活动性结核病患者密切接触者结核分枝杆菌潜伏感染率的Meta分析

The prevalence of latent tuberculosis infection among close contacts of active tuberculosis patients: a Meta-analysis

目的:评价不同结核病负担地区、不同筛查技术、不同筛查策略的活动性结核病患者密切接触者的结核分枝杆菌潜伏感染(简称“潜伏感染”)率。方法:通过检索中国期刊全文数据库、Web of Science、Medline和Embase数据库,按照文献纳入和排除标准筛选文献。共纳入214篇文献,从其中33篇文献中提取结核病续发率,从214篇文献中提取感染率。将纳入文献分别以研究地区、筛查技术、筛查策略进行分组,应用Meta分析的方法,计算并比较密切接触者调查所发现的潜伏感染率和(或)结核病续发率。结果:结核病高负担国家密切接触者潜伏感染率为12.0%(95%CI:9.0%~16.0%),高于低负担国家密切接触者潜伏感染率[7.0%(95%CI:5.8%~11.0%)];结核菌素皮肤试验筛查潜伏感染率为41.0%(95%CI:33.0%~49.0%),略高于γ-干扰素释放试验的36.0%(95%CI:26.0%~45.0%);通过对涂阳和涂阴患者密切接触者的调查,潜伏感染率分别为34.0%(95%CI:23.0%~45.0%)和20.0%(95%CI:10.0%~30.0%);家庭密切接触者潜伏感染率为24.0%(95%CI:16.0%~33.0%),高于一般人群(13.0%~20.0%);密切接触者中15岁以下儿童续发率高达4.6%(95%CI:2.6%~7.1%),高于15~60岁人群的2.6%(95%CI:0.9%~4.3%)及60岁以上人群的3.3%(95%CI:0.9%~4.3%);60岁以上人群潜伏感染率达31.0%(95%CI:0.9%~60.0%),高于15岁以下儿童的25.0%(95%CI:18.0%~33.0%)。结论:在结核病高负担国家,针对涂阳患者密切接触者的调查,以及家庭密切接触者的针对性筛查,是早期发现结核病患者的有效手段,儿童和老年人应作为密切接触者调查的重点对象。

Objective:To evaluate the latent tuberculosis infection prevalence among tuberculosis(TB)contacts across various regions with different TB burdens by utilizing different screening technologies and strategies.Methods:We screened studies by searching the Chinese Journal Full-text Database,Web of Science,Medline and Embase,selecting studies based on predetermined inclusion and exclusion criteria.A total of 214 articles were enrolled,33 articles were used for extracting secondary incidence rate of tuberculosis and all articles provided prevalence of latent TB infection.Studies were categorized by study areas,screening techniques and screening strategies,respectively,then a meta-analysis was conducted to calculate and compare the prevalence of TB and latent tuberculosis infection among contacts of patients.Results:The prevalence of latent TB infection was 12.0%(95%CI:9.0%-16.0%)among contacts from high TB burden settings,higher than those living in low-burden countries(7.0%,95%CI:5.8%-11.0%).Prevalence of latent infection detected by tuberculin skin test was higher than that detected by IFN-γreleased assay(41.0%,95%CI:33.0%-49.0%vs.36.0%,95%CI:26.0%-45.0%).Among contacts of smear-positive patients,the prevalence of latent infection was 34.0%(95%CI:23.0%-45.0%),compared to 20.0%(95%CI:10.0%-30.0%)among the contacts of smear-negative patients.The prevalence of latent infection among household contacts was 24.0%(95%CI:16.0%-33.0%),higher than that of the general population(13.0%-20.0%).The secondary incidence rate among close contacts aged under 15 years was as high as 4.6%(95%CI:2.6%-7.1%),which exceeded those observed in individuals aged 15 to 60 years(2.6%,95%CI:0.9%-4.3%),and those over 60 years(3.3%,95%CI:0.9%-4.3%).The prevalence of latent infection among population aged above 60 years old was 31.0%(95%CI:0.9%-60.0%),higher than that in children<15 years of age(25.0%,95%CI:18.0%-33.0%).Conclusion:In countries with a high burden of tuberculosis,the targeted screening strategies in close contacts of smear-positive patients and household contacts,constitutes an effective approach for early identification of tuberculosis cases.Children and the elderly should be the focus of screening.