我国学生结核分枝杆菌潜伏感染和预防治疗现状

目的了解上海市浦东新区大中专院校肺结核患者学生密切接触者结核潜隐感染(LTBI)的情况及影响因素。方法2017年1月1日—12月31日采用结核分枝杆菌特异性细胞免疫反应检测(酶联免疫法)(QFT)对479例肺结核患者学生密切接触者的LTBI情况进行检测，同时收集性别、年龄、户籍、接触时间等信息并进行单因素和多因素分析。结果479例学生密切接触者的平均年龄为(20.8±1.4)岁，QFT试验结果阳性47例。同寝室室友以及同楼层寝室且同班级的密切接触学生QFT阳性率(30.0%和12.5%)显著高于一般接触者(7.3%)。多因素分析结果显示，男生密切接触者发生LTBI的风险高于女生(OR=3.72，95%CI：1.06~12.99)；累计接触时间≥80 h的学生密切接触者发生LTBI的风险高于累计接触时间＜40 h者(OR=3.33，95%CI：1.12~9.86)。结论LTBI与接触程度和接触时间显著相关，其中同寝室室友以及同楼层寝室且同班级的密切接触学生是LTBI的高风险人群，应当在现有学校结核病防控的基础上增加对密切接触者的早期LTBI筛查，并尽早向LTBI者提供预防性治疗等。

Adherence to treatment for latent tuberculosis infection:systematic review of studies in the US and Canada

ObjectiveTo investigate the situation and the major influencing factors of latent tuberculosis infection(LTBI) in student close contacts with pulmonary TB patients among universities and technical secondary schools in Pudong New Area in Shanghai.MethodsA total of 479 student close contacts with pulmonary TB patients among universities and technical secondary schools were involved in this study in Pudong New Area in Shanghai from Jan 1, 2017 to Dec 31, 2017.The Quanti FERON-TB Gold test(QFT) was conducted to identify the LTBI and questionnaire was applied to collect the information of gender, age, household registration and duration of exposure and so on.Single and multivariate analysis were conducted to identify the major influencing factors of LTBI.ResultsThe mean age of student close contacts was (20.8±1.4) years.The QFT revealed that 47 student close contacts were latently infected with TB.According to the degree of close contact, the QFT positive rate of roommates and contacts on the same floor dormitory meanwhile in the same class was significantly higher than that of the general contacts.In multivariate analysis, the risk of LTBI was statistically associated with the gender of male(OR=3.72, 95%CI:1.06~12.99) and cumulative duration of exposure over 80 hours (OR=3.33, 95%CI:1.12~9.86).ConclusionRoommates and contacts on the same floor dormitory and in the same class are at a high risk on LTBI.Gender of male and cumulative duration of exposure over 80 hours might increase the risk of LTBI.Early screening of LTBI among student close contacts with TB patients should be enhanced on the basis of existing school TB control and intervening measures should be provided to infected persons as early as possible.