天津市某监狱羁押人员结核感染状况及危险因素分析

Survey of prevalence of latent TB infection and risk factors among inmates in a prison in Tianjin

目的了解天津市某监狱羁押人员结核感染状况及危险因素，为监狱肺结核防控提供参考依据。方法选取天津市某监狱3个监区共448名羁押人员为调查对象，收集基本信息，采用结核菌素试验（PPD试验）判定是否为结核感染，应用SAS9．13软件进行单因素χ2检验和多因素logistic回归分析，以明确结核感染的相关因素。结果受调查羁押人员总的结核感染率为65．8％（295／448），PPD强阳性率为44．4％（199／448）。〈25岁至≥45岁年龄组羁押人员的结核感染率为48．7％（38／78）至86．5％（45／52），PPD强阳性率为30．8％（24／78）至55．8％（29／52），年龄增长趋势与结核感染率、PPD强阳性率呈正相关，差异均有统计学意义（χ2趋势=16．74，P=0．001；χ2趋势=8．02，P=0．005）。既往有无入监史者结核感染率分别为78．3％（54／69）和62．7％（151／241），PPD强阳性率为60．9％（42／69）和38．6％（93／241），有元入监史与结核感染率、PPD强阳性率的差异均有统计学意义（χ2=5．83，P=0．016；χ2=10．83，P=0．001）。有无并发其他慢性病者的结核感染率为74．2％（23／31）和64．6％（224／347），差异无统计学意34（χ2=1．17，P=0．280）；PPD强阳性率分别为61．3％（19／31）和42．4％（147／347），差异有统计学意义（χ2=4．14，P=0．042）。有无卡介苗（BCG）接种卡痕者结核感染率为67．6％（186／275）和63．0％（109／173），差异无统计学意义（χ2=1．01，P=0．314）；PPD强阳性率为49．5％（136／275）和36．4％（63／173），差异有统计学意义（χ2=7．31，P=0．007）。年龄是羁押人员结核感染（Waldy χ2=7．72，P=0．006，OR=1．72，95％CI=1．17～2．51）和PPD强阳性（Wald χ2=5．27，P=0．022，OR=1．51，95％CI=1．06～2．15）的危险因素；既往入监史是PPD强阳性的危险因素（Wald χ2=6．26，P=0．012，OR=2．52，95％CI=1．22～5．22）。结论该监狱羁押人员结核感染率高，既往有入监史、并发其他慢性病、无BCG接种卡痕、年龄较大的羁押人员应为结核感染控制的重点人群。

Objective To understand prevalence of latent TB infection and the risk factors among inmates in prisons in Tianjin, so as to provide reference to the TB control in prisons. Methods Four hundred and forty-eight inmates from three incarceration sections in a prison in Tianjin were sampled as study subjects. Information was collected, PPD was adopted to test TB infection, univariate analysis and multivariate analysis by SAS 9.13 were applied to identify risk factors of TB infection. Results Rates of TB infection and PPD strong positive were 65.8% （295/448） and 44.4% （199/448） among all the inmates investigated. Among inmates age 〈25 to age ≥45, 2 rates of TB infection were 48.7% （38/78） to 86.5% （45/52）, the year trend was statistically significant χ2trend 16.74, P=0. 001）; rates of PPD strong positive were 30.8% （24/78） to 55.8% （29/52）, the year trend was also significant χ2trend = 8.02, P = 0.005）. Rates of TB infection were respectively 78.3% （54/69） and 62.7% （151/241） among inmates with and without previous incarceration history, the difference was statistically significant （χ2 =5.83, P=0. 016） ; and the PPD strong positive were respectively 60.9% （42/69） and 38.6% （93/241）, the difference was statistically significant between the two groups （χ2 =10.83, P= 0. 001）. Rates of TB infection were 74.2% （23/31） and 64.6% （224/347） among inmates with and without chronic disease concomitance, the difference was statistically significant （χ2 = 1.17, P=0. 280）; the rates of PPD strong positive were respectively 61.3% （19/31） and 42.4% （147/347） among the two groups, the difference was also statistically significant （χ2 =4.14, P=0. 042）. Among inmates with and without BCG scar, the rates of TB infection were respectively 67.6% （186/275） and 63.0% （109/173）, the difference was not statistically significant （χ2= 1.01, P=0. 314）; rates of PPD strong positive were respectively 49.5%（136/275） and 36.4% （63/173） among the two groups, the difference was also statistically significant （χ2 =7.31, P=0. 007）. Age was a risk factor of TB infection （Wald χ2 =7.72, P=0.006,OR=1.72,95% CI=1. 17-2.51） and PPD strong positive （Wald χ2=5.27,P=0.022,OR 1.51, 95% CI=1.06 2.15） among inmates. Previous incarceration history was a risk factor of PPD strong positive （Wald χ2 = 6.26, P = 0. 012, OR = 2.52,95 % CI = 1.22 - 5.22）. Conclusion Rate of TB infection was high among inmates in the prison, screening and control of TB infection should be conducted timely; inmates in old agc, with previous incarceration history, chronic disease, without BCG scar should be considered as priority population.