Article(id=1240395011590779797, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202501084, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1736092800000, receivedDateStr=2025-01-06, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773662816188, onlineDateStr=2026-03-16, pubDate=1753372800000, pubDateStr=2025-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773662816188, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773662816188, creator=13701087609, updateTime=1773662816188, updator=13701087609, issue=Issue{id=1240395006914130733, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773662815073, creator=13701087609, updateTime=1773662858015, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240395187109810535, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240395187109810536, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2651, endPage=2657, ext={EN=ArticleExt(id=1240395011871798191, articleId=1240395011590779797, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of latent tuberculosis infection screening and preventive treatment in high-risk populations, Henan, 2023, columnId=1228016572065837304, journalTitle=Modern Preventive Medicine, columnName=Experimental Technology and Applications, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the status and influencing factors of latent tuberculosis infection (LTBI) screened by the recombinant mycobacterium tuberculosis fusion protein (EC) test in Henan Province, and to understand the willingness of LTBI individuals to accept preventive treatment, with the aim of providing data support for improving tuberculosis (TB) control strategies in Henan Province.

Methods

In 2023, the EC test was used to screen for LTBI and conduct preventive treatment among high-risk groups for TB (including school teachers and students, healthcare workers, close contacts, and HIV/AIDS patients) in counties participating in the Henan Province TB Care Action public welfare project. Excel 2019 and SPSS 21.0 software were used to analyze the data. Binary logistic regression model was used to analyze the influencing factors of latent tuberculosis infection.

Results

A total of 4 818 subjects were included in the study, excluding those who had not been screened for latent infection due to other reasons such as screening contraindications. The positive rate of EC test was 4.42% (213/4 818). Four patients with active pulmonary tuberculosis were found, and the detection rate was 83.02/100 000 (4/4 818). 204 people met the criteria for preventive treatment, 86 people received preventive treatment, the acceptance rate was 42.16% (86/204), the completion rate was 89.53%(77/86), among which the main reason for refusal was that they thought they would not get sick (77.97% (92/118)). Binary logistic regression model analysis results showed that with students as the control group, medical staff (OR=9.762,95% CI:3.441-27.697), close contact staff (OR=6.853, 95% CI:3.074-15.277), HIV/AIDS (OR=4.387, 95% CI:1.582-12.165) were risk factors for TB infection.

Conclusion

Healthcare workers, close contacts, and HIV/AIDS patients are the focus of LTBI screening. Additionally, enhancing the awareness of preventive treatment among individuals with latent infections is crucial to improving the acceptance rate of preventive treatment and advancing TB control efforts in Henan Province.

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目的

分析河南省基于重组结核杆菌融合蛋白(EC)试验筛查出的结核潜伏感染情况及影响因素,了解结核潜伏感染人群对预防性治疗的接受意愿,以期为完善河南省结核病防控策略提供数据支撑。

方法

采用EC试验方法于2023年在河南省结核病关爱行动公益项目县针对结核病重点高危人群(包括学校师生、医务人员、密切接触者及HIV/AIDS等)开展结核潜伏感染者筛查和预防性治疗,利用Excel 2019、SPSS 21.0软件整理分析数据。采用率(%)描述分布特征,采用χ2检验和二分类logistic回归模型进行影响因素分析。

结果

纳入4 818例研究对象,EC试验阳性率4.42%(213/4 818);发现活动性肺结核患者4例,检出率为83.02/10万(4/4 818);符合预防性治疗标准人数204人,接受预防性治疗86人,接受率42.16%(86/204),完成率89.53%(77/86),拒绝预防性治疗的主要原因在于认为自己不会发病77.97%(92/118)。二分类logistic回归模型分析结果显示,以学生作为对照,医务人员(OR=9.762,95% CI:3.441~27.697)、密接人员(OR=6.853,95% CI:3.074~15.277)、HIV/AIDS(OR=4.387,95% CI:1.582~12.165)是结核感染的危险因素。

结论

医务人员、密切接触者及HIV/AIDS患者是结核潜伏感染筛查的重点,同时针对潜伏感染者加强其对预防性治疗的认知,以提高预防性治疗接受率,推动河南省结核病防控工作。

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孙建伟,E-mail:
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赵阿会(1996—),女,硕士,技师,研究方向:结核病防治工作

