摘要
目的:了解广州市中学和大学新生结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)的情况,为广州市学校结核病防控工作和策略制定提供参考依据。方法:选取广州市中学和大学共17所学校作为试点单位,对试点单位2018—2021年共计17632名入学新生(包括初高中、专科、高等院校的一年级学生)根据知情同意的原则进行结核菌素皮肤试验(tuberculin skin test,TST),对15岁以上学生同时加做胸部X线摄片检查;TST中度及以上阳性者(硬结平均直径≥10 mm)再进一步加做γ-干扰素释放试验(interferon gamma release assay,IGRA);TST和IGRA均为阳性或胸部X线摄片发现肺部异常阴影者,再进行痰涂片、痰培养等结核病辅助诊断检查。使用描述性流行病学方法对筛查结果进行分析。结果:实际筛查学生17204名,筛查率为97.57%(17204/17632)。TST阳性者共4449名,阳性率为25.87%(4449/17199),一般阳性率为15.98%(2748/17199),中度阳性率为7.65%(1315/17199),强阳性率为2.24%(386/17199)。高中组TST阳性率(33.81%,1408/4165)最高,初中组TST阳性率(30.58%,329/1076)次之,大学组TST阳性率(22.68%,2712/11958)最低,组间差异有统计学意义(χ^(2)=353.897,P<0.001)。男生TST阳性率为26.68%(2789/10452),明显高于女生的24.60%(1660/6747),差异有统计学意义(χ^(2)=35.855,P<0.001)。1701名TST中度及以上阳性者(即硬结平均直径≥10 mm)加做IGRA检测,IGRA阳性者244例,TST中度及以上阳性+IGRA阳性率为1.42%(244/17199)。筛查发现7例学生胸片异常,其中1例TST阴性(IGRA未做),6例TST阳性(其中5例IGRA阳性,1例IGRA阴性)。最终确诊肺结核5例,肺结核检出率为29.06/10万(5/17204)。结论:广州市学生结核感染情况不容忽视,应加强初中、高中新生入学结核病体检工作,及时发现学生结核病患者和LTBI者。TST和IGRA联合筛查有助于提高筛查的准确性和防控效率,符合成本效益原则。
Objective:To investigate the situation of latent tuberculosis infection(LTBI)among middle school and university freshmen in Guangzhou,and to provides a reference for the prevention and control of tuberculosis and the formulation of strategies in schools and universities in Guangzhou.Methods:A total of 17632 incoming freshmen(including first-year students of junior high schools,senior high schools,junior colleges and universities)from 17 middle schools and universities in Guangzhou were selected from 2018 to 2021.All of them were treated with tuberculin skin test(TST)according to the principle of informed consent,and chest X-ray examination was added to students over 15 years at the same time.Students with TST results of moderately positive and above(average diameter of induration≥10 mm)were further added with interferon-γrelease assay(IGRA);when both TST and IGRA results were positive or chest X-ray showed abnormal shadows of the lungs,others auxiliary diagnostic tests such as sputum smear or sputum culture would be used.Screening results were analyzed using descriptive epidemiological methods.Results:A total of 17204 students were actually screened,with a screening rate of 97.57%(17204/17632).There were 4449 TST positive students,with a positive rate of 25.87%(4449/17199),a general positive rate of 15.98%(2748/17199),a moderate positive rate of 7.65%(1315/17199),and a strong positive rate of 2.24%(386/17199).The TST positive rate was the highest in the senior high school group(33.81%,1408/4165),followed by that in junior high school group(30.58%,329/1076),the TST positive rate was the lowest in the university group(22.68%,2712/11958),and the difference between the groups was statistically significant(χ^(2)=353.897,P<0.001).The positive rate of TST in boys was 26.68%(2789/10452),which was significantly higher than that of girls(24.60%,1660/6747)(χ^(2)=35.855,P<0.001).The 1701 students with moderately positive and above in TST(i.e.,the average diameter of induration≥10 mm)were tested for IGRA,244 were positive for IGRA,and the positive rate of IGRA with TST moderate positive and above was 1.42%(244/17199).Of the 7 students found abnormal chest radiographs by screening,1 was negative(IGRA not done)in TST and 6 were positive(5 IGRA positive and 1 IGRA negative)in TST.In the end,5 cases of pulmonary tuberculosis were confirmed,and the detection rate of pulmonary tuberculosis was 29.06/100000(5/17204).Conclusion:The tuberculosis infection situation of students in Guangzhou cannot be ignored,the physical examination of tuberculosis for junior high school and high school should be strengthened,and tuberculosis patients and LTBI students should be detected in time.The combined screening of TST and IGRA helps to improve the accuracy and efficiency of screening and is cost-effective.
作者
钟敏儿
杜雨华
张丹妮
林莹
吴桂锋
王挺
刘健雄
Zhong Miner;Du Yuhua;Zhang Danni;Lin Ying;Wu Guifeng;Wang Ting;Liu Jianxiong(Department of Tuberculosis Control,Guangzhou Chest Hospital,Guangzhou 510095,China;Academy of Public Health,Guangzhou Medical University,Guangzhou 511436,China)
出处
《结核与肺部疾病杂志》
2023年第2期115-119,共5页
Journal of Tuberculosis and Lung Disease
基金
广州市卫生健康科技重大项目(2020A031003)
“十三五”国家科技重大专项(2017ZX10201302)。
关键词
分枝杆菌
结核
分枝杆菌感染
结核菌素试验
免疫学试验
学生
Mycobacterium tuberculosis
Mycobacterium infections
Tuberculin test
Immunologic tests
Students
