重庆市中学生结核病发病风险及风险因素随访分析

张文; 苏倩; 廖文平; 张理翌; 辛玉; 吕娟; 罗杰; 石林; 范君; 石亚玲

doi:10.16835/j.cnki.1000-9817.2025280

重庆市中学生结核病发病风险及风险因素随访分析

doi: 10.16835/j.cnki.1000-9817.2025280

张文¹,
苏倩²,
廖文平¹,
张理翌¹,
辛玉¹,
吕娟¹,
罗杰¹,
石林¹,
范君^3, ,,
石亚玲^3, ,

1.
重庆市结核病防治所医教科, 400050
2.
重庆市结核病防治所综合防治科
3.
重庆市结核病防治所行政办公室

基金项目:

重庆市科卫联合医学科研项目 2022MSXM018

重庆市九龙坡区科技计划项目 2024-04-023-Y

重庆市九龙坡区科技计划项目 2024-04-002-Z

详细信息

作者简介:
张文(1985-)，男，甘肃白银人，硕士，副主任医师，主要研究方向为结核病防控

通讯作者:
范君，E-mail：17540024@qq.com

石亚玲，E-mail：1687871166@qq.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R181.3⁺² R529.9 G478
计量
- 文章访问数: 2
- HTML全文浏览量: 1
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2025-04-22
- 修回日期: 2025-07-07
- 网络出版日期: 2025-10-10
- 刊出日期: 2025-09-25

Follow-up analysis of tuberculosis incidence risk and risk factors among middle school students in Chongqing

ZHANG Wen¹,
SU Qian²,
LIAO Wenping¹,
ZHANG Liyi¹,
XIN Yu¹,
LÜ Juan¹,
LUO Jie¹,
SHI Lin¹,
FAN Jun^{3
, ,},
SHI Yaling^{3
, ,}

1.
Department of Medical Education, Chongqing Municipal Institute of Tuberculosis, Chongqing 400050, China

摘要

摘要: 目的了解重庆市中学生结核病发病风险及风险因素，为制定结核病防控策略提供依据。方法 2022年9—12月，采用分层整群随机抽样方法从重庆市15个行政区抽取32 181例中学生作为研究队列，对队列成员开展结核菌素皮肤试验(TST)筛查并收集2023年1月1日—2024年12月31日相关信息。在主动筛查的基础上，将随访人员信息与国家结核病管理信息系统比对获取研究对象的发病情况，不同特征中学生发病率比较采用Log-lank法检验；并建立Cox比例风险模型进行结核病发病风险及风险因素的分析。结果队列成员TST筛查率为93.0%，2年随访期内共发生结核病36例，累计发病率111.87/10万，发病密度为55.95/10万。其中来自公办学校的学生累计发病率(170.44/10万)高于民办学校(41.16/10万)，学校所在区域为高疫情地区的累计发病率(153.95/10万)高于中疫情地区(69.00/10万)，差异均有统计学意义(χ²值分别为11.49，4.73)(P值均 < 0.05)。对不同TST结果进行Log-rank法检验，TST结果为强阳性与阴性的累计发病率(216.55/10万，81.40/10万)差异有统计学意义(χ²=5.85，P < 0.05)。采用Cox比例风险模型进行单因素分析，民办学校(HR=0.25，95%CI=0.10~0.59)、中疫情地区(HR=0.46，95%CI=0.23~0.94)中学生结核病发病风险均降低；TST结果为强阳性的中学生(HR=1.39，95%CI=1.05~1.84)结核病发病风险增加(P值均 < 0.05)。多因素Cox回归分析结果显示，民办学校学生结核病发病风险低于公办学校(HR=0.23，95%CI=0.08~0.62，P < 0.05)。结论重庆市中学生结核病年均发病率处于相对偏高水平。应加强公办学校、学校所在地疫情等级为高疫情地区、TST结果为强阳性的学生人群管理和干预，以降低结核病发病率。
- 结核 /
- 发病率 /
- 因素分析，统计学 /
- 学生
Abstract: Objective To understand the incidence risk and risk factors of tuberculosis (TB) among middle school students in Chongqing, so as to provide a basis for formulating TB prevention and control strategies. Methods From September to December 2022, 32 181 middle school students were selected as the study cohort from 15 administrative districts in Chongqing by using the stratified cluster random sampling method. All cohort members were screened with the tuberculin skin test (TST), and relevant information was collected from January 1, 2023 to December 31, 2024. On the basis of active screening, the follow-up data of the participants were compared with the National Tuberculosis Management Information System to obtain the incidence status of the study subjects. The Log-rank test was used to compare the TB incidence rates among students with different characteristics, and a Cox proportional hazards model was established to analyze the incidence risk and risk factors of TB. Results The TST screening rate of the cohort members was 93.0%. During the 2-year follow-up period, a total of 36 TB cases occurred, with a cumulative incidence rate of 111.87/100 000 and an incidence density of 55.95/100 000. Among them, the cumulative incidence rate of students from public schools (170.44/100 000) was higher than that of students from private schools (41.16/100 000), the cumulative incidence rate of students in schools located in high-epidemic areas (153.95/100 000) was higher than that in medium-epidemic areas (69.00/100 000), and the difference was statistically significant (χ²=11.49, 4.73, both P < 0.05). The Log-rank test for different TST results showed that the difference in TB comulative incidence rate between students with strongly positive TST results (216.55/100 000) and those with negative TST results (81.40/100 000) was statistically significant (χ²=5.85, P < 0.05). Univariate analysis using the Cox proportional hazards model revealed that the risk of TB was lower in students from private schools (HR=0.25, 95%CI=0.10-0.59) and students in medium-epidemic areas (HR=0.46, 95%CI=0.23-0.94); whereas the risk of TB was increased in students with strongly positive TST results (HR=1.39, 95%CI=1.05-1.84) (all P < 0.05). Multivariate Cox regression analysis showed that the risk of TB in students from private schools was lower than that of students from public schools (HR=0.23, 95%CI=0.08-0.62, P < 0.05). Conclusions The annual average incidence rate of TB among middle school students in Chongqing is at a relatively high level. It is necessary to strengthen the management and intervention for student groups, including those in public schools, those in schools located in high-epidemic areas, and those with strongly positive TST results, so as to reduce the incidence rate of TB.
- Tuberculosis /
- Incidence /
- Factor analysis, statistical /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 重庆市2023—2024年不同组别中学生结核病发病情况

