北京市部分学校肺结核病患者及其密切接触者筛查分析

目的 通过筛查北京市部分学校结核病患者及其密切接触者,了解不同学生群体结核病的感染特征和趋势,为不同阶段的学校结核病防控提供理论指导。方法 以2015年至2018年不同适龄阶段的学校发现的结核病患者及其密切接触者为研究对象,共6 215例研究对象纳入到本研究,包括114例指示病例,6 101例密切接触者。密切接触者进行结核菌素纯蛋白衍生物(purified protein derivative, PPD)皮肤试验及X线胸片检查,确定潜在的结核病患者,分析密切接触者中结核病的检出情况及相关危险因素。结果 密切接触者中共筛查出29例结核病患者,其中男性22例(75.86%),女性7例(24.14%);职业学校和大学阶段中结核病患者的比例较高,分别为41.38%(12/29)和48.28%(14/29),主要以学生为主。密切接触者中PPD阳性(硬结直径≥5 mm)2 206例(36.16%),强阳性(硬结直径≥15 mm)676例(11.08%),从幼儿园到大学阶段的密切接触者的PPD阳性率呈上升趋势,差异有统计学意义(χ²=59.879,P<0.05),同时肺结核的检出率也逐渐升高,差异有统计学意义(χ²=8.403,P=0.015)。随着PPD硬结的增大,肺结核检出率也在提高,差异有统计学意义(χ²=168.509,P<0.05)。结论 对不同适龄阶段的学校的肺结核密切接触者的筛查显示,对职业学校和大学阶段的学生应重点进行筛查,同时应采用新方法提高结核病检测阳性率,及早发现感染者,避免学校出现结核病疫情。

Screening analysis of tuberculosis patients and their close contacts in some schools in Beijing

Objective To understand the prevalence of tuberculosis among students by screening and analyzing tuberculosis patients and their close contacts in some schools in Beijing for the provide theoretical guidance for the prevention and control of tuberculosis in schools at different stages.Methods The tuberculosis patients and their close contacts found in the schools at different stages from 2015 to 2018 were collected as the research object. A total of 6 215 cases of data were included in this study, including 114 index cases and 6 101 close contacts. The close contacts were determined by tuberculin skin test with purified protein derivative(PPD) and X-ray chest radiography to identify potential tuberculosis patients, and to analyze the related risk factors of close contacts. Results Among close contacts,a total of 29 cases of tuberculosis were screened out, including 22 male (75.86%) and 7 female (24.14%); vocational schools and universities had higher rates of tuberculosis, 41.38%(12/29) and 48.28%(14/29), respectively, which mainly were students. Among close contacts, 2206 cases (36.16%) were positive for PPD (induration diameter≥5 mm) and 676 cases (11.08%) were strong positive (induration diameter≥15 mm); The positive rate of PPD from kindergarten to university showed an upward trend, with statistically difference (χ²=59.879,P<0.05), and the detection rate of tuberculosis gradually increased, with statistical difference(χ²=8.403,P=0.015). With the increase of PPD induration, the detection rates of tuberculosis also increased and the Chi-square test was statistically different(χ²=168.509,P<0.05). Conclusion Screening of close contacts of tuberculosis in schools of different ages should focus on the students at the vocational and university. At the same time, new methods should be adopted to improve the sensitivity of tuberculosis tests, to detect infected people early, and to avoid tuberculosis outbreaks in schools.