涂阳肺结核密切接触者预防性用药有效性及安全性

Efficacy and safety of prophylactic medication in close contacts of smear positive pulmonary tuberculosis patients

目的探讨涂阳肺结核密切接触者预防性用药有效性及安全性。方法选择2015年1月-2017年12月到河北大学附属医院就诊的涂阳肺结核密切接触者1355例进行结核菌素皮肤试验(TST)筛查,统计TST筛查结果,TST强阳性涂阳肺结核密切接触者胸片提示无异常者建议预防性用药,随访2年观察发病情况以及不良反应发生情况。结果1355例密切接触者中,TST强阳性例数共275例,占比20.30%;一般阳性例数共559例,占比41.25%。144例预防性用药的TST强阳性涂阳肺结核密切接触者1年期、2年期随访分别有0例(0.00%)、5例(3.47%)发病,131例未接受预防性用药的TST强阳性涂阳肺结核密切接触者1年期、2年期随访分别有21例(16.03%)、35例(26.72%)发病,组间比较差异有统计学意义(χ^(2)=24.992、29.820,P=0.000、0.000)。预防性用药组中,用药时间<6个月的TST强阳性涂阳肺结核密切接触者共79例,其中5例(6.33%)发病;用药时间≥6个月的TST强阳性涂阳肺结核密切接触者共65例,0例(0.00%)发病,差异有统计学意义(χ^(2)=4.262,P=0.039)。144例预防性用药的TST强阳性涂阳肺结核密切接触者中,共14例出现胃肠道不适症状,程度均较轻,无需停止用药;共5例出现肝功能指标异常,停药1周后均好转,继续用药。结论TST筛查能了解涂阳肺结核密切接触者结核菌感染情况,进行预防性用药能控制结核病蔓延,且基本上不会引起严重不良反应。

Objective To investigate the efficacy and safety of prophylactic medication in close contacts of smear-positive pulmonary tuberculosis patients.Methods A total of 1355 close contacts of smear-positive pulmonary tuberculosis patients in the Affiliated Hospital of Hebei University from January 2015 to December 2017 were selected and screened by tuberculin skin test(TST).The results of TST screening were statistically analyzed.If there was no abnormality in chest X-ray of close contacts with TST strongly positive,prophylactic medication was recommended.The incidences of disease and adverse reactions were observed after 2 years of follow-up.Results There were 275 cases of TST strongly positive(20.30%)and559 cases of generally positive(41.25%).Among the 144 cases of TST strongly positive close contacts of smear-positive pulmonary tuberculosis patients who received prophylactic medication,0 case occurred during 1-year follow-up(incidence rate was 0.00%),and 5 cases occurred during 2-year follow-up(incidence rate was 3.47%),however,among the 131cases of TST strongly positive close contacts of smear-positive pulmonary tuberculosis patients who did not receive prophylactic medication,21 cases occurred during 1-year follow-up(incidence rate was 16.03%),and 35 cases occurred during 2-year follow-up(incidence rate was 26.72%);the difference between the groups was statistically significant(χ^(2)=24.992,29.820,P=0.000,0.000).In the prophylactic medication group,there were 79 TST strongly positive close contacts of smear-positive pulmonary tuberculosis patients with a medication time of<6 months;of which,5 cases occurred(incidence rate was 6.33%);there were 65 TST strongly positive close contacts of smear-positive pulmonary tuberculosis with a medication time of≥6 months,and no one occurred(incidence rate was 0.00%);the difference between the two was statistically significant(χ^(2)=4.262,P=0.039).Among the 144 cases of TST strongly positive close contacts of smear-positive pulmonary tuberculosis patients who received prophylactic medication,14 cases had gastrointestinal discomfort symptoms,the above symptoms were mild,and there was no need to stop medication;5 cases had abnormal liver function indicators,and all recovered after drug withdrawal for 1 week,and then the medication could be continued.Conclusion TST screening could understand the tuberculosis infection of the close contacts of smear-positive pulmonary tuberculosis patients,and prophylactic medication could control the spread of tuberculosis,and would not cause serious adverse reactions.