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

Latent tuberculosis infection status and influencing factors among 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,并运用卡方检验和二元logistic回归模型对LTBI的影响因素进行分析。
    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),活动性肺结核检出率为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、共同生活及不采取戴口罩防护措施均与LTBI发生风险正相关(均P<0.05);多因素logistic回归分析结果显示,指示病例为痰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者的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感染率较高,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筛查及随访复查管理。

     

    Abstract:
    Objective To investigate the status and influencing factors of latent tuberculosis infection (LTBI) among close contacts of patients with bacteriologically confirmed pulmonary tuberculosis in Jing’an District, Shanghai, and to provide scientific evidence for the development of tuberculosis infection testing and preventive intervention strategies for close contacts of bacteriologically positive patients.
    Methods From October 2022 to October 2023, patients with bacteriological confirmed pulmonary tuberculosis registered in Jing’an District, Shanghai, and their close contacts were enrolled as the research subjects. The close contacts were screened for tuberculosis infection using the interferon-γ release assay (IGRA). The chi-square test and binary logistic regression model were used to analyze factors influencing LTBI.
    Results A total of 112 close contacts were included, of whom 30 (26.79%) were male and 82 (73.21%) were female. The age ranged from 1 to 86 years, with a median (25th, 75th percentiles) of 47.50 (32.25, 61.00) years. The infection rate of LTBI was 21.43% (24/112), and the incidence of active pulmonary tuberculosis was 2.68% (3/112). Univariate analyses showed that a positive sputum smear of the index case, being a direct relative of the index case, co-living, and not wearing a mask were significantly associated with LTBI (all P<0.05). Multivariate logistic regression analyses showed that the risk of latent infection in close contacts of the index case with a positive sputum smear was 6.50 times higher than in those with a negative sputum smear (95%CI: 1.82‒23.25, P=0.004).
    Conclusion The infection rate of LTBI in close contacts of patients with bacteriologically confirmed pulmonary tuberculosis in Jing’an District, Shanghai, is relatively high, and close contacts of sputum smear-positive patients face an even higher risk of infection. Therefore, tuberculosis infection screening and follow-up management should be strengthened for this population.

     

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