大学生预防性治疗的结核菌素反应强度标准研究

Tuberculin reactivity criteria for chemoprophylaxis in college students

目的 探讨结核菌素反应强度与结核病发病的相关性;提出预防性治疗对象的结核菌素反应标准.方法 对不同结核菌素反应强度的新入学大学生进行4年的结核病发病观察,分析结核菌素反应强度与发病危险性、发病时间的关系,比较不同反应强度预防性治疗对象发病率的变化.结果 26 543名健康学生进行了结核菌素试验和4年的发病观察,反应强度为0～4、5～9、10～14、15～19和≥20 mm或水泡丘疹者的年均结核病发病率分别为12.97/10万、13.34/10万、50.32/10万、167.56/10万和250.21/10万;0～4和5～9 mm反应者头2年发病率很低,第3、4年有所增高,而15～19和≥20 mm或水泡丘疹者头2年发病率很高,随着时间推移有下降趋势.当逐个计算反应强度每增加1 mm及以上反应者的发病率时,15 mm以上的各反应强度者中结核病发病率相似,一直维持在较高水平.PPD反应标准15 mm及以上可以覆盖80.8%的病人,而且病人的发现效率也维持在一个高水平.结论 结核菌素反应强度与结核病发病存在明显正相关,特别在头2年危险比更大;PPD反应≥15 mm或有水泡丘疹阳性者的发病机会明显升高,PPD反应≥15 mm或有水泡丘疹阳性标准能够覆盖80%以上的病人,病人的发现效率也最高.因此以PPD反应≥15 mm或有水泡丘疹作为预防性治疗对象的结核菌素反应标准更为合理.

Objective To determine the relationship between tuberculin reactivity and tuberculosis incidence, and to propose the tuberculin reactivity criteria for chemoprophylaxis. Methods A 4 - year follow - up to fresh college students at different level of tuberculin reactivity was conducted, the corclation of tuberculin reactivity with tuberculosis risk and disease time were analyzed, and the difference in the incidence of subjects at differcnt level of reactivity towards chemoprophylaxis was compared. Result Tuberculin testing and the 4 - year follow - up were conducted for 26 543 eligible subjects. Tuberclusis risks for the subjects with tuberculin reactivity of 0-4 mm, 5 -9 mm, 10 - 14 mm, 15 - 19 mm and more than 20 mm or with blister/papula were 12.97/ 100 000, 13.32/100 000, 50.21/100 000, 167.56/100 000 and 250.21/100 000 respectively. For the subjects with 0 - 4 mm and 5 - 9 mm tuberculin reactivity, tuberclusis risks were very low in the flint 2 years, and increased in the 3 rd and 4th year, while for the subjects with 15 - 19 mm and more than 20 mm or with blister/ papula tuberculin reactivity, tuberclusis risks were very high in the first 2 yearn, but decreased with time goes on. Calculating the tuberculosis incidence for different tuberculin reactivity criteria when increasing 1 mm interval or above, showed that tuberculosis incidence were simialr and high for all those with 15 mm or above on tuberculin reactivity criteria. The tuberculin reactivity criteria at 15 mm or above covered 80.8% patients, and the case - finding efficiency was at highest level. Conclusion Tuberculosis risk coorclated with tuberculin reactivity positively, espacially in the first 2 yearn. PPD rcacter at the 15 mm or above had significantly high risk to devel-op tuberculosis, and it can cover more than 80% patients with the the casefinding efficiency at highest level. Therefore, tuberculin reactivity criteria at more than 15 mm or with blister/papula was more reasonable for chemoprophylaxis.