2008-2013年浙江省诸暨市涂阳肺结核学生患者的密切接触者结核感染情况调查

目的调查分析涂阳肺结核学生患者的密切接触者感染情况及影响因素,为进一步防止结核病在学生中的扩散和蔓延提供依据。方法通过在诸暨市2008-2013年发生的涂阳肺结核学生患者的密切接触者的结核菌纯蛋白衍生物(purified protein derivative of tuberculin,PPD)筛查,以非密切接触者为感染情况作为本底对照;分层分析密切接触者感染情况的影响因素。结果调查28例涂阳肺结核学生患者密切接触者共1721人,强阳性400人,强阳性率为23.24%。同时调查非密切接触者1409人,强阳性39人,强阳性率为2.77%,密切接触者的强阳性率远高于非密切接触者(χ2=269.33,P=0.000)。影响密切接触者PPD试验结果的因素有发病季节、痰菌含量及就诊延误,通过分层分析,冬春季发病患者的密切接触者阳性率较高,特别是患者痰菌含量较高时(χ2=10.12,P=0.00;χ2=5.35,P=0.02);痰菌含量高的患者其密切接触者阳性率高,在春季发病患者的密切接触者中尤其明显(χ2=14.42,P=0.00;χ2=11.25,P=0.00);传染源诊断延误时间对密切接触者强阳性率的影响表现为患者痰菌含量较低时,冬春季发病患者的不同诊断延误患者的密切接触者强阳性率不同(χ2=4.60,P=0.03);而患者痰菌含量较高时,不同季节发病患者的密切接触者强阳性率差异无统计学意义。结论在影响涂阳肺结核学生患者PPD试验强阳性率的主要因素中,传染源的发病季节、痰菌含量和诊断延误各自起着一定的作用,其中以发病季节和痰菌含量的作用更为显著。

Infection status of Mycobacterium tuberculosis among close contacts of students diagnosed with smear-positive pulmonary tuberculosis in Zhuji,Zhejiang,2008- 2013

Objective To understand the infection status of Mycobacterium tuberculosis among the close contacts of the students diagnosed with smear-positive pulmonary tuberculosis（ TB） in Zhuji,Zhejiang province and provide the evidence for pulmonary TB control and prevention in schools. Methods PPD test was conducted among the close contacts of the students diagnosed with smear-positive pulmonary TB in Zhuji during 2008- 2013. Stratified analysis was conducted to identify the related factors to strong positive rate of PPD test among close contacts of the students diagnosed with smear-positive pulmonary TB. Results Totally 1721 close contacts of 28 smear-positive students were surveyed,the strong positive rate of PPD test was 23. 24%（400 /1721）. Meanwhile totally 1409 non-close contacts of smearpositive students were surveyed too,the strong positive rate of PPD test was 2. 77%（39 /1409）. The difference between the two groups was statistical significant（χ2= 269. 33,P = 0. 000）. The related factors to strong positive rate of the close contacts included the onset season,sputum bacteria content and diagnosis delay of the TB patients. The positive rate of PPD test among the close contacts was high when the onset of TB patients were in winter and spring,especially when the sputum bacteria content of the TB patient was high（ χ2= 10. 12,P = 0. 00;χ2= 5. 35,P = 0. 02）. The positive rate of PPD test among the close contacts was high when the sputum bacteria content of the TB patient was high,especially when the onset of the TB patient was in spring（χ2= 14. 42,P = 0. 00;χ2= 11. 25,P = 0. 00）. Diagnosis delay of the TB patients had influence on strong positive rate of the close contacts when the sputum bacteria content of the TB patient was low. The influences of diagnosis delay of the TB patients in winter and spring on the strong positive rate of close contacts were different（ χ2= 4. 60,P = 0. 03）. There was no statistical significance in strong positive rate among the close contacts of TB patients w