1475例肺结核病人密切接触者连续8个月随访调查分析

Risk Factors Analysis of Tuberculosis in Person with Close Contact with Tuberculosis Patients

目的探索攀枝花市肺结核病人密切接触者发病的相关危险因素。方法对2007年1月至2008年6月期间内尚未完成治疗疗程的各级结防机构登记的肺结核病人的密切接触者,通过胸部X线检查、痰涂片检查,并结合受检者的临床症状诊断是否患有活动性肺结核病,同时对所有密切接触者进行连续8个月的随访观察,对密切接触者检查获得的数据利用SPSS软件,应用Logistic回归进行分析和χ2检验对相关数据进行分析。结果共有1475名密切接触者接受检查,共发现活动性肺结核病人14例,持续8个月的跟踪观察全部密切接触者无新发肺结核病例。通过对检查结果应用Logistic回归分析发现影响肺结核病人密切接触者患病的危险因素为居住地(城市或农村)(χ2=3.415,P<0.05,OR=4.148)、密切接触者的性别(χ2=4.955,P<0.05,OR=0.232),而与密切接触者年龄(0～14岁或≥15岁)(χ2=1.181,P>0.05,OR=3.106)、密切接触者与肺结核病人的密切关系(亲属或非亲属)(χ2<0.001,P>0.05,OR<0.001)、肺结核病人的痰涂片检查结果(涂阴、±、1+、2+、3+、4+)(χ2=2.017,P>0.05,OR=0.771)、肺结核病人咳嗽程度(咳嗽<3周、≥3周或无咳嗽症状)(χ2=0.003,P>0.05,OR=0.971)无关。并应用χ2检验对攀枝花市与全国相关数据进行比较,发现攀枝花市活动性肺结核密切接触者的患病率为949.15/10万,高于2000年我国流调时367.03/10万的患病率(χ2=13.528,P<0.05,OR=2.601,OR95%C.I.(1.533,4.415)。结论影响攀枝花市肺结核病人密切接触者肺结核发病的相关危险因素由高到低依次为居住地、密切接触者的性别,而密切接触者与肺结核病人的密切关系、年龄、肺结核病人的痰涂片检查结果、肺结核病人咳嗽程度与密切接触者发病无关,提示我们在今后的工作中应重视痰涂片涂阴肺结核病人的密切接触者的筛查工作,尤其是在广大的农村地区我们更应重视密切接触者的筛查工作。

Objective To evaluate the risk of person with close contact with tuberculosis patients in this city. Methods Investigation was carried out between January 2007 and June 2008. 1 475 individuals with close contact with tuberculosis patients were checked for the infection. The tests included chest x-ray, sputum smear and clinical symptoms. These individuals were monitored for 8 months and the results were analyzed using the software SPSS. Results 14 cases of tuberculosis were found. Logistic regression analysis showed that the risk facts were residency （urban / country ） （X^2=3.415, P〈0.05, OR=4.148） and sex of the individual with close contact （X^2=4.955, P〈0.05, OR =0.232）, but not the age （ 0- 14 year or ≥ 15 year） （ X^2= 1.181, P〉0.05, OR =3.106） or the family factor （relative / friends） （x^2〈0.001 ,P〉0.05,OR〈0.001）. Results of sputum smear test： negative, ±,1＋,2＋,3＋,4＋ （x^2= 2.017, P〉0.05, OR=0.771 ）. There was no association with the frequency of cough （the period〈3 weeks,the period≥3 weeks or non-coughing） （x^2=0.003, P〉0.05, OR=0.971 ）. When compared with the national infection rate, the rate of infection was 949.15/100,000, and the incidence was higher than the value obtained in year 2000 （367.03/ 100,000; X^2=13.528, P〈0.05, OR=2.601,OR95% C.I. （1.533,4.415））. Conclusion The risk facts of infection for the individuals with close contact with tuberculosis were residency and sex. Attention should be paid especially when the result of sputum smear test was negative and the cases were in the country area.