病原学阳性肺结核患者密切接触者结核潜伏感染状况及影响因素分析

Analysis of the Tuberculosis Latent Infection Status and Influencing Factors in Close Contacts of Patients with Bacteriologically Confirmed Pulmonary Tuberculosis

  • 摘要: 目的:了解上海市静安区病原学阳性肺结核患者密切接触者结核分枝杆菌潜伏感染(LTBI)情况及其影响因素,为病原学阳性患者密切接触者的结核感染检测与预防性干预策略制定提供科学依据。方法:以2022年10月—2023年10月间在上海市静安区登记的病原学阳性肺结核患者及其密切接触者为研究对象。采用γ-干扰素释放试验(IGRA)对密切接触者开展结核感染筛查;采用卡方检验和Binary logistic回归模型对LTBI影响因素进行分析。结果:共纳入112名密切接触者,其中男性 30名(26.79%),女性 82 名(73.21%);年龄范围为 1~86 岁,年龄中位数(第25、75百分数)为 47.50(32.25,61.00)岁。LTBI感染率为21.43%(24/112),肺结核检出率为2.68%(3/112)。单因素分析结果显示,指示病例痰涂片阳性,密切接触者为直系亲属、共同生活以及不采取防护措施,均与较高的LTBI率相关,差异有统计学意义(均P<0.05);多因素分析结果显示,指示病例为涂片阳性的密切接触者发生潜伏感染的风险是痰涂片阴性的6.50倍(95%CI: 1.82~23.25,P=0.004)。结论:上海市静安区病原学阳性肺结核患者密切接触者的LTBI率较高,痰涂片阳性患者的密切接触者感染风险更高,应重点加强对该人群的结核感染检测及随访复查管理。

     

    Abstract: Objective: To investigate latent tuberculosis infection(LTBI)and associated risk factors among close contacts of positive pulmonary tuberculosis patients in JIngAn District,Shanghai.Provide a basis and reference for preventive intervention strategies and policies among close contacts in the future. Methods: The study subjects were pulmonary tuberculosis patients with bacteriological positive and their close contacts registered to test for Mycobacterium tuberculosis infection by intern gamma release assay(IGRA) in Jing'an District, Shanghai from October 2022 to October 2023. The influence factors of LTBI were analyzed by x2 test and binary logistic regression model. Results: A total of 112 close contacts were included, of which 30 (26.79%) were male and 82 (73.21%) were female; the age range was 1 to 86 years, with a median (Quartile) of 47.50 (32.25 61.00) years. LTBI infection rate was 21.43% (24/112), and the incidence of pulmonary tuberculosis was 2.68% (3/112). Univariate analysis results show that the sputum smear results of the index cases, whether the close contacts are immediate family members, whether they live together and whether protective measures are taken affect the incidence of tuberculosis latent infection in close contacts of patients with bacteriological positive pulmonary tuberculosis, and the difference statistically significant (P < 0.05). The risk of latent infection in close contacts of the index case with a positive sputum smear is 6.5 times higher than those with a negativeutum smear (OR=6.498, 9%CI: 1.82~23.25, P=0.004). Conclusion: The infection rate of LTBI in close contacts of pulmonary tuberculosis patients with pathogenic bacteria positive in Shanghai Jing'an District was relatively high especially for close contacts of pulmonary tuberculosis patients with positive sputum smear, the risk of LTBI infection was more prominent, and it was necessary to improve the tracking management of tuberculosis infection detection and follow-up reexamination.

     

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