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赵阿会(1996—),女,硕士,技师,研究方向:结核病防治工作

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赵阿会(1996—),女,硕士,技师,研究方向:结核病防治工作

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(In Chinese), articleTitle=Analysis of the status quo and preventive medication of latent tuberculosis infection among students in Zibo city from 2016 to 2020, refAbstract=null)], funds=[Fund(id=1240413545742005049, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011590779797, awardId=LHGJ20240636, language=CN, fundingSource=河南省医学科技攻关计划项目资助(LHGJ20240636), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240413537542140353, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011590779797, xref=1., ext=[AuthorCompanyExt(id=1240413537546334659, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011590779797, companyId=1240413537542140353, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Institute of Tuberculosis Control and Prevention, Henan Center for Disease Control and Prevention, Zhengzhou, Henan 450016, China), AuthorCompanyExt(id=1240413537554723268, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011590779797, companyId=1240413537542140353, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.河南省疾病预防控制中心,河南 郑州 450016)]), AuthorCompany(id=1240413537655386577, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011590779797, xref=2., ext=[AuthorCompanyExt(id=1240413537663775188, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011590779797, companyId=1240413537655386577, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.国家卫生健康委妇幼健康中心)])], figs=[ArticleFig(id=1240413544332718826, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011590779797, language=EN, label=Table 1, caption=

Results of EC skin test among 4 818 subjects in Henan Province

, figureFileSmall=null, figureFileBig=null, tableContent=
特征合计(nEC阳性EC阴性χ2P
例数(n百分比(95% CI例数(n百分比(95% CI
性别4.0290.045
2 5851003.868(3.125~4.612)2 48596.132(95.388~96.875)
2 2331135.061(4.151~5.970)2 12094.939(94.029~95.849)
年龄(岁)130.871<0.001
<151562616.667(10.753~22.579)13083.333(77.420~89.247)
15~343 8381082.814(2.291~3.337)3 73097.186(96.663~97.709)
35~54500489.600(7.009~12.191)45290.400(87.809~92.991)
55~65324319.568(6.348~12.788)29390.432(87.212~93.652)
学历132.663<0.001
小学及以下1182016.949(10.080~23.818)9883.051(76.182~89.920)
初中669629.268(7.065~11.470)60790.372(88.530~92.935)
高中3 566902.524(2.001~3.039)3 47697.476(96.961~97.999)
大专及以上465418.817(6.230~11.404)42491.183(88.596~93.770)
人群分类210.609<0.001
学生3 487802.294(1.797~2.791)3 40797.706(97.209~98.203)
教职员工240114.583(1.919~7.248)22995.417(92.752~98.081)
医务人员1182016.949(10.080~23.818)9883.051(76.182~89.920)
密接人员5497814.208(11.278~17.137)47185.792(82.863~88.722)
HIV/AIDS10099.000(3.293~14.707)9191.000(85.293~96.707)
其他a324154.630(2.330~6.930)30995.370(93.070~97.670)
合计4 8182134.421(3.840~5.002)4 60595.579(94.998~96.160)
), ArticleFig(id=1240413544483713779, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011590779797, language=CN, label=表1, caption=

河南省4 818名研究对象的EC筛查结果

, figureFileSmall=null, figureFileBig=null, tableContent=
特征合计(nEC阳性EC阴性χ2P
例数(n百分比(95% CI例数(n百分比(95% CI
性别4.0290.045
2 5851003.868(3.125~4.612)2 48596.132(95.388~96.875)
2 2331135.061(4.151~5.970)2 12094.939(94.029~95.849)
年龄(岁)130.871<0.001
<151562616.667(10.753~22.579)13083.333(77.420~89.247)
15~343 8381082.814(2.291~3.337)3 73097.186(96.663~97.709)
35~54500489.600(7.009~12.191)45290.400(87.809~92.991)
55~65324319.568(6.348~12.788)29390.432(87.212~93.652)
学历132.663<0.001
小学及以下1182016.949(10.080~23.818)9883.051(76.182~89.920)
初中669629.268(7.065~11.470)60790.372(88.530~92.935)
高中3 566902.524(2.001~3.039)3 47697.476(96.961~97.999)
大专及以上465418.817(6.230~11.404)42491.183(88.596~93.770)
人群分类210.609<0.001
学生3 487802.294(1.797~2.791)3 40797.706(97.209~98.203)
教职员工240114.583(1.919~7.248)22995.417(92.752~98.081)
医务人员1182016.949(10.080~23.818)9883.051(76.182~89.920)
密接人员5497814.208(11.278~17.137)47185.792(82.863~88.722)
HIV/AIDS10099.000(3.293~14.707)9191.000(85.293~96.707)
其他a324154.630(2.330~6.930)30995.370(93.070~97.670)
合计4 8182134.421(3.840~5.002)4 60595.579(94.998~96.160)
), ArticleFig(id=1240413544630514425, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011590779797, language=EN, label=Table 2, caption=

