大学生结核病控制的研究:(二)结核感染者的预防性治疗

Control in university students in Beijing:preventive therapy for tuberculosis-infected persons

目的探讨在大学生中开展结核感染的预防性治疗的效果,及其方案和管理措施。方法经广泛宣传后,学生红十字会员、校医院主管医生和结核病防治所分工管理,在知情同意基础上对PPD≥15mm新入学学生开展预防性治疗。将学生自然分为治疗组和对照组,两组均进行4年的发病观察。分别计算发病率。治疗方案每周2次口服利福喷汀加异烟肼,连续3个月,共服药25次。结果1948名学生参预防性治疗,完成疗程率90%,不良反应率3.3%,因不良反应而停药率1.0%。4年中发生结核病5例,年均发病率64.17/10万。对照组共1765名4年中发生结核18例,年均发病率254.96/10万,预防性治疗减少发病的保护率为74.8%。结论在大学生中采用3个月每周2次口服利福喷汀加异烟肼方案预防性治疗有效、可行和安全。在进行预防性治疗时,需落实传染源控制和组织管理措施,并注意不良反应的观察。

Objective To investigate efficacy of preventive chemotherapy treatment and management of administration for tuberculosis-infected students of university. Methods Members of Red Cross, doctors from hospital of university and district tuberculosis center were combined and shared out the work and help one another, including extensive health promotion PPD testing and management of preventive chemotherapy. Preventive chemotherapy was given to new students with over 15 mm PPD testing reactors based their consent. Placebo-controlled study was adopted and incidence rate was investigated during follow-up 4 years. Rifapentine and isoniazid intermittent regimen was selected twice weekly for 3 months, total 25 times. Results There were 3 713 students enrolled, 1948 and 1765 students of which were selected as treated and placebo groups respectively. Complete treatment rate was 90%. Side effects rate was 3.3% and stopping drug treatment rate 0.98%. There were 5 cases, 64.17/100,000 and 18 cases, 254.96/100,000 occurred in treated and placebo groups during 4 years follow-up respectively. It showed 74.8% protection against subsequent tuberculosis. Conclusion Previntive treatment with Rifapentine and Isoniazid twice weekly for 3 months is effectiveness, safety and feasibility in the students of university.