2007-2008年石家庄市涂阳肺结核患者密切接触者发病情况

Epidemiological studies on close contacts of smear-positive tuberculosis patients in Shijiazhuang city from 2007 to 2008

目的了解涂阳肺结核患者密切接触者的结核病发病情况。方法以2007-2008年石家庄市新确诊涂阳肺结核患者6653例为线索，根据其生活和活动范围确定其密切接触者19159名为研究对象，其中家属17334名、同班同学1825名。对其进行结核病相关知识和政策的健康教育和结核筛查，对同学关系的密切接触者进行结核菌素试验，可疑者进行胸部x线检查；对家庭密切接触者进行症状筛查，可疑者进行痰涂片和胸部X线检查。对未发病者进行症状随访观察，自涂阳患者确诊之日始共2年，每月1次，有症状者随时进行检查。结果随访观察2年内，共确诊肺结核患者281例，家属176例，非家属105例。肺结核发病率为1466．67／10万，其中涂阳22例。14～25、75～岁组发病率最高，分别为2907．18／10万（83／2855）、2650．96／10万（18／679）。从发病时间看，与涂阳患者密切接触6个月内、13—18个月各有一个高峰，发病率分别为929．07／10万（178／19159）、369．12／10万（70／18964）。从接触密切程度看，同宿舍、同班同学及夫妻关系发病率最高，分别为11384．62／10万（37／325）、4533．33／10万（68／1500）、1624．17／10万（86／5295）。结论密切接触者与涂阳肺结核患者接触越密切发病率越高，发病时间主要集中在接触6个月内、13—18个月，且14—25岁和75岁以上年龄组发病率较高。

Objective To analyze the incidence of tuberculosis （TB） in people who were in close contact with smear-positive TB patients. Methods A total of 19 159 subjects, including 17 334 family members and 1825 classmates of patients, in close contact with 6653 smear-positive TB patients in Shijiazhuang city from 2007 to 2008 were observed. All the classmates were tested by purified protein derivative （PPD） test and symptom screening, and all family members were screened by symptoms. All these subjects were trained with knowledge related to TB. The ones with positive PPD test and suspected TB symptoms were further examined by chest X-ray and sputum smear microscopy, and those without any symptom were followed up monthly throughout a two year period and were examined at any time if symptoms occurred. Results A total of 281 patients with pulmonary TB were diagnosed in 2 years, including 176 family members and 105 classmates in all close contacts. The smear-positive incidences were 1466. 67/100 000. The incidences for 14 -25 years old group and more than 75 years old group were 2907. 18/100 000（ 83/2855 ） and 2650. 96/100 000 （18/679） , which were higher than those for other groups. Two higher incidences were related to close contact time periods of 6 months （929. 07/100 000,178/ 19 159） and 13 -18 months（369. 12/100 000,70/18 964）. Three highest incidences were observed in the roommates （11 384. 62/ 100 000, 37/325 ）, classmates （ 4533.33/100 000, 68/1500 ） and couples （ 1624. 17/100 000,86/5295）. Conclusion Closer contact with smear-positive patients with TB may result in the higher chance of TB. Close contact for 6 months or 13 to 18 months caused more patients, and the 14 - 25 years old group and more than 75 years old group had higher incidences of TB.