喀什地区肺结核患者密切接触者发病因素分析

Analysis of pathogenic factors of close contacts of pulmonary tuberculosis patients in Kashi prefecture

目的 分析2018—2021年新疆喀什地区肺结核患者密切接触者发病的影响因素,为制定喀什地区结核病防控策略提供依据。方法 从中国疾病预防控制信息系统子系统结核病管理信息系统导出2018年1月1日—2021年12月31日喀什地区登记治疗的活动性肺结核患者个案信息,以整群抽样方法抽取患者来源为肺结核患者的密切接触者(病例组)146例,按照1∶1及年龄±5岁的匹配原则选取该家庭内未发病的密切接触者(对照组)146人作为对研究对象。设计问卷调查表,现场对其两组人群进行调查,收集研究对象一般信息、人口学特征、临床诊断、健康教育、居住环境、接触方式等资料,以是否患肺结核为应变量进行单因素和多因素Logistic回归分析。结果 单因素分析结果显示,农民(χ^(2)=8.674)、经济条件差(χ^(2)=21.696)、文化程度为初中及以下学历(χ^(2)=16.367)、BMI<18.50 kg/m^(2)(χ^(2)=33.828)、无卡介苗接种史(χ^(2)=21.922)、有肺结核可疑症状(χ^(2)=22.031)、有共同居住史(χ^(2)=33.585)、接触时间3个月以上(χ^(2)=138.102)、接触场所通风条件差(χ^(2)=22.844)、未接受过健康教育(χ^(2)=6.116)、不知晓肺结核的传播途径(χ^(2)=22.711)和痰标本的处置方式(χ^(2)=89.724)是密切接触者发病的影响因素(P<0.05);多因素Logistic分析结果显示,职业为农民(OR=2.237,95%CI:1.153~4.675)、经济状况差(OR=2.863,95%CI:1.293~6.937)、BMI<18.5kg/m^(2)(OR=4.470,95%CI:1.668~9.481)、接触时间3个月以上(OR=6.851,95%CI:2.562~12.646)、不知晓肺结核传播途径(OR=3.105,95%CI:1.365~7.196)和痰标本处置方式(OR=5.383,95%CI:1.837~11.223)是密切接触发病的危险因素,有卡介苗接种史(OR=0.384,95%CI:0.242~0.792)、接触场所通风条件良好(OR=0.233,95%CI:0.076~0.695)的密切接触者不易发病。结论喀什地区肺结核密切接触者发病危险因素较多;应加强对农村、经济收入低、营养不良及居住环境差的肺结核患者密切接触者的健康宣传教育和入户随访管理,加大结核病高危人群的筛查力度,实现早发现、早隔离,降低肺结核发病的风险。

Objective To analyze the influencing factors of morbidity among close contacts of pulmonary tuberculosis patients in Kashi prefecture of Xinjiang from 2018 to 2021,and provide basis for formulating tuberculosis prevention and control strategies in Kashi prefecture.Methods The information of active tuberculosis patients registered for treatment in Kashi from January 1st,2018 to December 31st,2021 was collected from the Tuberculosis Management Information System,a subsystem of China Disease Prevention and Control Information System.A total of onset 146 close contacts of pulmonary tuberculosis patients were selected as the case group with cluster sampling method,and another 146 close contacts of pulmonary tuberculosis patients who did not develop the disease in the patient family were selected as the control group,according to the matching principle of 1:1 and within the age of 5 years.The questionnaire was developed,and the survey was carried out in both groups.The general information,demographic characteristics,clinical diagnosis,health education,living environment,contact modes et.al.were collected,and the univariate and multivariate logistic regression analysis were conducted,with and without pulmonary tuberculosis were set as the dependent variable.Results The result of univariate analysis showed that the farmers(χ^(2)=8.674,P<0.05),poor economic conditions(χ^(2)=21.696,P<0.05),junior high school or below(χ^(2)=16.367,P<0.05),BMI<18.50 kg/m^(2)(χ^(2)=33.828,P<0.05),no BCG vaccination history(χ^(2)=21.922,P<0.05),suspicious symptoms of pulmonary tuberculosis(χ^(2)=22.031,P<0.05),history of living together(χ^(2)=33.585,P<0.05),more than 3 months contact(χ^(2)=138.102,P<0.05),bad ventilation in contact place(χ^(2)=22.844,P<0.05),no health education(χ^(2)=6.116,P<0.05),did not know the transmission route of pulmonary tuberculosis(χ^(2)=22.711,P<0.05)and the disposal method of sputum samples(χ^(2)=89.724,P<0.05)were the influencing factors of onset of the close contacts(P<0.05).The results of multivariate logistic analysis showed that the farmers(OR=2.237,95%CI:1.153~4.675),poor economic status(OR=2.863,95%CI:1.293-6.937),BMI<18.5 kg/m^(2)(OR=4.470,95%CI:1.668-9.481),exposure time more than 3 months(OR=6.851,95%CI:2.562-12.646),did not know the route of pulmonary tuberculosis transmission(OR=3.105,95%CI:1.365-7.196)and the disposal method of sputum samples(OR=5.383,95%CI:1.837-11.223)were the risk factors for close contacts.Close contacts with a history of BCG vaccination(OR=0.384,95%CI:0.242-0.792)and good ventilation in contact place(OR=0.233,95%CI:0.076-0.695)were not easy to develop disease.Conclusions There are many risk factors can affect onset in close contacts of pulmonary tuberculosis patients in Kashi prefecture.It is necessary to strengthen the health publicity and education and household follow-up management,and reinforce the screening in the groups at high risk of tuberculosis,so as to achieve early finding,early isolation,and reduce the risk of onset of pulmonary tuberculosis.