15例耐药肺结核患者家庭接触者发展为活动性肺结核的临床特征分析

Analysis of clinical characteristics of 15 household contacts of patients with drug-resistant pulmonary tuberculosis who developed active pulmonary tuberculosis

目的:分析耐药肺结核患者家庭接触者中检出为肺结核的患者的临床特征,为耐药肺结核患者家庭接触者的管理提供依据。方法:观察2019年1月至2021年6月在西安市胸科医院确诊为耐药肺结核的650例患者的家庭接触者,1100名家庭接触者中最终被诊断为活动性肺结核的患者(简称“罹患病例”)共计15例,对其人口学特点、与指示病例接触情况、发病时间、临床特点、实验室检查结果、病原学特点及治疗结局进行总结和分析。结果:15例罹患病例中,女性11例(73.3%),男性4例(26.7%);年龄3~56岁,平均年龄(36.1±13.0)岁。15例罹患病例中,5例为共同流行病例,10例为继发病例。罹患病例中,指示病例的妻子及子女患病例数较多,占80.0%(12/15),其他包括婆媳、翁婿、兄妹关系各有1例,均占6.7%(1/15)。家庭接触者在接触指示病例6个月以内发病者8例(53.3%,8/15),在6~12个月内发病者6例(40.0%,6/15),1例(6.7%,1/15)为接触指示病例后1年发病。罹患病例中,8例通过主动筛查发现,7例通过因症就诊发现;12例为初次筛查发现,3例在筛查多次后诊断为活动性肺结核;9例病原学为阳性,药物敏感性试验结果与指示病例一致,6例病原学为阴性,药物敏感性试验结果未知。所有罹患病例病灶肺野数均≤3个,合并空洞者4例(26.7%,4/15)。15例罹患病例均进行了规范的抗结核药物治疗,11例治愈,4例经过治疗后达到细菌学阴转。结论:耐药肺结核患者家庭接触者发展为活动性肺结核时大多也为耐药患者,主动筛查在肺结核早期发现中起着至关重要的作用,家庭接触者进展为活动性肺结核后病情相对较轻,经早期发现及积极治疗后可取得较好的治疗效果。

Objective:To analyze the clinical characteristics of patients with pulmonary tuberculosis detected in household contacts of patients with drug-resistant pulmonary tuberculosis(DR-TB),and to provide evidence for the management of household contacts of patients with DR-TB.Methods:The clinical data of family contacts(1100 cases)of patients diagnosed with DR-TB(650 cases)who developed active pulmonary tuberculosis(referred to as TB patients)in Xi’an Chest Hospital from January 2019 to June 2021 were retrospectively analyzed.Demographic characteristics,contact with index cases,onset time,clinical characteristics,laboratory test results,etiological characteristics and treatment outcomes were summarized and analyzed.Results:Among 15 TB patients in the contacts,11 were female(73.3%)and 4 were male(26.7%);they were aged 3-56 years,with an average age of(36.1±13.0)years.The number of wives and children of the index case was higher,accounting for 80.0%(12/15),and the others,such as mother-in-law,son-in-law,and brother-sister relationship,each had 1 case which accounted for 6.7%(1/15).Eight cases(53.3%,8/15)developed TB within six months of exposure to the index case,6 cases(40.0%,6/15)developed TB at 6-12 months after exposure,and 1 case(6.7%,1/15)developed TB at more than 1 year after exposure to the index case.Eight cases were detected through active screening,and 7 cases were detected during medical visits after symptoms showed.Twelve cases were detected by initial screening,and 3 cases were diagnosed with active TB after multiple screenings.Nine cases of all the TB patients were etiologically positive,the drug susceptibility results were consistent with the index cases.The other 6 cases were etiologically negative,and the drug susceptibility were unknown.All cases had less than 3 lung fields being infected,and 4 cases(26.7%,4/15)had cavities.All 15 cases received standard anti-TB treatment,11 cases were cured,4 cases achieved bacteriological negative conversion after treatment,and were still under treatment.Conclusion:Most of the household contacts of DR-TB patients got DR-TB when they developed active TB.Active screening played a crucial role in the early detection of TB.The disease was relatively mild after progressing to active TB.Good therapeutic effect could be achieved with early detection and proactive treatment.