2018—2021年新疆维吾尔自治区喀什地区肺结核患者家庭内密切接触者发病情况及影响因素分析

Analysis of the incidence and influencing factors of household close contacts of pulmonary tuberculosis patients in Kashgar,Xinjiang Uygur Autonomous Region,2018-2021

目的:分析结核病高负担环境中肺结核患者家庭内密切接触者发病风险及影响因素。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”中收集2018年1月1日至2021年12月31日新疆维吾尔自治区喀什地区12个县(市)确诊的肺结核患者作为指示病例,通过接触者筛查建立家庭内密切接触者队列,跟踪随访观察其发病情况。采用泊松回归模型分析指示病例的病原学特征、治疗状态、暴露情况,以及家庭内密切接触者既往肺结核病史等对其肺结核发病的影响因素。结果:截至2021年12月31日,共计调查了40182例肺结核指示病例、57142名家庭内密切接触者。在4年的随访期间,随访时间中位数(四分位数)为3.2(2.7,3.3)年,共计发现了3585例家庭内密切接触者肺结核续发患者,续发率为6.27%,共计观察180543人年,平均发病密度为1985.68/10万人年。其中,指示病例确诊后的第1年,其家庭内密切接触者肺结核发病率最高,约为3317.62/10万人年。泊松回归分析显示,指示病例病原学检测为涂阴、初治,家庭内密切接触者为男性、≥55岁、既往有肺结核接触史和肺结核病史均是家庭内密切接触者肺结核发病的危险因素[RR(95%CI)值分别为2.491(2.347~2.562)、1.221(1.102~1.354)、1.449(1.306~1.607)、8.451(6.388~11.179)、2.680(2.314~3.104)、4.479(3.852~5.207)]。结论:家庭内密切接触者是肺结核指示病例传播的高危人群,应加强家庭内密切接触者的筛查和宣传教育工作,尤其是其中的老年、男性、既往有肺结核接触史和肺结核病史者;也有必要在结核病高负担地区系统地扩大和加强家庭内密切接触者的追踪和预防性治疗策略。同时,建议在当前策略基础上纳入全部肺结核患者的密切接触者进行筛查,尤其是涂阴和仅分子生物学检测阳性患者。

Objective:To analyze the risk and influencing factors among household close contacts of pulmonary tuberculosis(PTB)patients in a high tuberculosis burden setting.Methods:From January 1,2018 to December 31,2021,patients diagnosed with PTB in 12 counties in Kashgar Prefecture of Xinjiang Uygur Autonomous Region were selected from the subsystem“Tuberculosis Management Information System”of the China Information System for Disease Control and Prevention as indicator cases.A family close contact cohort was established through contact screening,and the incidence was followed up and observed.Poisson regression model was used to analyze the etiological characteristics,treatment status,exposure,and previous history of PTB in close family contacts of the indicator cases.Results:As of December 31,2021,a total of 40182 indicated cases of PTB and 57142 close contacts within the household had been investigated.During the 4-year follow-up period,the median(quartile)duration of follow-up was 3.2(2.7,3.3)years,3585 close family contacts with secondary cases were identified,the secondary attack rate was 6.27%,total 180543 person-years of observation,with an average incidence density of 1985.68/100000 person-years.Among them,the highest incidence of PTB among close contacts within household was about 3317.62/100000 person-years in the first year after the diagnosis of the indicated case.Poisson regression analysis showed that smear-negative pathogenetic testing in the indicated cases,primary treatment,close contacts in the household being male,≥55 years of age,previous exposure to PTB and history of PTB were all risk factors for the development of PTB in close contacts in the household(RR(95%CI)were 2.491(2.347-2.562),1.221(1.102-1.354),1.449(1.306-1.607),8.451(6.388-11.179),2.680(2.314-3.104),4.479(3.852-5.207)).Conclusion:Close contacts within household are the high-risk group for the transmission of indicated cases of PTB,and screening and education of close contacts should be strengthened,especially the elderly,males,previous PTB patients or contacts of PTB patients;there is also a need to systematically scale up and strengthen household contact tracing and preventive treatment strategies for close contacts in high tuberculosis burden areas.It is also recommended to include all PTB patients for screening based on the current strategy,especially smear-negative and only positive molecular biological test patients.