Table 1. Tuberculosis incidence among middle school students in different groups in Chongqing (2023-2024)

组别	人数	发病数	累计发病率/10^-5	年均发病率/10^-5	随访人年	发病密度/10^-5
性别
男	17 264	19	110.06	55.03	34 521	55.04
女	14 917	17	113.96	56.98	29 826	57.00
年龄/岁
< 13	1 325	0	0	0	2 650	0
13~15	7 235	14	193.50	96.75	14 467	96.77
16~18	23 352	22	94.21	47.11	46 692	47.12
>18	269	0	0	0	538	0
学段
初中	2 694	0	0	0	5 388	0
高中	29 487	36	122.09	61.04	58 959	61.06
学校属性
公办	17 602	30	170.44	85.22	35 193	85.24
民办	14 579	6	41.16	20.58	29 154	20.58
区域疫情等级^a
高疫情地区	16 239	25	153.95	76.98	32 465	77.01
中疫情地区	15 942	11	69.00	34.50	31 882	34.50
TST筛查
接受	29 925	35	116.96	58.48	59 835	58.49
未接受	2 256	1	44.33	22.16	4 512	22.16
TST结果
阴性	17 199	14	81.40	40.70	34 395	40.70
一般阳性	3 783	5	132.17	66.09	7 566	66.09
中度阳性	4 787	7	146.23	73.11	9 569	73.15
强阳性	4 156	9	216.55	108.28	8 305	108.37
注： ^a重庆市低疫情地区仅有1个区，且该区筛查时间均只在每年上半年开展，与其他区县不一致，因此未纳入调查。

下载: 导出CSV

表 2 重庆市中学生结核病发病风险的单因素Cox比例风险模型分析(n=32 181)

Table 2. Univariate Cox proportional hazards model analysis of tuberculosis incidence risk among middle school students in Chongqing (n=32 181)

自变量	β值	标准误	Wald χ²值	P值	HR值(95%CI)
性别
女	0.03	0.33	0.01	0.93	1.03(0.54~1.99)
年龄/岁
13~15	3.26	3.20	1.04	0.31	26.05(0.05~13 864.79)
16~18	1.54	2.09	0.55	0.46	4.68(0.08~279.87)
>18	-	-	-	-	-
学段
高中	3.14	2.63	1.42	0.23	23.00(0.13~3 996.40)
学校属性
民办	-1.40	0.45	9.78	< 0.01	0.25(0.10~0.59)
区域疫情等级
中疫情地区	-0.77	0.36	4.50	0.03	0.46(0.23~0.94)
TST筛查
未接受	0.96	1.01	0.90	0.34	2.62(0.36~19.09)
TST结果
一般阳性	0.49	0.52	0.90	0.34	1.64(0.59~4.55)
中度阳性	0.30	0.23	1.66	0.20	1.35(0.86~2.12)
强阳性	0.33	0.14	5.39	0.02	1.39(1.05~1.84)
注：自变量性别以男生、年龄以 < 13岁、学段以初中、学校属性以公办、区域疫情等级以高疫情地区、TST筛查以接受、TST结果以阴性为参照。

