肺结核密切接触者结核分枝杆菌潜伏感染情况及影响因素分析

doi:10.19983/j.issn.2096-8493.20230065

摘要/Abstract

摘要：

目的: 分析肺结核密切接触者结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)情况及影响因素。 方法: 以苏州地区张家港市2021年1月1日至12月31日期间登记管理的肺结核患者(76例)及其密切接触者(498名)为研究对象,调查研究对象人口学特征和接触方式等信息,采用结核菌素皮肤试验判定LTBI者。应用非条件的Binary Logistic逐步回归模型筛选肺结核密切接触者发生LTBI的影响因素,绘制森林图。 结果: 498名肺结核密切接触者中,LTBI者179例,潜伏感染率为35.94%。病原学阳性患者密切接触者LTBI发生率(37.64%,172/457)明显高于病原学阴性者(17.07%,7/41),差异有统计学意义(χ²=6.910,P<0.001)。多因素分析显示,以年龄最低三分位(<20岁)为参考,肺结核密切接触者(20~39岁和≥40岁)发生LTBI风险的OR(95%CI)值分别为1.768(1.132~2.763)和2.020(1.093~3.733),呈现随年龄增加,感染风险上升的趋势( $χ 趋势 2$ =15.743,P<0.001);社会密切接触者发生LTBI的风险是家庭密切接触者的2.892(95%CI:1.673~4.999)倍。 结论: 苏州地区张家港市肺结核密切接触者LTBI发生率较高,病原学阳性患者密切接触者、年龄≥40岁密切接触者和社会密切接触者是发生LTBI的高风险人群,应进行针对性开展预防性服药干预。

关键词: 结核, 肺, 接触者追踪, 结核菌素, 皮肤试验, 因素分析, 统计学

Abstract:

Objective: To analyze latent tuberculosis infection (LTBI) and related factors in close contacts of pulmonary tuberculosis patients. Methods: Tuberculosis patients (76 cases) and their close contacts (498 cases) registered and managed in Zhangjiagang City of Suzhou area from January 1 to December 31, 2021 were taken as research objects. The demographic characteristics and contact approaches of the research objects were investigated, and LTBI was determined by tuberculin skin test. The non-conditioned Binary Logistic stepwise regression model was used to screen the influencing factors of LTBI among close contacts of tuberculosis patients, and a forest plot was drawn. Results: Among 498 subjects, there were 179 cases of LTBI, resulting in an infection rate of 35.94%. The LTBI rate of close contacts of etiologically positive patients (37.64%, 172/457) was significantly higher than that of etiologically negative patients (17.07%, 7/41; χ²=6.910, P<0.001). Multivariable analysis showed that compared with the lowest three quartiles of age (<20 years) as the reference, the OR (95%CI) values of the risk of LTBI among close contacts of tuberculosis patients aged 20-39 years and ≥40 years were 1.768 (1.132-2.763) and 2.020 (1.093-3.733), respectively, showing an increasing trend of infection risk with increasing age ( $χ t r e n d 2$ =15.743, P<0.001). The infection risk of LTBI among non-family close contacts was 2.892(95%CI: 1.673-4.999) times of that of family close contacts. Conclusion: The LTBI rate among close contacts of tuberculosis patients in Zhangjiagang City, Suzhou area was relatively high. Close contacts of patients with etiologically positive pulmonary tuberculosis, close contacts aged 40 years and older, and non-family close contacts were at high risk of LTBI, and targeted preventive medication interventions should be carried out.

Key words: Tuberculosis, pulmonary, Contact tracing, Tuberculin, Skin tests, Factor analysis, statistical

中图分类号:

R521

蒋骏, 李云, 姜伟, 张晓龙. 肺结核密切接触者结核分枝杆菌潜伏感染情况及影响因素分析[J]. 结核与肺部疾病杂志, 2023, 4(4): 318-322. doi: 10.19983/j.issn.2096-8493.20230065

Jiang Jun, Li Yun, Jiang Wei, Zhang Xiaolong. Analysis of latent tuberculosis infection and related factors in close contacts of pulmonary tuberculosis patients[J]. Journal of Tuberculosis and Lung Disease, 2023, 4(4): 318-322. doi: 10.19983/j.issn.2096-8493.20230065

图/表 3

表1

表2

肺结核密切接触者发生LTBI的Binary logistic回归分析

特征	非感染数(名)	感染数(名)	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
年龄组(岁)
<20	232	97					1
20~39	62	57	0.570	0.228	6.268	0.012	1.768(1.132~2.763)
≥40	25	25	0.703	0.313	5.032	0.025	2.020(1.093~3.733)
接触方式
家庭	91	19					1
社会	228	160	1.062	0.279	14.464	<0.001	2.892(1.673~4.999)
常量			―1.769	0.273	42.004	<0.001	0.171

表2

图1

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特征	阴性(267例)	一般阳性(52例)	中度阳性(114例)	强阳性(65例)	χ²值	P值
年龄组(岁)					27.392	<0.001
<20	198(74.15)	34(65.38)	70(61.40)	27(41.54)
20~39	50(18.73)	12(23.08)	32(28.07)	25(38.46)
≥40	19(7.12)	6(11.54)	12(10.53)	13(20.00)
性别					2.993	0.393
男性	150(56.18)	33(63.46)	63(55.26)	31(47.69)
女性	117(43.82)	19(36.54)	51(44.74)	34(52.31)
接触方式					25.683	<0.001
家庭	81(30.34)	10(19.23)	15(13.16)	4(6.15)
社会	186(69.66)	42(80.77)	99(86.84)	61(93.85)