摘要
目的评价PPD与γ干扰素释放试验(interferon-gamma release assay,IGRA)在结核病集团感染评价中的价值,探索控制集团感染的最佳策略。方法在一起结核病暴发事件中,将513名接触者按照暴露程度分为6级,由高到低(1级至6级)接触者数量依次为:47、81、110、90、122和63名,对接触者进行PPD与IGRA联合检测。采用多分类logistic回归分析统计不同Mtb感染判断标准(PPD≥10mm、PPD≥15mm、PPD阳转及IGRA阳性)与暴露等级的相关性;在删除40例行预防性治疗的接触者后,采用二分类logistic回归分析确定患者续发(共19例续发患者)的高风险因子;比较不同暴露等级、不同感染判断标准的发病率,同时评价各种感染控制方案的优劣。结果PPD≥10mm、PPD≥15mm、PPD阳转和IGRA阳性结果与暴露等级(6级)均密切相关,P<0.05,OR值分别为1.78(95%CI:1.14～2.78)、1.01(95%CI:0.69～1.47)和2.84(95%CI:2.01～4.01);IGRA阳性(P=0.03,OR=3.63)与暴露程度(P=0.00,OR=2.77)是患者续发的高风险因子。高密切接触等级(L1～L2)、中密切接触等级(L3～L4)和低密切接触等级(L5～L6)的续发率分别为13.3%(13/98)、3.2%(6/190)和0.0%(0/185)。高密切接触等级的续发病率显著高于低暴露等级,差异具有统计学意义,χ2=29.85,P<0.05。IGRA阳性组发病率为8.3%(15/180),显著高于IGRA阴性组的1.4%(4/293),具有统计学意义,χ2=14.04,P<0.05;对于高暴露等级(1级)无论PPD及IGRA结果如何,全部进行化学预防,对其他等级均依据IGRA阳性作为预防性治疗对象,其发病预测的敏感度为94.7%(18/19),特异度为46.1%(124/269),阳性似然比为1.8,阴性似然比为0.1,符合最佳效益原则。结论IGRA在结核感染诊断和发病预测等价值方面优于PPD;暴露程度和IGRA阳性是制定集团感染控制策略的重要参考条件。
Objective To evaluate the effect of TST and IGRA in the assessment of tuberculosis（TB） group infection,and to explore the optimal strategy on TB group infection.Methods 513 contacts in an outbreak of TB were divided into 6 groups according to the degree of exposure,the number of contacts in each group with decreasing degree of exposure（from 1 to 6） were 47,81,110,90,122 and 63 respectively.All contacts were tested by TST and IGRA jointly.Multiple logistic regression statistics was applied to analyse the correlation between Mtb infection criteria（PPD≥10 mm、PPD≥15 mm、PPD conversion and IGRA-positive） and degree of exposure.After exclusion of 40 contacts who were taking preventive treatment,binary logistic regression was used to determine high risk factors for secondary cases（a total of 19 secondary cases）.Incidence rates of different exposure degrees and infection criteria were compared,as well as the evaluation of the pros and cons of various infection control plan.Results PPD≥10 mm,PPD≥15 mm,PPD conversion and IGRA-positive are closely related to the exposure level（6 levels）,P0.05,OR values were 1.78（95% CI： 1.14 to 2.78）,1.01（95% CI： 0.69 to 1.47） and 2.84（95% CI： 2.01 to 4.01）.IGRA-positive（P=0.03,OR=3.63） and the degree of exposure（P=0.00,OR=2.77） are high risk factors for secondary cases.Secondary attack rates of high exposure（L1-L2）,medium exposure（L3-L4） and low exposure（L5-L6） were 13.3%（13/98）,3.2%（6/190） and 0.0%（0/185） respectively.The secondary attack rate of a high close contact level was higher than the low exposure levels,there was statistical significance,χ2=29.85,P0.05.The incidence rate of IGRA positive group（8.3%,15/180） was significantly higher than that of the IGRA negative group（1.4%,4/293）,which was statistically significant,χ2=14.04,P0.05.For high exposure level（1st level）,chemoprevention were provided for all contacts regardless of TST and IGRA results,for other groups contacts with positive IGRA were the objects of preventive treatment,the sensitivity of the prediction of TB was 94.7%（18/19） and specificity was 46.1%（124/269）,positive likelihood ratio was 1.8 and negative likelihood ratio was 0.1,which was in line with the principle of the best benefits.Conclusion IGRA in the diagnosis of tuberculosis infection and incidence prediction is better than TST.Degree of exposure and IGRA positive are important references for the development of TB group infection control strategy.
出处
《中国防痨杂志》
CAS
2012年第10期637-641,共5页
Chinese Journal of Antituberculosis
基金
大连市科技局项目(2009E12SF145)
关键词
结核
肺/流行病学
结核
肺/预防和控制
结核菌素试验
Γ干扰素释放试验
传染病控制
Tuberculosis
pulmonary/epidemiology
Tuberculosis
pulomary/prevention and control
Tuberculin test
Interferon-gamma release tests
Communicable disease control