Variable assignment table

, figureFileSmall=null, figureFileBig=null, tableContent=
变量因素编码赋值说明
应变量阳性Y是=1;否=0
自变量性别X1男=1;女=2
年龄(岁)X2<15=1;15~34=2;35~54=3;55~65=4
学历X3小学及以下=1;初中=2;高中=3;大学及以上=4
人群分类X4学生=1;教职员工=2;医务人员=3;密接人员=4;HIV/AIDS=5;其他=6
), ArticleFig(id=1240413544794092288, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011590779797, language=CN, label=表2, caption=

变量赋值表

, figureFileSmall=null, figureFileBig=null, tableContent=
变量因素编码赋值说明
应变量阳性Y是=1;否=0
自变量性别X1男=1;女=2
年龄(岁)X2<15=1;15~34=2;35~54=3;55~65=4
学历X3小学及以下=1;初中=2;高中=3;大学及以上=4
人群分类X4学生=1;教职员工=2;医务人员=3;密接人员=4;HIV/AIDS=5;其他=6
), ArticleFig(id=1240413545012196109, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011590779797, language=EN, label=Table 3, caption=

Binary logistic regression model analysis of EC skin test results among 4 818 subjects in Henan Province

, figureFileSmall=null, figureFileBig=null, tableContent=
变量合计(n)阴性阳性单因素分析
Wald χ2OR值(95% CIP
性别
2 5852 4851001.000
2 2332 1201134.0051.325(1.006~1.744)0.045
年龄(岁)
<15156130261.000
15~343 8383 73010867.0770.145(0.091~0.230)<0.001
35~54500452485.7910.531(0.317~0.889)0.016
55~65324293314.9550.529(0.302~0.927)0.026
学历
小学及以下11898201.000
初中669607626.1440.500(0.290~0.865)0.013
高中3 5663 4769059.530.127(0.075~0.214)<0.001
大专及以上465424416.4160.474(0.266~0.845)0.011
人群分类
学生3 4873 407801.000
教职员工240229114.7402.046(1.074~3.896)0.029
医务人员118982064.0528.691(5.118~14.759)<0.001
密接人员54947178137.5717.053(5.089~9.775)<0.001
HIV/AIDS10091915.3284.212(2.050~8.652)<0.001
其他324309156.3782.067(1.177~3.632)0.012
变量合计(n阴性阳性多因素分析
Wald χ2OR值(95% CIP
性别
2 5852 4851001.000
2 2332 1201130.5711.118(0.837~1.494)0.450
年龄(岁)
<15156130261.000
15~343 8383 7301083.4920.543(0.286~1.030)0.062
35~54500452481.4690.697(0.389~1.250)0.226
55~65324293310.0270.947(0.500~1.794)0.869
学历
小学及以下11898201.000
初中669607620.8380.762(0.427~1.363)0.360
高中3 5663 476900.0801.134(0.477~2.695)0.777
大专及以上465424410.3880.776(0.349~1.725)0.533
人群分类
学生3 4873 407801.000
教职员工240229112.5862.402(0.826~6.987)0.108
医务人员118982018.3399.762(3.441~27.697)<0.001
密接人员5494717822.1436.853(3.074~15.277)<0.001
HIV/AIDS1009198.0724.387(1.582~12.165)0.004
其他324309151.6061.909(0.702~5.185)0.205
), ArticleFig(id=1240413545133830932, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011590779797, language=CN, label=表3, caption=

