学校肺结核疫情风险与指示病例就诊间隔的关联

张晓龙; 崔彩岩; 傅颖; 王斐娴; 李云; 蒋骏

doi:10.16835/j.cnki.1000-9817.2024038

学校肺结核疫情风险与指示病例就诊间隔的关联

doi: 10.16835/j.cnki.1000-9817.2024038

江苏省苏州市疾病预防控制中心结核病防制所, 215004

基金项目:

苏州市重大疾病、传染病预防和控制关键技术项目 GWZX202001

苏州市卫生青年骨干人才"全国导师制"培训项目 Qngg2022031

详细信息

作者简介:
张晓龙(1983-), 男, 甘肃定西人, 硕士, 副主任医师, 主要从事结核病防制工作

通讯作者:
蒋骏, E-mail: junjiang.jj@163.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: G478 R181.3⁺² R521
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- 被引次数: 0
出版历程
- 收稿日期: 2023-10-16
- 修回日期: 2023-11-15
- 网络出版日期: 2024-02-01
- 刊出日期: 2024-01-25

Association between the risk of tuberculosis outbreak in schools and the visit interval of index cases

Suzhou Center for Disease Control and Prevention, Suzhou (215004), Jiangsu Province, China

摘要

摘要: 目的分析学校肺结核疫情风险与指示病例就诊间隔的关系, 为公共卫生部门预判肺结核疫情聚集风险和制定干预措施提供科学依据。方法以2015年1月至2022年12月期间, 苏州市学校肺结核疫情630例指示病例为研究对象, 收集其人口统计学、就诊史、病原学诊断以及发现方式等资料。采用限制性立方样条(RCS), 非条件Logistic回归和受试者工作特征曲线(ROC曲线)进行统计学分析。结果 RCS拟合曲线显示, 当病原学阴性患者就诊间隔>5.79 d, 或病原学阳性患者就诊间隔>8.37 d时, 肺结核疫情风险呈线性增加。调整性别、年龄和病原学检查后, 指示病例就诊间隔每延长1 d, 疫情发生高风险的OR值(95%CI)为1.10(1.07~1.13)(P＜0.05)。按就诊间隔三分位分析, 与就诊间隔＜14 d相比, 就诊间隔在14~＜28 d和≥28 d的学校肺结核发生高风险疫情的OR值(95%CI)分别为10.32(3.04~35.10)和82.58(28.42~239.95)(P值均＜0.01), 呈就诊间隔延长, 疫情风险上升趋势。通过ROC曲线分析, 预测学校肺结核疫情高风险的最佳阈值为23.5 d, 曲线下面积为0.93(95%CI=0.89~0.98)。结论指示病例就诊间隔延长是学校肺结核高风险疫情的良好预警指标, 可作为疫情早期干预和风险控制的关键考量。
- 结核, 肺 /
- 疾病暴发流行 /
- 病例报告 /
- 门诊医疗 /
- 学生
Abstract: Objective To analyze the relationship between the risk of tuberculosis outbreaks in schools and the visit interval of index cases, so as to provide a scientific reference for predicting the risks of tuberculosis outbreak and making preventive measures. Methods A total of 630 index cases from school tuberculosis outbreaks were studied during January, 2015 to December, 2022. Data on demographics, consultation history, etiological diagnosis, and methods of detection were collected. Restricted Cubic Splines (RCS), unconditional Logistic regression, and the receiver operating characteristic curve (ROC curve) were used for analysis. Results The RCS fitted curve showed that the risk of a tuberculosis outbreak linearly increased when the consultation interval for etiologically negative patients exceeded 5.79 days, or for etiologically positive patients exceeded 8.37 days. After multi-factor adjustment, for every additional day in the visit interval of the index case, the odds ratio (OR) value for a high-risk outbreak was 1.10 (95%CI=1.07-1.13)(P < 0.05). When analyzed by tertiles of visit intervals, compared to an interval of < 14 days, the OR values (95%CI) for high-risk outbreaks in schools with intervals of 14- < 28 days and ≥28 days were 10.32(3.04-35.10) and 82.58(28.42-239.95), respectively(P < 0.01), indicating a trend of increasing outbreak risk with longer visit intervals. Based on the ROC curve analysis, the optimal threshold for predicting a high-risk school tuberculosis outbreak was 23.5 days, with an area under the curve (AUC) of 0.93 (95%CI=0.89-0.98). Conclusion An extended visit interval of index cases is a good early warning indicator for high-risk tuberculosis outbreaks in schools and could be considered a key factor in early intervention and risk control strategies.
- Tuberculosis, pulmonary /
- Disease outbreaks /
- Case reports /
- Ambulatory care /
- Students
注释:

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图 1 指示病例就诊间隔时间与学校肺结核疫情风险的剂量-反应关系

Figure 1. Dose-response relationship between visit interval time of index cases and the risk of tuberculosis outbreak in schools

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表 1 不同特征指示病例构成在低风险疫情区与高风险疫情区组间比较

Table 1. Comparison of different characteristic compositions of indicating cases between low risk epidemic areas and high risk epidemic areas

特征	选项	低风险疫情(n=578)	高风险疫情(n=52)	χ²值	P值
性别	男	346(59.86)	35(67.31)	1.11	0.29
	女	232(40.14)	17(32.69)
学校类别	幼儿园/早教机构	18(3.11)	0	7.32	0.20
	小学	50(8.65)	0
	初中	78(13.49)	9(17.31)
	高中	122(21.11)	12(23.08)
	职业院校/中专	216(37.37)	23(44.23)
	大学	94(16.26)	8(15.38)
人员类别	教职工	61(10.55)	3(5.77)	1.20	0.27
	学生	517(89.45)	49(94.23)
病原学检查	阴性	298(51.56)	16(30.77)	8.25	＜0.01
	阳性	280(48.44)	36(69.23)
发现方式	因症就诊	475(82.18)	42(80.77)	0.15	0.93
	主动筛查	17(2.94)	2(3.85)
	健康体检	86(14.88)	8(15.38)
注： ()内数字为构成比/%。

下载: 导出CSV

表 2 就诊间隔预测肺结核高风险疫情效能评估(n=630)

Table 2. Evaluation of the efficacy of visit intervals in predicting high-risk tuberculosis outbreaks(n=630)

特征	阈值/d	灵敏度/%	特异度/%	阳性预测值/%	阴性预测值/%	AUC(95%CI)
就诊间隔	23.5	82.69	88.93	98.28	40.19	0.93(0.89~0.98)
病原学阳性就诊间隔	29.5	77.78	92.86	97.01	58.33	0.92(0.86~0.98)
病原学阴性就诊间隔	15.5	93.75	80.20	99.58	20.27	0.94(0.89~0.99)

下载: 导出CSV

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