一起学校肺结核疫情病例相关人群的5年追踪随访分析

秦林蓉; 刘彬; 王江; 杨静; 罗春燕; 向登峰; 张婷; 庞艳

doi:10.16835/j.cnki.1000-9817.2023.10.028

一起学校肺结核疫情病例相关人群的5年追踪随访分析

doi: 10.16835/j.cnki.1000-9817.2023.10.028

秦林蓉¹,
刘彬^2, ,,
王江³,
杨静¹,
罗春燕¹,
向登峰¹,
张婷⁴,
庞艳⁴

1.
重庆市开州区疾病预防控制中心结核病防制科，重庆 405400
2.
重庆市开州区疾病预防控制中心地方病与寄生虫病防制科
3.
重庆市开州区疾病预防控制中心免疫规划科
4.
重庆市结核病防治所区县科

详细信息

作者简介:
秦林蓉(1987-)，女，重庆开州人，大学本科，主治医师，主要从事结核病预防控制工作

张婷(1984-)，女，重庆酉阳人，硕士，副主任医师，主要从事结核病预防控制工作

通讯作者:
刘彬，E-mail：281530261@qq.com

利益冲突声明 所有作者声明无利益冲突。
秦林蓉与张婷为共同第一作者。
中图分类号: G478 R521 R181.3⁺²
计量
- 文章访问数: 260
- HTML全文浏览量: 120
- PDF下载量: 48
- 被引次数: 0
出版历程
- 收稿日期: 2023-04-05
- 修回日期: 2023-07-10
- 网络出版日期: 2023-10-27
- 刊出日期: 2023-10-25

A 5-year follow-up analysis of cases in a high school tuberculosis outbreak

1.
Department of Tuberculosis Prevention, Chongqing Kaizhou District Center for Disease Control and Prevention, Chongqing(405400), China

摘要

摘要: 目的探讨结核分枝杆菌潜伏感染(LTBI)者预防性治疗的效果，为学校聚集性疫情处置及预防性治疗工作提供借鉴。方法收集重庆市开州区一所学校寄宿制高中2016级师生在2017年6月至2018年3月发生的学校肺结核疫情资料进行调查分析，并对发病情况、LTBI者及预防性治疗后发病情况追踪随访5年。结果该校2017年6月至2018年3月共确诊34例肺结核患者。6次集中接触者筛查中共筛查1 357人，筛查确诊结核率为2.43%，结核菌素皮肤试验(TST)阳性率为27.41%，TST强阳性率为7.39%。其中，首发病例班级确诊率、TST阳性率远高于其他班级，差异均有统计学意义(χ²值分别为286.30，98.59，P值均＜0.01)。发现LTBI者88例，有31例进行预防性治疗(35.23%)，其中28例完成预防性治疗(90.32%)。经5年追踪随访，该校高中部2016级共确诊肺结核患者73例，发病率为0.98/10²(人/人年)。88例LTBI者有15例确诊肺结核，发病率为3.33/10²(人/人年)，其中完成预防性治疗组发病率[0.7/10²(人/人年)]低于医学观察组[4.5/10²(人/人年)]，差异有统计学意义(χ²=4.31，P＜0.05)。结论 TST阳性率、强阳性率越高的班级发病率越高，提高LTBI者预防性治疗率可有效降低结核发病率。
- 结核，肺 /
- 疾病暴发流行 /
- 随访研究 /
- 发病率 /
- 学生
Abstract: Objective To explore the effectiveness of preventive treatment for latent tuberculosis infection (LTBI) patients, so as to provide reference for the management and preventive treatment of clustered epidemic in schools. Methods Data came from the school tuberculosis outbreak of a boarding high school in Kaizhou District, Chongqing, which occurred between June 2017 and March 2018 among 2016 grade high school teachers and students for investigation and analysis. The total incidence, LTBI patients, and the incidence after preventive treatment for 5 years were followed up. Results A total of 34 cases of pulmonary tuberculosis from June 2017 to March 2018. A total of 1 357 individuals were screened for 6 concentrated contact screenings, with a confirmed tuberculosis rate of 2.43%, a tuberculosis skin test (TST) positive rate of 27.41%, and a strong TST positive rate of 7.39%. Among them, the confirmed tuberculosis rate and TST positive rate in the first case class were much higher than those in other classes, with statistically significant differences (χ²=286.30, 98.59, P < 0.01). 88 cases of LTBI were found, with 31 cases receiving preventive treatment (35.23%), of which 28 completed preventive treatment (90.32%). After five years of follow-up, 73 cases of pulmonary tuberculosis were diagnosed in 2016 by the school senior high school, with a incidence rate of 0.98/10² (person/person years). Fifteen of the 88 LTBI patients were diagnosed with pulmonary tuberculosis, and the incidence rate was 3.33/10² (person/person years). The incidence rate of the preventive treatment group was 0.7/10² (person/person years)lower than that of the medical observation group 4.5/10² (person/person years), with a statistically significant difference (χ²=4.31, P < 0.05). Conclusion The classes with higher TST positive rate and strong positive rate have higher incidence rate. Improving the preventive treatment rate of LTBI patients can effectively reduce the incidence rate of tuberculosis.
- Tuberculosis, pulmonary /
- Disease outbreaks /
- Follow-up studies /
- Incidence /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

