监狱羁押人群中两种结核分枝杆菌潜伏感染检测结果不一致原因及预防性治疗效果分析OACSTPCD
Factors for discrepancy between two methods in testing latent tuberculosis infection and effect of preventive anti-tuberculosis treatment among prisoners
目的:分析羁押人群中γ-干扰素释放试验(IGRA)和结核菌素皮肤试验(TST)结果差异的相关因素,以及预防性治疗对肺结核发病的效果.方法:采用社区随机对照试验,选取某市5所监狱,每所监狱以监区为单位分为对照组和干预组.结核分枝杆菌检测于2016年7-8月进行,对照组981例,采用常规结核病防治措施;干预组981例,在常规措施基础上采用IGRA和TST检测结核分枝杆菌潜伏感染,并对IGRA阳性者实施自愿的预防性治疗.收集所有研究对象的流行病学资料,每年定期开展X线胸片检查.分析IGRA和TST结果的一致性及相关因素;对比干预组和对照组3年内肺结核发病情况.结果:IGRA和TST两种方法判读结果一致率为77.93％(745/956).BCG卡痕(OR=1.477,95％CI:1.068～2.043)是两种检测方法结果差异的相关因素.共计157例IGRA阳性者接受并均完成了预防性治疗,随访3年中发病率为0.00％(0/157),其他未预防性服药者发病率为2.05％(7/342),差异无统计学意义(x2=3.259,P=0.071);IGRA阴性者中,发病率为0.00％(0/460),低于IGRA阳性未服药者的发病率[2.05％(7/342)],差异有统计学意义(x2=9.498,P=0.002);最终干预组肺结核发病率为0.71％(7/981),对照组发病率为1.22％(12/981),差异无统计学意义(x2=1.329,P=0.249).结论:在羁押人群中,BCG接种史是IGRA和TST差异的主要影响因素;应用IGRA进行结核分枝杆菌潜伏感染检测并对阳性者开展预防性治疗可有效减少狱内肺结核的发病.
Objective:To understand factors associated with discrepancy between interferon-y release assay(IGRA)and Tuberculin Mantoux test(TST),and effect of preventive treatment in preventing tuberculosis incidence among prisoners.Methods:A community-based randomized controlled trail was conducted by selecting five prisons in a city,and allocating separate wards into intervention group and control group in each prison.The control group enrolled 981 participants,who underwent routine Tuberculosis control strategy;the intervention group enrolled 981 participants,who were tested for latent tuberculosis infection(LTBI)using IGRA and TST on the basis of routine tuberculosis control strategy,and the IGRA positive ones were provided preventive treatment under informed consent.All participants were interviewed for epidemiological information,and underwent regular chest X-ray examination every year.We analyzed factors associated with the discrepancy between results of IGRA and TST,and compared tuberculosis incidence in the following three years between the two groups.Results:The consistency between IGRA and TST was 77.93％(745/956).BCG scar(OR=1.477,95％CI:1.068-2.043)was associated with the discrepancy between the two testing methods.In the three years'follow-up,tuberculosis incidence was 0％(0/157)among 157 IGRA positive participants who accepted and all completed preventive anti-tuberculosis treatment,and 2.05％(7/342)among those who did not take preventive treatment(x2=3.259,P=0.071);the tuberculosis incidence was 0％(0/460)among IGRA negative participants,significantly lower than 2.05％(7/342)among the IGRA positive ones who didn't take preventive treatment(x2=9.498,P=0.002);overall,tuberculosis incidence was 0.71％(7/981)in the intervention group and 1.22％(12/981)in control group(x2=1.329,P=0.249).Conclusion:Among prisoners,BCG vaccination is the key factor associated with the discrepancy between IGRA and TST;LTBI testing using IGRA followed by preventive treatment to the positive ones is an effective way to reduce tuberculosis incidence in prisons.
张国钦;魏文亮;张志;张玉华;钟达;张帆
天津市结核病控制中心研究室,天津 300041天津市结核病控制中心团检科,天津 300041天津市结核病控制中心门诊部,天津 300041天津市结核病控制中心办公室,天津 300041
临床医学
分枝杆菌,结核结核菌素试验监狱诊断,鉴别
Mycobacterium tuberculosisTuberculin testPrisonDiagnosis,differential
《中国防痨杂志》 2024 (001)
45-53 / 9
Tianjin High-level Talent Selection and Training Project in Health Profession(TJSQNYXXR-D2-117);Tianjin Health Area Key Reach Project(16KG171)天津市卫生健康行业高层次人才选拔培养工程(TJSQNYXXR-D2-117);天津市卫生行业重点攻关项目(16KG171)
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