下载: 导出CSV

表 3 重庆市中学生结核病发病风险的多因素Cox比例风险模型分析(n=32 181)

Table 3. Multivariable Cox proportional hazards model analysis of tuberculosis incidence risk among middle school students in Chongqing (n=32 181)

变量	β值	标准误	Wald χ²值	P值	HR值(95%CI)
年龄/岁	0.26	0.15	2.82	0.09	1.29(0.96~1.74)
学校属性
民办	-1.48	0.51	8.28	< 0.01	0.23(0.08~0.62)
区域疫情等级
中疫情地区	-0.51	0.39	1.69	0.19	0.60(0.28~1.30)
TST
一般阳性	-0.87	0.43	4.14	0.04	0.42(0.18~0.97)
中度阳性	-0.42	0.56	0.57	0.45	0.66(0.22~1.97)
强阳性	-0.34	0.51	0.44	0.51	0.72(0.27~1.93)
注：年龄为连续型变量，学校属性以公办、区域疫情等级以高疫情地区、TST结果以阴性为参照。

下载: 导出CSV

参考文献(23)

[1]	彭小梅, 刘月园, 欧阳朦. 2015—2020年江西省学校结核病防控工作情况调查分析[J]. 疾病监测, 2023, 38(11): 1313-1317. PENG X M, LIU Y Y, OUYANG M. Investigation of performance of tuberculosis prevention and control in schools in Jiangxi, 2015-2020[J]. Dis Surveill, 2023, 38(11): 1313-1317. (in Chinese)
[2]	WEI W, XIA L, WU J, et al. The environmental and socioeconomic effects and prediction of patients with tuberculosis in different age groups in southwest China: a population-based study[J]. JMIR Public Health Surveill, 2023(9): e40659.
[3]	张文, 余雅, 范君, 等. 2016—2020年重庆市学生肺结核流行病学特征分析[J]. 中国防痨杂志, 2022, 44(8): 784-791. ZHANG W, YU Y, FAN J, et al. Epidemiological characteristics of pulmonary tuberculosis among students in Chongqing from 2016 to 2020[J]. Chin J Antituberc, 2022, 44(8): 784-791. (in Chinese)
[4]	缪志鹏, 汪义锦, 袁寒艳, 等. 高中生结核病防治知识态度行为性别差异分析[J]. 中国学校卫生, 2024, 45(11): 1634-1637. doi: 10.16835/j.cnki.1000-9817.2024339 MIAO Z P, WANG Y J, YUAN H Y, et al. Analysis of gender differences in knowledge, attitudes and behaviors regarding tuberculosis prevention and control among high school students[J]. Chin J Sch Health, 2024, 45(11): 1634-1637. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2024339
[5]	WU B, YU Y, WU C, et al. Addressing the burden and detection gap of latent tuberculosis infection in schoolchildren and adolescents in China: a cross-sectional study[J]. BMC Infect Dis, 2024, 24(1): 984. doi: 10.1186/s12879-024-09812-0
[6]	中华人民共和国国家卫生和计划生育委员会. 肺结核诊断: WS 288—2017[S]. 北京: 中国标准出版社, 2017. National Health and Family Planning Commission of the PRC. Diagnosis of tuberculosis: WS 288-2017[S]. Beijing: Standards Press of China, 2017. (in Chinese)
[7]	中国防痨协会. 结核分枝杆菌重组蛋白皮肤试验操作规范: T/CHATA 020—2022[S]. 北京: 中国标准出版社, 2022. Chinese Antituberculosis Association. Operation specification of mycobacterium tuberculosis recombinant protein skin test: T/CHATA 020-2022[S]. Beijing: Standards Press of China, 2022. (in Chinese)
[8]	BEHR M A, KAOFMANN E, DUFFIN J, et al. Latent tuberculosis: two centuries of confusion[J]. Am J Respir Crit Care Med, 2021, 204(2): 142-148. doi: 10.1164/rccm.202011-4239PP
[9]	重庆市人民政府办公厅. 关于印发《重庆市结核病防治行动方案(2024—2035年)》的通知[EB/OL]. (2024-11-06)[2025-04-21]. http://www.cq.gov.cn/zwgk/zfxxgkml/szfwj/qtgw/202411/t20241106_13773971.html.
[10]	BAGCCHI S. WHO's global tuberculosis report 2022[J]. Lancet Microbe, 2023, 4(1): e20. doi: 10.1016/S2666-5247(22)00359-7
[11]	陈卉, 张灿有, 张慧, 等. 2004—2021年全国学校肺结核疫情分析[J]. 中国防痨杂志, 2022, 44(8): 768-776. CHEN H, ZHANG C Y, ZHANG H, et al. Analysis on the epidemic situation of pulmonary tuberculosis in schools in China from 2004 to 2021[J]. Chin J Antituberc, 2022, 44(8): 768-776. (in Chinese)
