2023年山东省青岛市西部某省生源高中学生潜伏结核感染状况分析

代晓琦; 李烁; 宁昌鹏; 宋颂; 徐红红; 孙海燕; 陈梦; 李学奎; 张梦涵; 张华强; 王忠东

doi:10.3784/jbjc.202312040638

2023年山东省青岛市西部某省生源高中学生潜伏结核感染状况分析

Analysis on prevalence of latent tuberculosis in senior high school students from a western province in Qingdao, Shandong, 2023

摘要

摘要:
目的分析山东省青岛市来自西部某省的高中学生的结核潜伏感染情况，为开展青岛市学校结核潜伏感染筛查工作提供数据支持和工作思路。
方法通过问卷调查的方式收集西部某省生源高中学生的基本情况、结核病接触史等信息，并由结核病定点医疗机构开展结核菌素皮肤试验（TST）、γ-干扰素释放试验（IGRA）及胸部X线检查；采用Kappa一致性检验分析两种检测方法结果的一致性，采用χ²检验进行组间比较和单因素分析，多因素logistic回归模型分析潜伏感染影响因素。
结果共纳入研究对象621人，均进行TST及IGRA检测，其中IGRA阳性121例（19.48%）、TST强阳性61例（9.82%），阳性/强阳性率差异有统计学意义（配对χ² =47.368，P<0.001），两种检测方法为一致性中等（Kappa=0.520）。性别、民族、年级、户籍类型、身体质量指数及结核病接触史人群阳性率差异有统计学意义（P<0.05），一致性为中等或较好。多因素logistic回归模型分析发现，高三年级［比值比（OR）=2.23，95%置信区间（95%CI）：1.37～3.60］、有结核病接触史（OR=2.12，95%CI：1.12～4.20）学生的潜伏感染风险更高。 1名潜伏感染学生在筛查后3个月末追踪随访时诊断结核病，其IGRA阳性和TST强阳性、有结核病接触史、无肺结核可疑症状。
结论在青岛市高感染风险学生群体中使用IGRA检测更具有实际意义；应加强升学、假期返校后的重点人群筛查工作，为青岛市学校结核病疫情防控工作提供了新的思路。

Abstract:
Objective To investigate the prevalence of latent tuberculosis (TB) in senior high school students from a western province in Qingdao, Shandong province, and provide data support for the screening of latent TB in students in Qingdao.
Methods The information of 621 senior high school students from a western province and the information about their TB exposure histories were collected by using questionnaire. Tuberculin skin test (TST), interferon-Gamma release assay (IGRA) and chest X-ray examination were performed for them by designated medical institutions. Kappa consistency test was used to analyze the consistency of the results of the two methods, and χ² test was used for comparison between groups and univariate analysis. Multivariate Logistic regression model was used to identify the influencing factors of latent tuberculosis.
Results A total of 621 subjects were included in this study, in whom 121 were positive in IGRA (19.48%) and 61 were strong positive in TST (9.82%), the difference in positive/strong positive rate was significant (χ²=47.368, P<0.001). The consistency of the two detection methods was medium (Kappa=0.5197). The differences in the positive rate among different gender, ethnic, grade, household registration, body mass index and TB exposure groups were significant (P<0.05), and the consistency was medium or good. The results of multivariate Logistic regression analysis showed that the student in grade 3 odds ratio (OR)=2.23, 95% confidence interval (95%CI): 1.37–3.60 and the student with TB exposure history (OR=2.12, 95%CI: 1.12–4.20) had higher risk for latent TB. One student with latent infection was diagnosed with TB at follow up three months later, his IGRA result was positive and TST result was strong positive, and he had TB exposure history but had no suspected TB symptoms.
Conclusion This study suggested that IGRA detection is more effective in the screening of population with high risk for TB. It is necessary to strengthen the screening of TB in freshmen and students returning after vacation to provide evidence for the prevention and control of TB in schools.

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