上海市大学生肺结核患者密切接触者筛查方法评价

Evaluation of screening methods for the students who had close contact with pulmonary tuberculosis patients in Shanghai

【目的】初步评价现行学生肺结核患者密切接触者的筛查方法,以期准确识别预防性服药人群,为进一步完善上海市学校结核病防控工作给予建议。【方法】采用前瞻性观察性研究方法,在研究现场连续纳入2019学年上海市浦东新区、松江区、闵行区所有大学一、二年级学生肺结核患者密切接触者作为研究对象。所有研究对象入组时同时接受结核菌素皮肤试验(TST)和QuantiFERON-TB gold intube(QFT)检测,并在签署知情同意书后进行问卷调查及基线结核分枝杆菌(简称“结核”)感染检测,随访2年,监测其结核感染状态转变及结核病发病情况。【结果】9名基线QFT阳性的密切接触者中,4名(44.4%)在2年随访时QFT检测结果转阴。300名基线QFT阴性的密切接触者中,5名(1.7%)在2年随访时QFT转阳,阳转对象中有1名诊断为活动性肺结核患者。当取TST硬结平均直径≥15 mm为界值时,与QFT诊断一致率最高(94.0%),Kappa值为0.45(95%CI:0.32~0.59)。【结论】上海市在高于国家工作要求的基础上,学校结核病防控工作仍须落实落细,强化日常防控措施,完善学校疫情处置规范。

[Objective]To evaluate the current screening methods for the students who were in close contact with tuberculosis patients,that could accurately identify the preventive treatment subjects,and to improve the tuberculosis prevention and control in Shanghai schools.[Methods]The freshman/sophomore who were in close contact with active tuberculosis patients in the colleges in 2019 were recruited.All the subjects underwent both tuberculin skin test(TST)and QuantiFERON-TB gold in-tube(QFT)test at the enrollment.After signed the informed consent,all of the participants filled in a questionnaire and determined their baseline tuberculosis infection status.They were followed up for 2 years to monitor the conversion of infection status and the incidence of tuberculosis.[Results]Four of 9(44.4%)positive participants had conversion to negative results,and 5 of 300(1.7%)negative participants had conversion to positive during the 2-year follow-up,one of which was diagnosed with active tuberculosis.We assessed diagnostic agreement between QFT and TST at different cut-off values.The highest coincidence rate was 94.0%when choosing 15 mm as the cut-off value,with Kappa coefficient of 0.45(95%CI:0.32‒0.59).[Conclusion]Although stricter than the national work requirements,the prevention and control of tuberculosis in Shanghai schools still need to be carried out meticulously.It's necessary to strengthen daily prevention and control measures,and improve the ability of management.