上海市普陀区结核菌近期传播特征及影响因素研究

Pattern and Impact Factors of Recent Tuberculosis Transmission in Putuo District,Shanghai

[目的]了解上海市普陀区结核病近期传播特征及其影响因素,为制定具有针对性的结核病控制策略提供依据。[方法]对2009—2010年普陀区结核病定点医院登记的结核病患者中分离获得的结核分枝杆菌进行基因分型,利用可变数目串联重复序列(VNTR)基因分型方法识别结核菌基因型的"成簇性"和"独特性",通过流行病学调查描述结核病患者结核菌的成簇性分布特征,分析人口学特征、临床特点、社会学特征对结核病传播的影响。[结果]本次研究共纳入180例患者,其中感染北京基因型菌株患者153例(85.00%)。有48例患者感染的菌株具有成簇性,形成20个簇,总成簇率为26.67%(48/180),其余132例患者感染的菌株基因型表现为独特性。有65.00%(13/20)的簇包含户籍患者和非户籍患者。同簇病例中有2簇为家庭内接触;有8簇居住在同一社区。30～59岁年龄组(30～岁/18～岁:OR=3.783,95%CI:1.421～10.074)和北京基因型菌株(北京株/非北京株OR=6.446,95%CI:1.446～28.731)更易成簇。[结论]普陀区结核病患者中存在一定比例的近期传播,户籍与非户籍患者存在混合传播。由于辖区结核病流行菌株为北京基因型,结合影响本区结核病传播的危险因素及非户籍人口特征,非户籍人口为本区结核病防控重点人群。

[ Objective ] To identify the characteristics and impact factors of recent tuberculosis in Putuo District, Shanghai, and to provide basis for making control measures against tuberculosis. [ Methods ] Isolates of Mycobacterium tuberculosis were collected from all tuberculosis patients registered to designated tuberculosis hospitals in Putuo District from 2009 to 2010. Variable number tandem repeats （VNTR） genotyping was used to identify clustered and unique isolates. Univariate and multivariate analyses were performed to describe the distribution of the clusters and to identify demographic, clinical, and social factors associated with recent transmission of tuberculosis. [ Results ] This study enrolled 180 patients, and the isolates from 153 patients （85.00%） belonged to Beijing genotyping strains. Totally, 20 clusters （26.67%） （48 isolates） and 132 unique isolates were identified. There were 65.00% （13/20） of the clusters infected both registered local residents and migrants. The patients of two clusters were proved to have epidemiologic links of family members＇ contact, and the patients of eight clusters lived in the same communities. The patients who were aged 30-59 years （versus 18-29 years, OR=3.783, 95%C1： 1.421-10.074） and being infected with Beijing genotyping strains （versus non-Beijing genotyping strains, OR=6.446, 95%CI： 1.446-28.731） were more likely to be clustered. [ Conclusion ] It is speculated that recent transmission of tuberculosis exists between migrants and local residents in Putuo. Beijing genotyping strains are predominant strains in the district. Considering the related impact factors and demographic characteristics, migrant oatients should be the target oooulation for tuberculosis control in the district.