河南省4 818名研究对象EC筛查结果的二分类logistic回归模型分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量合计(n)阴性阳性单因素分析
Wald χ2OR值(95% CIP
性别
2 5852 4851001.000
2 2332 1201134.0051.325(1.006~1.744)0.045
年龄(岁)
<15156130261.000
15~343 8383 73010867.0770.145(0.091~0.230)<0.001
35~54500452485.7910.531(0.317~0.889)0.016
55~65324293314.9550.529(0.302~0.927)0.026
学历
小学及以下11898201.000
初中669607626.1440.500(0.290~0.865)0.013
高中3 5663 4769059.530.127(0.075~0.214)<0.001
大专及以上465424416.4160.474(0.266~0.845)0.011
人群分类
学生3 4873 407801.000
教职员工240229114.7402.046(1.074~3.896)0.029
医务人员118982064.0528.691(5.118~14.759)<0.001
密接人员54947178137.5717.053(5.089~9.775)<0.001
HIV/AIDS10091915.3284.212(2.050~8.652)<0.001
其他324309156.3782.067(1.177~3.632)0.012
变量合计(n阴性阳性多因素分析
Wald χ2OR值(95% CIP
性别
2 5852 4851001.000
2 2332 1201130.5711.118(0.837~1.494)0.450
年龄(岁)
<15156130261.000
15~343 8383 7301083.4920.543(0.286~1.030)0.062
35~54500452481.4690.697(0.389~1.250)0.226
55~65324293310.0270.947(0.500~1.794)0.869
学历
小学及以下11898201.000
初中669607620.8380.762(0.427~1.363)0.360
高中3 5663 476900.0801.134(0.477~2.695)0.777
大专及以上465424410.3880.776(0.349~1.725)0.533
人群分类
学生3 4873 407801.000
教职员工240229112.5862.402(0.826~6.987)0.108
医务人员118982018.3399.762(3.441~27.697)<0.001
密接人员5494717822.1436.853(3.074~15.277)<0.001
HIV/AIDS1009198.0724.387(1.582~12.165)0.004
其他324309151.6061.909(0.702~5.185)0.205
), ArticleFig(id=1240413545309991710, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011590779797, language=EN, label=Table 4, caption=

Preventive treatment among 4 818 subjects in Henan Province [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
特征筛查人数符合预防性治疗人数接受预防性治疗人数完成疗程人数接受率
(%)
完成率
(%)
性别
2 585(53.65)94(46.08)363536.3697.22
2 233(46.35)110(53.92)504243.8684.00
年龄(岁)
<15156(3.24)26(12.75)201576.9275.00
15~343 838(79.66)103(50.49)403837.7495.00
35~54500(10.38)47(23.04)151530.61100.00
55~65324(6.72)28(13.73)11934.3881.82
学历
小学及以下118(2.45)18(8.82)6630.00100.00
初中669(13.89)59(28.92)191230.6563.16
高中3 566(74.01)88(43.14)363640.00100.00
大专及以上465(9.65)39(19.12)252360.9892.00
人群分类
学生3 487(72.37)78(38.24)303037.97100.00
教职员工240(4.98)11(5.39)6654.55100.00
医务人员118(2.45)20(9.80)161680.00100.00
密接人员549(11.39)74(36.27)292137.1872.41
HIV/AIDS100(2.08)6(2.94)4440.00100.00
其他324(6.72)15(7.35)106.670.00
合计4 818(100.00)204(100.00)867742.1689.53
), ArticleFig(id=1240413545431626531, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011590779797, language=CN, label=表4, caption=