2) 秦林蓉与张婷为共同第一作者。

HTML全文

参考文献(17)

[1]	穆晶, 赵丹, 董宇杰, 等. 结核病病理学诊断的研究进展与临床应用[J]. 结核病与肺部健康杂志, 2017, 6(4): 386-390. https://www.cnki.com.cn/Article/CJFDTOTAL-FBJK201704023.htm MU J, ZHAO D, DONG Y J, et al. Research progress and clinical application of pathological diagnosis of tuberculosis[J]. J Tuberculosis Lung Health, 2017, 6(4): 386-390. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-FBJK201704023.htm
[2]	杨蕴轶. 学校涂阳肺结核密切接触者筛查及预防性治疗效果分析[J]. 中国现代药物应用, 2017, 11(22): 63-65. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY201722036.htm YANG Y Y. Screening of close contacts of smear positive pulmonary tuberculosis in school and analysis of the effect of preventive treatment[J]. Mod Drug Use China, 2017, 11(22): 63-65. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY201722036.htm
[3]	范君, 苏倩, 陈健, 等. 重庆市一起学校肺结核聚集性疫情调查分析[J]. 中国防痨杂志, 2022, 44(8): 792-796. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202208006.htm FAN J, SU Q, CHEN J, et al. Investigation and analysis of an epidemic situation of pulmonary tuberculosis in school in Chongqing[J]. Chin J Antitubercul, 2022, 44(8): 792-796. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202208006.htm
[4]	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. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202208003.htm CHEN H, ZHANG C Y, ZHANG H, et al. Analysis of tuberculosis 2004-2021[J]. Chin J Antitubercul, 2022, 44(8): 768-776. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202208003.htm
[5]	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. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202208005.htm ZHANG W, YU Y, FAN J, et al. Epidemiological characteristics of pulmonary tuberculosis among students in Chongqing from 2016 to 2020[J]. Chin J Antitubercul, 2022, 44(8): 784-791. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202208005.htm
[6]	中华人民共和国国家卫生和计划生育委员会办公厅, 中华人民共和国教育部办公厅. 关于印发学校结核病防控工作规范(2017版)的通知(国卫办疾控发【2017】22号)[A]. 2017-06-26. National Health and Family Planning Commission Office of the PRC, Office of Ministry of Education of of the PRC. Circular on the issuance of norms for the prevention and control of tuberculosis in schools (2017 edition) (CDC[2017] No. 22)[A]. 2017-06-26. (in Chinese)
[7]	姚旭, 吴成果, 龚德华, 等. 肺结核患者密切接触者12周预防性治疗方案的服药情况及影响因素分析[J]. 中国防痨杂志, 2021, 43(3): 233-239. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202103008.htm YAO X, WU C G, GONG D H, et al. Analysis of the status and influencing factors of 12-week prophylactic treatment regimen in close contacts of patients with pulmonary tuberculosis[J]. Chin J Antitubercul, 2021, 43(3): 233-239. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202103008.htm
[8]	中华人民共和国国家卫生健康委员会办公厅, 中华人民共和国教育部办公厅. 关于印发中国学校结核病防控指南的通知(国卫办疾控函【2020】910号)[A]. 2020-10-16. General Office of Ministry of Education of the PRC, National Health Commission of the PRC. Circular on issuing guidelines on prevention and control of tuberculosis in schools in China National Health Office Disease Control (Letter[2020]910)[A]. 2020-10-16. (in Chinese)