[12]	庞艳, 吴成果, 汪清雅, 等. 2021年重庆市新生筛查结核病结果分析[J]. 实用预防医学, 2023, 30(2): 165-168. PANG Y, WU C G, WANG Q Y, et al. Screening results of tuberculosis among new students in Chongqing Municipality, 2021[J]. Pract Prev Med, 2023, 30(2): 165-168. (in Chinese)
[13]	LI Y, ZHENG Y H, LU L P, et al. Acceptance of chemo-prophylaxis for latent tuberculosis infection among high school/college student contacts of tuberculosis patients in Shanghai, China[J]. Biomed Environ Sci, 2018, 31(4): 317-321.
[14]	WILLIAMS B, PICKARD L, GRANDJEAN L, et al. The need to implement effective new entrant tuberculosis screening in children: evidence from school 'outbreak'[J]. J Public Health, 2016, 38(4): e511-e515.
[15]	成君, 夏愔愔, 刘二勇, 等. 学校结核病突发疫情处置的思考[J]. 中国防痨杂志, 2018, 40(2): 145-148. CHENG J, XIA Y Y, LIU E Y, et al. Thinking on the disposal of tuberculosis outbreak in schools[J]. Chin J Antituberc, 2018, 40(2): 145-148. (in Chinese)
[16]	陈卉, 夏愔愔, 张灿有, 等. 2014—2018年全国学生肺结核疫情变化趋势及特征分析[J]. 中国防痨杂志, 2019, 41(6): 662-668. CHEN H, XIA Y Y, ZHANG C Y, et al. Epidemic trends and characteristics of pulmonary tuberculosis in students in China from 2014 to 2018[J]. Chin J Antituberc, 2019, 41(6): 662-668. (in Chinese)
[17]	刘毅, 黄旭, 尹文琴, 等. 中国学生结核病发病趋势的系统评价[J]. 中国循证医学杂志, 2022, 22(1): 46-50. LIU Y, HUANG X, YIN W Q, et al. Incidence trends of tuberculosis among Chinese students: a systematic review[J]. Chin J Evid Based Med, 2022, 22(1): 46-50. (in Chinese)
[18]	申慧杰, 焦锋, 马迎华, 等. 中小学校突发公共卫生事件应急处置能力调查[J]. 中国学校卫生, 2023, 44(3): 454-457, 461. doi: 10.16835/j.cnki.1000-9817.2023.03.031 SHEN H J, JIAO F, MA Y H, et al. Public health emergency response capacity in primary and secondary schools[J]. Chin J Sch Health, 2023, 44(3): 454-457, 461. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2023.03.031
[19]	孙远鹏, 张勇, 马敏, 等. 山东省中小学校卫生保健机构建设现状研究[J]. 中国公共卫生管理, 2024, 40(6): 856-858, 862. SUN Y P, ZHANG Y, MA M, et al. Analysis on construction status of primary and secondary school health care institutions in Shandong Province[J]. Chin J Public Health Manage, 2024, 40(6): 856-858, 862. (in Chinese)
[20]	CAMPBELL J R, WINTERS N, MENZIES D. Absolute risk of tuberculosis among untreated populations with a positive tuberculin skin test or interferon-gamma release assay result: systematic review and Meta-analysis[J]. BMJ, 2020, 368: m549.
[21]	肖海浩, 张言斌. 结核分枝杆菌潜伏感染研究进展[J]. 实用医学杂志, 2022, 38(6): 664-668. XlAO H H, ZHANG Y B. Research progress of latent mycobacterium tuberculosis infection[J]. J Pract Med, 2022, 38(6): 664-668. (in Chinese)
[22]	陈淑林, 孙德全, 石俊峰, 等. 高中新生PPD反应程度与结核病发病危险的队列研究[J]. 中华疾病控制杂志, 2013, 17(2): 180-181. CHEN S L, SUN D Q, SHI J F, et al. Relationship between PPD reaction extent and tuberculosis risk among senior high school students[J]. Chin J Dis Control Prev, 2013, 17(2): 180-181. (in Chinese)
[23]	梁瑞英, 徐伟, 吴春萍. 北京市朝阳区2013-2015年高校新生结核菌潜伏感染现状及发病情况[J]. 中国学校卫生, 2019, 40(9): 1373-1375, 1379. doi: 10.16835/j.cnki.1000-9817.2019.09.026 LIANG R Y, XU W, WU C P. Latent tuberculosis infection and tuberculosis incidence college freshmen in Chaoyang District during 2013 to 2015[J]. Chin J Sch Health, 2019, 40(9): 1373-1375, 1379. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2019.09.026