河南省4 818名研究对象的预防性治疗情况[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
特征筛查人数符合预防性治疗人数接受预防性治疗人数完成疗程人数接受率
(%)
完成率
(%)
性别
2 585(53.65)94(46.08)363536.3697.22
2 233(46.35)110(53.92)504243.8684.00
年龄(岁)
<15156(3.24)26(12.75)201576.9275.00
15~343 838(79.66)103(50.49)403837.7495.00
35~54500(10.38)47(23.04)151530.61100.00
55~65324(6.72)28(13.73)11934.3881.82
学历
小学及以下118(2.45)18(8.82)6630.00100.00
初中669(13.89)59(28.92)191230.6563.16
高中3 566(74.01)88(43.14)363640.00100.00
大专及以上465(9.65)39(19.12)252360.9892.00
人群分类
学生3 487(72.37)78(38.24)303037.97100.00
教职员工240(4.98)11(5.39)6654.55100.00
医务人员118(2.45)20(9.80)161680.00100.00
密接人员549(11.39)74(36.27)292137.1872.41
HIV/AIDS100(2.08)6(2.94)4440.00100.00
其他324(6.72)15(7.35)106.670.00
合计4 818(100.00)204(100.00)867742.1689.53
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河南省2023年结核病重点高危人群潜伏感染筛查和预防性治疗分析
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赵阿会 1 , 骆洪梅 2 , 高敏 1 , 张沛 1 , 李明菊 1 , 孙定勇 1 , 孙建伟 1
现代预防医学 | 实验技术及其应用 2025,52(14): 2651-2657
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现代预防医学 | 实验技术及其应用 2025, 52(14): 2651-2657
河南省2023年结核病重点高危人群潜伏感染筛查和预防性治疗分析
全屏
赵阿会1, 骆洪梅2, 高敏1, 张沛1, 李明菊1, 孙定勇1, 孙建伟1
作者信息
  • 1.河南省疾病预防控制中心,河南 郑州 450016
  • 2.国家卫生健康委妇幼健康中心
  • 赵阿会(1996—),女,硕士,技师,研究方向:结核病防治工作

通讯作者:

孙建伟,E-mail:
Analysis of latent tuberculosis infection screening and preventive treatment in high-risk populations, Henan, 2023
A-hui ZHAO1, Hong-mei LUO2, Min GAO1, Pei ZHANG1, Ming-ju LI1, Ding-yong SUN1, Jian-wei SUN1
Affiliations
  • Institute of Tuberculosis Control and Prevention, Henan Center for Disease Control and Prevention, Zhengzhou, Henan 450016, China
出版时间: 2025-07-25 doi: 10.20043/j.cnki.MPM.202501084
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目的

分析河南省基于重组结核杆菌融合蛋白(EC)试验筛查出的结核潜伏感染情况及影响因素,了解结核潜伏感染人群对预防性治疗的接受意愿,以期为完善河南省结核病防控策略提供数据支撑。

方法

采用EC试验方法于2023年在河南省结核病关爱行动公益项目县针对结核病重点高危人群(包括学校师生、医务人员、密切接触者及HIV/AIDS等)开展结核潜伏感染者筛查和预防性治疗,利用Excel 2019、SPSS 21.0软件整理分析数据。采用率(%)描述分布特征,采用χ2检验和二分类logistic回归模型进行影响因素分析。

结果

纳入4 818例研究对象,EC试验阳性率4.42%(213/4 818);发现活动性肺结核患者4例,检出率为83.02/10万(4/4 818);符合预防性治疗标准人数204人,接受预防性治疗86人,接受率42.16%(86/204),完成率89.53%(77/86),拒绝预防性治疗的主要原因在于认为自己不会发病77.97%(92/118)。二分类logistic回归模型分析结果显示,以学生作为对照,医务人员(OR=9.762,95% CI:3.441~27.697)、密接人员(OR=6.853,95% CI:3.074~15.277)、HIV/AIDS(OR=4.387,95% CI:1.582~12.165)是结核感染的危险因素。

结论

医务人员、密切接触者及HIV/AIDS患者是结核潜伏感染筛查的重点,同时针对潜伏感染者加强其对预防性治疗的认知,以提高预防性治疗接受率,推动河南省结核病防控工作。

结核病  /  重组结核分枝杆菌融合蛋白  /  潜伏感染  /  预防性治疗
Objective

To analyze the status and influencing factors of latent tuberculosis infection (LTBI) screened by the recombinant mycobacterium tuberculosis fusion protein (EC) test in Henan Province, and to understand the willingness of LTBI individuals to accept preventive treatment, with the aim of providing data support for improving tuberculosis (TB) control strategies in Henan Province.

Methods

In 2023, the EC test was used to screen for LTBI and conduct preventive treatment among high-risk groups for TB (including school teachers and students, healthcare workers, close contacts, and HIV/AIDS patients) in counties participating in the Henan Province TB Care Action public welfare project. Excel 2019 and SPSS 21.0 software were used to analyze the data. Binary logistic regression model was used to analyze the influencing factors of latent tuberculosis infection.

