在中学开展结核菌潜伏感染者预防性治疗的可行性研究

Feasibility of preventive therapy for latent Mycobacterium tuberculosis infection in middle school students

目的探索在农村寄宿制中学开展结核分枝杆菌潜伏感染筛查和抗结核预防性服药的可行性,为完善学生潜伏性感染者预防性服药的干预策略和措施提供政策建议。方法根据当地结核病疫情、卫生和教育部门建立的学校结核病防控体系和制度、有农村寄宿制中学等因素,选择山西省长治市武乡县3所中学共2 822人作为研究对象,采用结核菌素(PPD)皮肤试验进行结核潜伏感染的检测。结果 PPD筛查率为85.05%(2 400/2 822),未接受筛查的原因排在前3位的分别是有过敏史(47.63%)、患有疾病(19.43%)和发热(17.30%);接受筛查的对象中PPD强阳性率为2.63%(63/2 400),在签署知情同意书的前提下共有38人接受了预防性服药,不接受预防性服药的对象均为担心发生药物不良反应;接受预防性治疗的对象全部完成疗程,且总体规则服药率为100%,共有4例发生不良反应,但无中重度不良反应发生。结论在农村寄宿制中学开展结核潜伏感染预防性治疗,必须在充分考虑当地结核病疫情、防治服务能力、防治经费、相关方配合等因素的基础上,由教育部门和卫生计生部门共同参加,并广泛开展健康教育和社会动员。

Objective To evaluate the feasibility of preventive therapy for latent Mycobacterium（ M.） tuberculosis infection in middle school students,and provide evidence for the development of school tuberculosis（ TB） control and prevention strategies. Methods According to local TB epidemic and the current status of school TB control and prevention,three middle school in a county from Shanxi province were selected. A total of 2 822 students were surveyed. PPD was adopted for skin test in the detection oflatent M. tuberculosis infection,the average diameter of induration ≥ 15 mm,blisters,necrosis,or lymphatic inflammation were believed to be strongly positive. The chest X-ray,routine blood test,liver and renal functions test were carried out for excluding activity TB. Based on the informed consent,6 months isoniazid therapy were given,the daily dosage was 10 mg / kg / d,less than 300 mg / d. Results The screening rate was 85. 05%（ 2 400 /2 822）,the first 3reasons for refusing screening were history of allergies（ 47. 63%）,being ill（ 19. 43%） and fever（ 17. 30%）. The strong positive rate was 2. 63%（ 63 /2 400）. A total of 38 students received preventive therapy,thestudents who refused the treatment were all afraid of adverse drug reaction. All the students who received the treatment completed the courses of therapy and the regular drug taking rate was 100%,and 4 cases of mild adverse reaction occurred. Conclusion Multi-department cooperation,health education and social mobilization were essential to improve the acceptability of preventive therapy for latent M. tuberculosis infection in middle school students. Factors such as local TB epidemic,medical service system,funding,cooperation and so on should be considered for the development of TB prevention strategies.