[9]	姚晶, 顾凯侃, 李智红, 等. 结核潜伏感染的研究现况概述[J]. 结核与肺部疾病杂志, 2020, 1(6): 82-88. https://www.cnki.com.cn/Article/CJFDTOTAL-FBJK202002019.htm YAO J, GU K K, LI Z H, et al. Current status of research on latent infection of tuberculosis[J]. J Tubercul Pulmon Dis, 2020, 1(6): 82-88. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-FBJK202002019.htm
[10]	黄玉, 王晓萌, 徐水洋, 等. 一起学校肺结核聚集性疫情的随访调查[J]. 预防医学, 2016, 28(8): 804-806. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYFX201608012.htm HUANG Y, WANG X M, XU S Y, et al. A follow-up investigation on a cluster epidemic of pulmonary tuberculosis in a school[J]. Prev Med, 2016, 28(8): 804-806. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZYFX201608012.htm
[11]	卢鹏, 成君, 路希维, 等. 科学开展预防性治疗加速遏制结核病进程[J]. 中国防痨杂志, 2020, 42(4): 316-321. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202004004.htm LU P, CHENG J, LU X W, et al. Scientific development of preventive treatment to accelerate the process containment tuberculosis[J]. Chin J Antitubercul, 2020, 42(4): 316-321. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202004004.htm
[12]	马艳, 陆伟, 高磊, 等. 终止结核病流行须加强结核分枝杆菌潜伏感染高危人群筛查和预防性治疗的管理[J]. 中国防痨杂志, 2022, 44(3): 209-214. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202203002.htm MA Y, LU W, GAO L, et al. To stop the prevalence of tuberculosis, it is necessary to strengthen the management of screening and preventive treatment of high-risk groups with latent infection of Mycobacterium tuberculosis[J]. Chin J Antitubercul, 2022, 44(3): 209-214. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202203002.htm
[13]	STAGG H R, ZENNER D, HARRIS R J, et al. Treatment of latent tuberculosis infection: a network Meta-analysis[J]. Ann Intern Med, 2014, 161(6): 419-428.
[14]	陈霞, 陈文山, 刘晓静, 等. 预防性治疗对TST强阳性学生机体体液免疫和肺结核发病率的影响[J]. 实验与检验医学, 2020, 38(4): 302-304. CHEN X, CHEN W S, LIU X J, et al. Effect of prophylactic treatment on humoral immunity and incidence of pulmonary tuberculosis in TST strongly positive students[J]. Exp Lab Med, 2020, 38(4): 302-304. (in Chinese)
[15]	魏春琴, 张海云, 刘士勇. 北京某高校新生结核菌素试验强阳性检出率及预防性投药治疗分析[J]. 中国现代药物应用, 2010, 4(10): 234-235. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY201010221.htm WEI C Q, ZHANG H Y, LIU S Y. Analysis of strong positive Mantoux test rate and prophylactic drug treatment among freshmen in a university in Beijing[J]. Chin J Mod Drug Appl, 2010, 4(10): 234-235. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY201010221.htm
[16]	高谦, 梅建. 我国学校结核病预防与控制的思考[J]. 中国防痨杂志, 2020, 42(3): 195-199. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202003004.htm GAO Q, MEI J. Thoughts on the prevention and control of tuberculosis in schools in China[J]. Chin J Antitubercul, 2020, 42(3): 195-199. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202003004.htm
[17]	卢鹏, 王荣, 刘家松, 等. 结核菌素皮肤试验诊断结核分枝杆菌潜伏感染学校人群预防性服药临界值的确定[J]. 中国防痨杂志, 2022, 44(8): 797-801. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202208007.htm LU P, WANG R, LIU J S, et al. Determination of the critical value of preventive medication for the diagnosis of latent infection of Mycobacterium tuberculosis in school population using tuberculin skin test[J]. Chin J Antitubercul, 2022, 44(8): 797-801. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202208007.htm