结核菌素试验强阳性人群化学预防前瞻性定群研究

Chemoprophylaxis in Population with Strong Positive Reaction to Tuberculin Skin Test: A Prospective Study

目的探讨不同的人群对结核菌素(PPD)皮肤试验的反应强度以及对强阳性反应者采用异烟肼(INH)化学预防的远期效果。方法(1)按人群不同分为3组:A组,高校4896名在校大学生;B组,568名进城农民工;C组,活动性肺结核病家庭接触人群483人。(2)分别对3组人群进行PPD皮肤试验,筛选强阳性人群。每组强阳性人群再分成2组:预防组给予INH300mg/d口服,1次/d,疗程为10个月。对照组不给予任何药物治疗。2组人群均随访3年。结果(1)3组人群结核病检出率间差异有统计学意义(χ2=17.88,P<0.01)。(2)3组人群PPD试验结果强阳性率间差异有统计学意义(χ2=181.98,P<0.01)。(3)INH预防:A组,68人;B组,23人;C组,41人。随访3年后,结核病发病人数:A、B组均无一例发病,C组2人发病,总发病率为1.52%(2/132)。(4)对照组发病人数:A组,7人(7.00%);B组,3人(7.32%);C组,5人(14.29%),总发病率为6.83%(12/176)。3组人群发病率比较差异有统计学意义(χ2=7.32,P>0.05)。(5)预防组和对照组发病率比较差异有统计学意义(χ2=4.89,P<0.05)。结论结核病在不同的人群中有不同程度的流行,PPD反应强阳性者采用INH化学预防效果是肯定的。

Objective To explore the response intensity to tuberculin skin test of purified protein derivative （PPD） in different populations and the long - term effect of isoniazid （INH） chemoprophylaxis on strong positive reactors. Methods （ 1 ） The chosen subjects were divided into three groups： group A （4 896 students in one university）, group B （568 immigrants） and group C （483 individuals who had close contact with patients with active pulmonary tuberculosis in their families）. （2） The three groups were given PPD skin test to screen the strong positive reactors who were afterwards divided into two groups ： a prophylaxis group and a control group. The former were given orally INH in a dose of 300 mg/d, once a day, for ten months. The latter were not given any drug treatment. Both groups were followed up for three years. Results （ 1 ） Nine subjects were found with tuberculosis in group A （0. 18% ）, three in group B （0. 53% ） and six in group C （ 1.20% ）. Significant difference was found among them （ P 〈0. 01 ）. （2） There were 168 subjects found with strong positive reaction to PPD skin test in group A （3.43%） , 64 in group B （ 11.26% ） and 76 in group C （ 15.73% ）. There was significant difference amon~ them （ P 〈 0. 01 ）. （3） In the prophylaxis group, 68 subjects were from group A, 23 from group B and 41 from group C. After three - year follow - up, no subjects were found with tuberculosis in group A and B, but two Were found with tuberculosis in group C. The total morbidity rate of the prophylaxis group was 1.52% （2/132）. （4） In the control group, 7 were found with tuberculo- sis in group A （7.00%） ; 3 in group B （7.32%） ; 5 in group C （ 14. 29% ）. The total morbidity rate was 6. 83% （12/176）. There was no significant difference among group A, group B and group C in the control group （ P 〉 0. 05 ）. （5） Significant difference was found in morbidity rate between the prophylaxis group and the control group （X2 = 4. 89, P 〈 0. 05 ）. Conclusion The epidemic of tuberculosis differs in degree among different populations. The chemoprophylaxis effect of INH on strong positive reactors is regarded as positive.