结核病医院护士结核潜伏感染和发病风险的评估

Risk assessment of latent tuberculosis infection and tuberculosis incidence in nurses working in tuberculosis hospitals

目的评价结核病医院护士结核潜伏感染及结核发病的风险。方法以在首都医科大学附属北京胸科医院护士班学习后分配到该医院工作的1985级至1988级护士共77名为研究对象,对其进行胸部CT及结核分枝杆菌感染T细胞斑点试验(简称T-SPOT.TB检测),同时通过标准化问卷调查收集护士的信息。按照工作岗位的不同,将研究对象分为结核科、肿瘤科和后勤科室3组,采用χ~2检验对3组的发病率和潜伏感染率进行比较分析。结果 77名护士中7人患肺结核,肺结核的发病风险为9.1%(95%CI2.6%～15.6%),肺结核的发病率为0.0036/人年(95%CI0.0009～0.0063),其中结核科4人(57.1%),肿瘤科2人(28.6%),后勤科室1人(14.3%)。除外7名患病人员,余70人均经影像学、临床表现除外活动性肺结核,该70人行血T-SPOT.TB检测,结果阳性28人(40.0%),阴性42人(60.0%),其中潜伏感染率结核科为43.5%,肿瘤科为40.0%,后勤科室为36.4%,统计学分析显示,结核科、肿瘤科和后勤科室护士结核潜伏感染发生率差异无显著性(χ~2=0.237,P=0.888)。结论长期于结核病医院工作的护士结核病潜伏感染和发病的风险较高,应定期进行体检筛查并采取足够的感染控制措施。

Objective To evaluate the risk of latent tuberculosis infection and tuberculosis incidence in nurses working in tuberculosis hospitals. Method A study was conducted on the thoracic CT and Mycobacterium tuberculosis infection T cell spot test (T-SPOT.TB), which was assigned to the hospital’s 1985 -1988 grade nurses who were assigned to the hospital after studying at the Nursing Class of Beijing Chest Hospital Affi liated to Capital Medical University. And the information of the nurses was collected through the standardized questionnaire. According to the different job positions, the subjects were divided into three groups: tuberculosis department, oncology department and logistics department. The chi-square test method was used to analyze the three groups’ incidence and latent infection. Result In this study, among 77 people seven suffering from tuberculosis, The risk of pulmonary tuberculosis was 9.1%(95% CI 2.6%- 15.6%), the incidence of tuberculosis rate was 0.0036 / person-year (95% CI 0.0009-0.0063), including 4 subjects (57.1%) in tuberculosis department, 2 in cancer department (28.6%) and 1 in the logistics department (14.3%). Except 7 patients, 70 people except active pulmonary tuberculosis. 70 people for the T-SPOT.TB blood test, test results: T-spot .TB was positive in 28 (28/70, 40%), negative in 42 (42/70, 60%).The rate of latent tuberculosis infection was 43.5% in tuberculosis group, 40% in the oncology department and 36.4% in the logistics department. By the chi square test, there was no signifi cant difference in latent tuberculosis infection between the three groups (χ2=0.237,P=0.888). Conclusion The risk of latent tuberculosis infection and tuberculosis incidence is high in nurses working in tuberculosis hospitals. In high-risk workplaces, tuberculosis and latent tuberculosis infections occur more frequently, and regular physical examinations and tuberculosis infection is necessary. At the same time, these data show that the tuberculosis hospitals should take adequate infection control measures.