摘要
目的 分析不同人群结核菌素皮肤试验（TST）强阳性者异烟肼预防用药后随访5年的结核病发病情况.方法 按数字表法随机选取2003年1至12月三类不同人群共12598人,其中高校学生8896人,进城农民工2496人,有活动性肺结核密切接触者1206人.将TST强阳性且肺部无异常的人群按1∶1的比例分为异烟肼预防用药组（服用10个月）和对照组（不接受任何预防治疗）,两组均密切跟踪随访5年,分别记录第2年、第3～5年各组的结核病发病情况.采用χ^2检验比较两组以及三类不同人群结核病发病率的差异.结果 12598名不同人群中,TST强阳性共897人（7.12％）,其中大学生、农民工和密切接触者分别为316,388和193人,强阳性率分别为3.55％（316/8896）,15.54％ （388/2496）和16.00％ （193/1206）,农民工和密切接触者的TST强阳性率明显高于大学生（χ^2=483.51和344.11,P＜0.01）.TST强阳性人群中诊断为结核病37例.其中,大学生11例,结核病检出率为0.12％（11/8 896）;农民工12例,结核病检出率为0.48％（12/2496）;密切接触者14例,结核病检出率为1.16％（14/1 206）;农民工和密切接触者的结核病检出率明显高于大学生（χ^2=12.34和42.18,P＜0.01）.随访2年,预防用药组429例中9例因药物不良反应停药,其余420例中9例发生结核病,发病率为2.14％（9/420）;三类人群结核病的发病率分别为1.34％（2/149）,1.60％ （3/188）和4.82％（4/83）,三类人群比较差异无统计学意义（χ^2=2.92,P＞0.05）.对照组31例发生结核病,发病率为7.23％（31/429）,与异烟肼预防用药组比较差异有统计学意义（χ^2=12.69,P＜0.01）.随访第3～5年,异烟肼预防用药组失访23例,其余388例中发生结核病8例,发病率为2.06％（8/388）,三类人群结核病的发病率分别为1.41％ （2/142）,2.35％（4/170）和2.63％（2/76）,不同人群差异无统计学意义（χ^2 =3.11,P ＞0.05）;对照组有17例发病,发病率为4.27％ （17/398）,与异烟肼预防用药组比较差异无统计学意义（χ^2=2.47,P＞0.05）.结论 进城农民工和活动性肺结核密切接触者是结核病高危人群,TST强阳性者异烟肼单药预防10个月,2年内预防效果明显.
Objective To examine the 5-year incidence of tuberculosis in different populations with strongly positive tuberculin skin test （TST） receiving preventive administration of isoniazide.Methods A total of 12598 subjects including 8896 college students,2496 migrant workers and 1206 close contacts with active pulmonary were selected from January to December 2003.Subjects with strongly positive TST but without abnormal lung findings were divided into isoniazide group （given isoniazide for 10 months） and control group （not given any drugs）.The incidence of tuberculosis in year 2-5 were observed and compared usingx2 test.Results Among 12 598 subjects,897（7.12%） had strongly positive TST,including 316 college students,388 migrant workers and 193 close contacts,and the TST strongly positive rates were 3.55% （316/8896）,15.54% （388/2496） and 16.00% （193/1206）,respectively.Migrant workers and close contacts had higher TST positive rates than college students （χ^2 =483.51 and 344.11,P 〈 0.01）.Among 897 TST-positive individuals,37 were diagnosed as tuberculosis,including 11 college students,12 migrant workers and 14 close contacts,and the tuberculosis rates in three populations were 0.12% （11/8896）,0.48% （12/2496） and 1.16% （14/1 206）,respectively.Migrant workers and close contacts also had higher tuberculosis rates than college students （χ^2 =12.34 and 42.18,P 〈0.01）.In the second follow-up year,9 out of 429 subjects in isoniazide group quit the study due to adverse reactions,and in the rest 420 subjects,9 （2.14%） were diagnosed as tuberculosis.The incidence of tuberculosis in three populations were 1.34% （2/149）,1.60% （3/188） and 4.82% （4/83）,and no significant difference was found （χ^2 =2.92,P 〉 0.05）.While in the control group,31 out of 429 （7.23%） individuals were diagnosed as tuberculosis,and the incidence was higher than that in isoniazide group （χ^2 =12.69,P 〈 0.01）.During the next three follow-up years,23 individuals in isoniazide group drop out of the study,and in the rest 388 subjects,8 （2.06%） were diagnosed as tuberculosis.The incidence of tuberculosis in three populations were 1.41% （2/142）,2.35% （4/170） and 2.63% （2/76）,and no significant difference was found （χ^2 =3.11,P 〉 0.05）.While in the control group,17 out of 398 （4.27%） subjects were diagnosed as tuberculosis,and the incidence was not of significant difference compared with that in isoniazide group （χ^2 =2.47,P 〉 0.05）.Conclusion Migrant workers and close contacts are high risk populations of tuberculosis,and preventive administration of isoniazid for 10 months may reduce the incidence of tuberculosis in the following 2 years.
出处
《中华临床感染病杂志》
CAS
2014年第5期420-423,共4页
Chinese Journal of Clinical Infectious Diseases