Results

A total of 4 818 subjects were included in the study, excluding those who had not been screened for latent infection due to other reasons such as screening contraindications. The positive rate of EC test was 4.42% (213/4 818). Four patients with active pulmonary tuberculosis were found, and the detection rate was 83.02/100 000 (4/4 818). 204 people met the criteria for preventive treatment, 86 people received preventive treatment, the acceptance rate was 42.16% (86/204), the completion rate was 89.53%(77/86), among which the main reason for refusal was that they thought they would not get sick (77.97% (92/118)). Binary logistic regression model analysis results showed that with students as the control group, medical staff (OR=9.762,95% CI:3.441-27.697), close contact staff (OR=6.853, 95% CI:3.074-15.277), HIV/AIDS (OR=4.387, 95% CI:1.582-12.165) were risk factors for TB infection.

Conclusion

Healthcare workers, close contacts, and HIV/AIDS patients are the focus of LTBI screening. Additionally, enhancing the awareness of preventive treatment among individuals with latent infections is crucial to improving the acceptance rate of preventive treatment and advancing TB control efforts in Henan Province.

Tuberculosis  /  Recombinant mycobacterium tuberculosis fusion proteins  /  Latent tuberculosis infection  /  Preventive treatment
赵阿会, 骆洪梅, 高敏, 张沛, 李明菊, 孙定勇, 孙建伟. 河南省2023年结核病重点高危人群潜伏感染筛查和预防性治疗分析. 现代预防医学, 2025 , 52 (14) : 2651 -2657 . DOI: 10.20043/j.cnki.MPM.202501084
A-hui ZHAO, Hong-mei LUO, Min GAO, Pei ZHANG, Ming-ju LI, Ding-yong SUN, Jian-wei SUN. Analysis of latent tuberculosis infection screening and preventive treatment in high-risk populations, Henan, 2023[J]. Modern Preventive Medicine, 2025 , 52 (14) : 2651 -2657 . DOI: 10.20043/j.cnki.MPM.202501084
结核病(Tuberculosis, TB)是由结核分枝杆菌(Mycobacterium tuberculosis, MTB)引起的一种呼吸道慢性传染性疾病,是单一传染病死亡的主要原因[1]。世界卫生组织(World Health Organization, WHO)报道,2023年全球新发结核病患者1 080万例,其中中国结核病新发患者数74.1万(占全球发病数6.8%),发病数排全球第三位[2]。结核分枝杆菌潜伏感染(Latent tuberculosis infection, LTBI)者是结核病源源不断发病的潜在“患者库”[3],也是导致疫情难以控制的原因之一。WHO于2015年倡导积极开展LTBI检测和预防性治疗[4],之后不断发布指南以推动LTBI人群的预防性治疗工作[5-6]。2000年我国在第四次全国结核病流行病学抽样调查中开展LTBI调查,显示全年龄组结核感染率为44.5%[7]。因此,LTBI的筛查与预防是终止结核流行的重点工作。重组结核杆菌融合蛋白(EC)作为我国自主研发的结核感染免疫诊断新技术,已于2020年通过国家药品监督管理局批准上市。本研究对2023年河南省4 818例研究对象的EC试验筛查结果数据和预防性治疗情况进行分析,了解河南省重点高危人群结核潜伏感染及预防性治疗情况,以期为完善河南省结核病防控策略提供数据支撑。
