医务人员结核菌素试验强阳性者化学预防10年效果分析

Analysis of the effectiveness of chemoprophylaxis on health care workers with strong positive reaction to tuberculin skin test

目的 分析医务人员结核菌素试验（TST）强阳性者异烟肼联合利福平预防效果。方法 选取医务人员658人,分别进行TST筛查结核病患者及强阳性人群,并对强阳性者行胸部X线检查,无异常者根据治疗意愿分组：预防组给予异烟肼,300 mg,1次/d,利福平450 mg,1次/d,疗程4个月;对照组无任何治疗。对两组人群随访10年。结果 1 658人中,阴性202人,阴性率30.70%;阳性456人,阳性率69.30%,其中强阳性125人,强阳性率为19.00%。筛查出肺结核病患者8人,结核病检出率1.22%。2随访3年内,预防组和对照组分别有2人和9人发病,发病率分别为3.39%（2/59）和15.52%（9/58）,差异有统计学意义（χ^2=5.05,P=0.025）;3年内保护率为78.16%。3第4-6年内,预防组和对照组分别有1和2人发病,发病率分别为1.75%（1/57）和4.08%（2/49）,无失访人数,两组发病率无统计学差异（χ^2=0.52,P=0.89）。4第7-10年内,预防组和对照组均有1人发病,无失访人数。发病率1.79%（1/56）和2.13%（1/47）,无差异性（χ^2=0.02,P=0.55）。510年内预防组和对照组分别有4人和12人发病,无失访。10年内的发病率分别为6.78%（4/59）和20.69%（12/58）,有统计学差异（χ^2=4.79,P=0.03）。10年内保护率67.23%。6预防组有5人发生药物不良反应,发生率8.47%（5/59）,完成率100%。结论 医务人员是结核病易感人群,TST强阳性者采用异烟肼联合利福平预防是安全有效的。

Objective To analyze the prophylaxis results of isoniazid （INH） plus rifampicin （RFP） for the health care workers （HCW） with strong positive reaction to tuberculin skin test （TST）. Methods 658 HCWs were selected and given TST to screen the TB and the strong positive reactions, which were received chest X-ray examination. The subjects with lung negative results by chest X-ray were divided into the prophylaxis group and the control group according to intention-to-treat. The former were given orally INH 300mg plus RFP 450mg daily for four months, while the later were not given any drugs treatment. Both groups were followed up for 10 years. Results ① 202 subjects were negative to TST, and the negative rate was 30.70%. 456 subjects were positive to TST, 125 of which were strong positive, and the positive rate was 69. 30% and the strong positive rate was 19.00%. 8 subjects were diag- nosed as TB in the total subjects and the recall ratio was 1.22% （8/658）. ② During the 3-year follow-up, there were 2 subjects in the prophylaxis group and 9 subjects in the control group stricken by TB. The morbidity rate was 3.39% （2/59） and 15.52% （9/58）, respectively （χ^2 = 5.05, P = 0. 025）. The protective rate was 78.16% with- in 3 years. ③ From the fourth to sixth years of follow-up, there was 1 subject in the prophylaxis group and 2 subjects in the control group diagnosed as TB, and the incidence was 1.75% （1/57） and 4. 08% （2/49） respectively （χ^2 = 0. 52, P = 0. 89）. ④ From the seventh to tenth years of follow-up, there was 1 subject in each group diagnosed as TB, and the incidence of TB was 1.79% （1/56）and 2. 13% （1/47） respectively （χ^2 = 0. 02, P = 0. 55）. ⑤ There were 4 subjects in the prophylaxis group and 12 in the control group suffered from TB during 10-years follow-up, and the incidence was 6. 78% （4/59） and 20. 69 （ 12/58 ） respectively （χ^2= 4. 79, P = 0. 03）. The protective rate was 67. 23% during 10-years follow-up. ⑥ There were 5 HCWs with adverse drug reaction during therapy, and the inci- dence was 8.47% （5/59） and the complete rate was 100%. Conclusion The HCWs are susceptible population to TB. The chemoprophylaxis by taking 4 months of INH plus RFP for strong positive to TST is safe and effective.