北京市昌平区高等院校新生结核分枝杆菌潜伏感染状况调查及潜伏感染者预防性治疗效果分析

Investigation on latent infection of Mycobacterium tuberculosis among freshmen in Colleges and universities in Changping District of Beijing and analysis of preventive treatment effect of latent infection

目的:了解北京市昌平区大学新生结核分枝杆菌潜伏感染状况,对其进行预防性治疗并随访结核病发病情况,为昌平区制定学校结核病防控工作策略提供依据。方法:2015—2018年对昌平区9所高等院校的97648名入学新生进行结核菌素皮肤试验(TST)和胸部X线摄片检查,TST试剂采用结核菌素纯蛋白衍生物(PPD);对单纯性PPD强阳性者5769名给予预防性治疗;根据PPD结果及预防性治疗情况分为4组(PPD强阳性预防性治疗组、PPD强阳性未预防性治疗组、PPD阳性组、PPD阴性组)随访观察4年肺结核发病情况,组间率的比较采用χ^(2)检验,影响因素分析采用单因素和多因素Cox回归分析。结果:97648名入学新生PPD强阳性率为6.01%(5873/97648),2015—2018年入学新生PPD强阳性率分别为7.68%(1919/24974)、6.08%(1422/23371)、5.64%(1420/25196)和4.61%(1112/24107),呈下降趋势,差异具有统计学意义(Z=-14.274,P<0.01)。随访4年,PPD强阳性未预防性治疗组肺结核发病率为495.77/10万(17/3429);PPD强阳性预防性治疗组肺结核发病率85.47/10万(2/2340);PPD阳性组肺结核发病率为40.63/10万(7/17230);PPD阴性组肺结核发病率为29.52/10万(22/74530)。PPD强阳性是结核病发病的危险因素(HR=16.83,95%CI:8.94~31.70)。PPD强阳性学生中,预防性治疗是结核病发病的保护性因素(HR=0.17,95%CI:0.04~0.75)。结论:对PPD强阳性者进行预防性治疗可以有效降低活动性肺结核发病率,对控制学校结核病的流行具有重要意义。

Objective:To understand the status of latent tuberculosis infection(LTBI)among college freshmen in Changping District,Beijing,to provide preventive therapy and follow-up of TB incidence.in order to provide a basis for the development of strategies on tuberculosis(TB)prevention and control.Methods:From 2015 to 2018,97648 freshmen from 9 colleges and universities in Changping District were tested with tuberculin skin test(TST)and chest radiography.The TST reagent used tuberculin purified protein derivative(PPD);5769 patients with strong positive PPD were given preventive treatment;According to the results of PPD and preventive treatment,they were divided into 4 groups(PPD strongly positive preventive treatment group,PPD strongly positive non-preventive treatment group,PPD positive group,PPD negative group).The incidence of pulmonary tuberculosis was observed for 4 years.The rates between groups were compared byχ2 test,and the influencing factors were analyzed by univariate and multivariate Cox regression analysis.Results:The strong positive rate of PPD among 97648 freshmen was 6.01%(5873/97648).The strong positive rates of PPD among freshmen from 2015 to 2018 were 7.68%(1919/24974),6.08%(1422/23371),5.64%(1420/25196)and 4.61%(1112/24107)respectively,showing a downward trend,and the difference was statistically significant(Z=-14.274,P<0.01).After 4 years of follow-up,the incidence rate of tuberculosis in the PPD strongly positive group without preventive treatment was 495.77/100000(17/3429);The incidence rate of pulmonary tuberculosis in PPD strongly positive preventive treatment group was 85.47/100000(2/2340);The incidence rate of tuberculosis in PPD positive group was 40.63/100000(7/17230);The incidence rate of tuberculosis in PPD negative group was 29.52/100000(22/74530).Strong positive PPD was a risk factor for tuberculosis(HR=16.83,95%CI:8.94-31.70).Among PPD strongly positive students,preventive treatment was the protective factor of tuberculosis(HR=0.17,95%CI:0.04-0.75).Conclusion:Preventive therapy of PPD strong response can effectively reduce the incidence of active TB,which is important for controlling the epidemic of TB in schools.