率的比较采用χ2检验,P<0.05为差异有统计学意义。结果 潜伏感染者对药物预防性治疗的接受率、规则服药率在DOT组和全程管理组分别为90.0%(117/130)、90.6%(106/117)和67.0%(61/91)、42.6%(26/61),χ2值分别为18.0、48.2, P值均<0.05。药物不良反应总发生率为4.5%(8/178);其中DOT组和全程管理组分别为4.3%(5/117)和4.9%(3/61)。对采取药物预防性治疗的潜伏感染者中断治疗原因(共计46例:其中DOT组11例,全程管理组35例)进行调查:在DOT组中,药物不良反应、主观忽视是造成中断治疗的主要原因,分别占27.3%(3/11)和27.3%(3/11)。在全程管理组中,主观忽视和对药物不良反应的担心是造成中断治疗的主要原因,分别占34.3%(12/35)和28.6%(10/35)。结核病暴发后进行了1年的续发患者随访,结核病续发率在PPD硬结平均直径<15 mm组、PPD硬结平均直径≥15 mm且规则用药组及PPD硬结平均直径≥15 mm且不规则用药组分别为1.6%(5/315)、0.0%和2.2%(2/89)。结论 在提高结核潜伏感染者对药物预防性治疗的依从性和改善规则服药方面,DOT将发挥不可替代的作用。

Abstract: Objective To improve the management efficiency of preventive treatment for latent tuberculosis infection(LTBI), explore the new measures to increase the compliance of LTBI preventive treatmentMethods Management efficiency of DOT and whole process management for LTBI preventive therapy had been compared during 2010—2014. TB outbreaks occurred in Neusoft Institute of Information and Dalian Ocean University were set in DOT group. The group consisted of 292 cases of close contacts, in which 130 cases were with latent infection. Other TB outbreaks happened in Dalian Technology University, Dalian Jiaotong University were set in whole process management group (control group). The group consisted of 244 cases of close contacts, in which 91 cases were LTBI. The rate of compliance and regular treatment were observed, and the causes of interruption of treatment were investigated. SPSS 19.0 was used for statistical analysis. Chi-square text was used compared rates and P value less than 0.05 were considered statistically significant. Results The acceptance rate of preventive treatment for LTBI, regularly therapy rate in the DOT and full management was 90.0%(117/130),90.6%(106/117), and 67.0%(61/91), 42.6%(26/61) respectively, χ2=18.0, 48.2, P values less than 0.05. The total rate of adverse drug reactions was 4.5%(8/178). In which the rate of DOT and full management group was 4.3 %(5/117) and 4.9%(3/61) respectively. The reasons of treatment interruption in the preventive treatment for LTBI were investigated(total 46 cases: 11 cases were in DOT group, and the rest 35 cases were in management group). In the DOT group, the main reasons were drugs side reactions and subjective neglect, accounted 27.3%(3/11) and 27.3% (3/11) respectively. While in the full management group, the main causes of treatment interruption were the fear of adverse drug reactions and subjective neglect, accounted 34.3%(12/35) and 28.6%(10/35) respectively. One-year-follow-ups after TB outbreaks, secondary attack rates in TST<15 mm group, regularly treatment with TST≥15 mm group, and inregularly treatment with TST≥15 mm group, were 1.6%(5/315),0.0% and 2.2%(2/89) respectively. Conclusion DOT will play the irreplaceable role in the fields of improving the compliance of preventive treatment for LTBI and promoting regularly preventive therapy.