2023年中国疾病预防控制中心采用典型抽样的方法选取了河南省焦作市温县、驻马店市泌阳县和商丘市柘城县作为项目县开展结核病关爱行动公益项目工作,内容为针对重点高危人群开展结核潜伏感染筛查和预防性治疗。
根据《中国结核病防治工作技术指南》[8]重点高危人群包括但不限于学校师生、医务人员、密切接触者及HIV/AIDS等。参照国内外有关研究资料并咨询相关专家,预计目标人群结核分枝杆菌潜伏感染率p=20%,设检验水平α=0.05,容许误差δ=0.02,每个项目县样本量例。项目县内从事结核病防控工作的相关医务人员全部纳入,其余各类重点高危人群数量根据县区结核病防控工作实际情况纳入。纳入标准:①均为结核病重点高危人群;②6月龄及以上婴儿、儿童及65周岁以下成人。排除标准:①存在筛查禁忌症:患急性传染病(如麻疹、流感等)、急性眼结膜炎、急性中耳炎;有多种药物过敏反应史者;患有全身皮肤性疾病;临床医生判定暂不适合进行EC试验的情况。②不愿意接受筛查:单纯不愿意接受;担心副作用;没时间参与等。本研究经中国疾病预防控制中心伦理审查委员会审查批准(编号:202316)。
EC试验是一种以重组结核杆菌融合蛋白[该制品名称是国家药典委员会确定的药品中文通用名称,“EC”为重组融合蛋白“结核分枝杆菌早期分泌性抗原靶6(EAST-6)和培养滤液蛋白10(CFP-10)”]作为免疫原,检测机体是否受MTB感染的新型皮肤试验。EC试剂(50U 1.0 ml/瓶)来自结核病关爱行动公益项目提供,由经统一培训后的护士采取孟都法注射0.1 ml EC于受试者前臂掌侧皮内,48~72h内观察结果[9]。反应平均直径[(横径+纵径)/2]≥5 mm为阳性反应,凡有水疱、坏死、淋巴管炎者均属于强阳性反应。单纯EC阳性为结核潜伏感染标准[10]
EC阳性者转诊至当地结核病定点医疗机构,开展胸部影像学和结核相关病原学检查,由临床医生依据《肺结核诊断标准(WS288-2017)》[11]进行诊断。
EC阳性率=阳性人数/接受筛查人数×100%;患者检出率=结核病定点医疗机构诊断患者人数/接受筛查人数×100%;预防性治疗接受率=接受预防性治疗人数/符合预防性治疗标准人数×100%;预防性治疗完成率=完成疗程的预防性治疗人数/接受预防性治疗人数×100%。
使用Excel 2016软件建立数据库,采用SPSS 21.0软件对数据进行统计分析。计数资料采用率和构成比描述。采用χ2检验进行不同组间率的比较。采用logistic回归模型分析研究对象EC阳性率相关影响因素。检验水准α设为0.05。
2023年河南省共4 927名研究对象纳入研究,在知情同意的基础上,排除因筛查禁忌症等其他原因未开展潜伏感染筛查者109人(2.21%),剩余4 818人接受潜伏感染筛查并纳入数据分析。对象中男性占53.65%(2 585/4 818),女性占46.35%(2 233/4 818),男女比例1.16∶1;平均年龄(23.15±13.43)岁,3 838例(79.66%)研究对象年龄在15~34岁之间;学历以高中为主,占74.01%(3 566/4 818);学生3 487人,占72.37%。
EC试验阳性人数213人,阳性率为4.42%。男性阳性率3.87%,女性阳性率5.06%,差异具有统计学意义(P=0.045)。阳性率由高到低依次为医务人员、密接人员、HIV/AIDS、教职员工、其他、学生,不同人群分类的阳性率差异具有统计学意义(P<0.001)。不同年龄段、不同学历间的EC试验阳性率差异也具有统计学意义(P均<0.05)。见表1
变量赋值见表2。多因素logistic回归分析结果显示,以学生作为对照,医务人员(OR=9.762,95% CI:3.441~27.697)、密接人员(OR=6.853,95% CI:3.074~15.277)、HIV/AIDS(OR=4.387,95% CI:1.582~12.165)是结核感染的危险因素。见表3
213例EC阳性人员转诊至当地结核病定点医疗机构,经相关检查后,4例被确诊为活动性肺结核,检出率为83.02/10万。排除确诊及其他情况后符合预防性治疗指标的人数204人,愿意接受预防性治疗86人,接受率42.16%,完成率89.53%,见表4。拒绝预防性治疗的原因前2位为:认为自己不会发病77.97%(92/118)、担心药物不良反应16.10%(19/118)。
开展LTBI筛查的主动发现和预防性治疗是实现“END TB”全球战略目标的重要手段[12],尤其是在学校师生、医务人员、病原学阳性患者密切接触者、HIV/AIDS及糖尿病患者等结核病重点高危人群中强化主动筛查工作[13],可有效减少结核传播,加速结核病疫情下降。当前,国际上MTB感染状态的检测方法主要有TST、IGRA和C-TST[14]。中国的EC属于C-TST试剂的一种,具有特异性高,不受卡介苗(BCG)和非结核分枝杆菌影响的优点。本研究采用EC试验在结核病重点高危人群中开展潜伏感染筛查,结果显示EC试验阳性率为4.421%,低于我国基于IGRA检测结果估算的结核潜伏感染率[15]。可能原因一方面在于两者检测方法不同;另一方面是由于人群LTBI率与地区的结核病疫情存在正相关性,近年来结核病防治工作取得一定成效,活动性肺结核报告发病率逐年下降[16]
