耐多药结核病患者密切接触者感染状况分析

Analysis of Latent Tuberculosis Infection among the Contacts in Multidrug-Patients with Tuberculosis

目的了解上海市静安区耐多药结核病患者密切接触者感染状况。方法以2013-2019年在静安区结核病定点医院登记管理的结核分枝杆菌痰培养阳性中药敏结果为耐多药的患者的密切接触者为研究对象,采用结核感染T细胞斑点试验结合现场流行病学调查,分析耐多药结核患者的密切接触者结核感染现状及其影响因素。结果纳入研究对象67人,胸部X线检查64人(3位14岁以下未拍片),均未见活动性结核病变;T-SPOT检查41人,结核感染阳性率为21.95%。耐多药结核患者密切接触者结核感染的影响多因素分析结果显示,未接种卡介苗(OR=12.860,95%CI∶1.391~118.905)是患者密切接触者结核感染相关的危险因素。结论本研究中耐多药结核病患者密切接触者结核感染阳性率未呈现很高状况,目前接种卡介苗防治措施还不能松懈。建议结核患者化疗访视医生做好自我防护措施,同时对患者和家属进行针对性健康教育干预,以降低结核感染率。

OBJECTIVE To investigate the situation of latent tuberculosis infection(LTBI)and associated risk factors among the multidrug-resistant tuberculosis(MDR-TB)contacts in Jing’an District of Shanghai.METHODS The contacts of MDR-TB patients registered in the TB designated hospitals in Jing’an District during 2013 to 2019 were analyzed,LTBI screening was performed by TSPOT.TB assay.With the results of field epidemiological investigation,univariate and multivariate analysis were performed to analysis the LTBI and influencing factors.RESULTS A total of 67 contacts were included in the study,64 took chest X-ray check(3 under 14 years of age were not check),there no TB patients was diagnosed.41 contacts were T-SPOT tested,latently infected with M.TB was identified in 21.95%.of the close contacts.the multivariate analysis revealed that BCG unvaccinated(OR=12.860,95%CI:1.391,118.905)were independently associated with the LTBI among the studied close contacts.CONCLUSION The rate of LTBI in close contacts of MDR-TB cases was not significantly higher.However,the current measures for the BCG vaccinated were still necessary.It suggested that that doctors for tuberculosis patients who took chemotherapy should take self-protection measurement.Meanwhile,specific health education should be conducted on patients and their family members,so as to reduce the prevalence for tuberculosis.