北京口岸赴美移民人群结核病监测结果分析

目的调查北京口岸移民人群日市结核的发病及感染情况，建立出入境口岸防控结核病科学有效的监测管理体系，防止结核病通过口岸跨境传播。方法对2008年7月至2013年6月期间l5598名赴美移民结核病监测资料进行回顾性分析，2～〈15岁组的2488名儿童均行结核菌素皮肤试验或7下扰素体外释放试验；≥15岁组13110名均摄x线胸片，对所有x线胸片可疑的401例肺结核患者进行痰涂片和痰培养检查，对11例培养阳性菌株进行结核分枝杆菌菌种鉴定和抗结核药物敏感性试验。结果按照美国CIX＂结核病筛查指南要求并参照我国肺结核诊断标准确定：（1）继发（}舌动）性肺结核：≥15岁组13110名x线胸片提示可疑肺结核401例，从中确诊肺结核患者15例（检出率114．42/10万），其中菌阳11例，菌阴4例（检出率分别为83．91／10万和30．51／10万）；（2）非活动性肺结核：≥15岁组确诊非活动性肺结核386例，检出率2944．32／10万；（3）儿童潜伏结核分枝杆菌感染：2～〈15岁组2488名儿童中共444例确诊为结核分枝杆菌潜伏感染，其中结核菌素试验硬结平均直径≥10mm、者423例，7干扰素体外释放试验阳性者2l例，儿童结核分枝杆菌感染率17845．66／10万，444例x线胸片均未见异常；（4）≥15岁组密切接触者2例；（5）细菌学检测：≥15岁组中X线胸片异常的401例均进行3个痰标本检测。检出涂阳培阳4例、涂阴培阳7例和涂阴培阴390例；1l例菌株均属结核分枝杆菌；药敏试验结果为敏感株9例，耐药株2例（1例为MDKTB，1例为PDRTB）；（6）活动性肺结核以60岁及以上组检出率最高，为371．52／10万（6／1615）；15～〈30岁组次之，检出率为145．88／10万（G／4113）。结论对口岸地区的≥15岁年龄组x线胸片异常者作为肺结核的防控重点人群，2～〈15岁组人群结核菌素试验硬结平均直径≥10mm或γ干扰素体外释放试验阳性者也不容忽视。

Analysis of TB screening results among applicants for immigration to the United States in Beijing

Objective To investigate the situation of tuberculosis （TB） morbidity and infection among appli cants for living abroad in Beijing, and to fill this knowledge gap which will be used for establishing an effective mo nitoring and management system at the ports, thereby preventing TB transmission across national boundaries. Methods A retrospective analysis was conducted. The data used for analysis were from 15 598 immigration appli cants to the United States （US） who received TB screening at Beijing International Travel Health Care （;enter from July 2008 to June 2013. Tuberculin skin testing （TST） or interferon gamma release assays （IGRAs） was performed on 2488 children aged 2 ≤15 years; chest X-ray （CXR） was taken on 13 110 applicants aged 15 years and older, sputum smear and culture were performed on 401 applicants with a CXR result suggesting pulmonary TT （PTB） or suspected PTB, strain identification of Mycobacterium tuberculosis （Mtb） and drug susceptibility testing （DST） were done using the strains isolated by culture. Results Accordance to the updated guidelines for using I（;RAs to detect Mtb infection issued by US CDC in 2010 and the Chinese diagnostic criteria for PTB, the following resulss were obtained： （1） Active PTB： among 401 applicants with abnormal CXRs who were identified from 13 110 appli cants aged 15 years and older, 15 PTB cases were detected （114.42 per 100 000）, including 11 bacteriologically con firmed cases and 4 bacteriologically-negative cases （83.91 and 30.51 per 100 000, respectively）. （2） Inactive TB： 386 inactive TB were found among applicants aged 15 years and older, the rate was 2944.32 per 100 000. （3） I.atent TB infection （LTBI） in children： among 2488 children aged 2-%15 years, 444 children were diagnosed as LTBI with normal CXRs, including 423 were TST≤10 mm and 21 were IGRAs positive. The rate of LTBI among children was 17 845.66 per 100 000. （4） There were 2 close contacts of TB patients among the applicants aged 1.5 years and older. （5） Bacteriological examinations： 3 sputum specimens were collected from each of 401 applicants with abnormal CXRs and aged 15 years and older, smear and culture were performed, of which were detected： 4 cases were smear positive and culture positive （S＋C＋）, 7 cases were smear-negative but culture-positive （S-C＋ ） and 390 cases were smear-negative and culture-negative （S--C--）. All of the 11 culture-positive cases were identified as Mtb, 9 of them were confirmed by I）ST as susceptible TB while other 2 were drug-resistant TB （ 1 was multidrug resistant TB and 1 was poly drug-resistant TB）. （6） The active TB prevalence reached a peak for the age group 60 years and older （371.52 per 100 000）, followed by the age group 15-〈30 years （ 145.88 per 100 000）. Conclusion People with abnormal CXRs and aged 15 years and older should be considered as the target populations of TB control in the immigration health check-up, and those with TST≥10 mm or IGRAs positive and aged 2-〈15 years should not be neglected either.