本研究显示医务人员潜伏感染率为16.95%,低于重庆市(33.80%)[17];密切接触者潜伏感染率14.21%,低于苏州市(35.94%)[18]和上海市(26.76%)[19];HIV/AIDS患者潜伏感染率9.00%,高于江苏省扬州市(7.27%)[20];学生潜伏感染率2.28%,略低于重庆市(5.93%)[21],可能与地区差异或河南省具有较完善的疫情防控措施有关,提示不同地区不同人群潜伏感染率存在不同,得到相关研究支持[18]。此外,logistic回归模型分析结果显示:相比于学生群体,医务人员EC阳性率高,LTBI风险也较高,原因在于职业暴露是结核感染的重要影响因素,医务人员接触肺结核患者的机会多、时间长,容易增加医务人员的感染甚至发病风险[17]。这提示应重视定点医疗机构内结核感染控制措施,否则容易导致机构内传播风险,进而导致患者、陪护人员等更容易感染和发生结核病。密接人员EC阳性率也高于学生,原因在于人群中肺结核的传播方式通常为飞沫传播,有密切接触史的这类人群暴露程度更大,感染结核分枝杆菌的风险也更高[21]。密切接触为肺结核传播提供了途径,在结核病防控工作中应加强对此类人群的重视。HIV/AIDS患者EC阳性率也较高,主要是人体感染HIV病毒后,机体内CD4+T淋巴细胞数量减少,引起免疫功能降低,因此在同等机会接触结核分枝杆菌的情况下,更易感染结核分枝杆菌[22]。结核病的主动发现是河南省结核病防控策略的重要工作之一,针对以上情况,应将医务人员、密切接触者及HIV/AIDS列为重点的筛查对象,以期实现对结核病的早期发现,进而降低结核病的传播。
本研究中筛查出的结核潜伏感染者对预防性治疗的接受意愿不高,主要原因一是认为自己身体状况不错,发病风险不高(77.97%),二是对预防性治疗有顾虑,担心出现药物不良作用(16.10%)。任敬娟等[23]采用横断面研究了解我国潜伏感染者接受预防性治疗意愿及影响因素,接受率仅为16.99%,拒绝治疗的原因在于对副作用的担忧和治疗效果的误解,这与本研究结果相似。本研究中预防性治疗接受率为42.16%,高于全国[23],但低于四川省[24]、江苏省[25],这可能与不同地区经济水平有关,提示我们虽然预防性治疗工作开展相对较好,但与江苏等省份仍然存在差距。LTBI人群若未进行干预,将会有5%~10%的可能性发展为结核病,而开展预防性治疗能够实现60%~90%的保护效果[15, 26]。然而,由于疗程时间、督导管理等原因可能影响预防性治疗依从性。本研究中接受预防性治疗的潜伏感染者中治疗完成率为89.53%,高于四川省[24],可能与我省宣传教育、督导管理等工作开展较好有关。建议今后应定期组织相关培训,同时结合新媒体平台(如微信公众号、抖音等)开展预防性治疗知识的健康教育活动,提高公众对预防性治疗的认识,从而提高预防性治疗接受度。
实施“患者主动发现+潜伏感染者预防性治疗”为核心的防控策略能够加速结核病疫情下降[13]。在筛查方面,应将工作进一步细化,将医务人员、密切接触者及HIV/AIDS列为重点的筛查对象,同时加强针对预防性治疗知识的健康教育工作,以提高公众对预防性治疗的接受意愿,从而在重点高危人群中真正实现主动的防治结合,进一步降低结核病疫情。
  • 河南省医学科技攻关计划项目资助(LHGJ20240636)
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2025年第52卷第14期
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doi: 10.20043/j.cnki.MPM.202501084
  • 接收时间:2025-01-06
  • 首发时间:2026-03-16
  • 出版时间:2025-07-25
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  • 收稿日期:2025-01-06
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河南省医学科技攻关计划项目资助(LHGJ20240636)
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    1.河南省疾病预防控制中心,河南 郑州 450016
    2.国家卫生健康委妇幼健康中心

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孙建伟,E-mail:
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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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