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Article(id=1325530174783242555, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325530078536553117, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025280, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1745251200000, receivedDateStr=2025-04-22, revisedDate=1751817600000, revisedDateStr=2025-07-07, acceptedDate=null, acceptedDateStr=null, onlineDate=1793960620828, onlineDateStr=2026-11-06, pubDate=1758729600000, pubDateStr=2025-09-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793960620828, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793960620828, creator=13701087609, updateTime=1793960620828, updator=13701087609, issue=Issue{id=1325530078536553117, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='9', pageStart='1217', pageEnd='1368', issueExtLink='null', onlineDate='null', pubDate='1758729600000', pubDateStr='2025-09-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793960597879, creator='13701087609', updateTime=1793960597879, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1351, endPage=1354, ext={EN=ArticleExt(id=1325530176356106556, articleId=1325530174783242555, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Follow-up analysis of tuberculosis incidence risk and risk factors among middle school students in Chongqing, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the incidence risk and risk factors of tuberculosis (TB) among middle school students in Chongqing, so as to provide a basis for formulating TB prevention and control strategies.

Methods

From September to December 2022, 32 181 middle school students were selected as the study cohort from 15 administrative districts in Chongqing by using the stratified cluster random sampling method. All cohort members were screened with the tuberculin skin test (TST), and relevant information was collected from January 1, 2023 to December 31, 2024. On the basis of active screening, the follow-up data of the participants were compared with the National Tuberculosis Management Information System to obtain the incidence status of the study subjects. The Log-rank test was used to compare the TB incidence rates among students with different characteristics, and a Cox proportional hazards model was established to analyze the incidence risk and risk factors of TB.

Results

The TST screening rate of the cohort members was 93.0%. During the 2-year follow-up period, a total of 36 TB cases occurred, with a cumulative incidence rate of 111.87/100 000 and an incidence density of 55.95/100 000. Among them, the cumulative incidence rate of students from public schools (170.44/100 000) was higher than that of students from private schools (41.16/100 000), the cumulative incidence rate of students in schools located in high-epidemic areas (153.95/100 000) was higher than that in medium-epidemic areas (69.00/100 000), and the difference was statistically significant (χ2=11.49, 4.73, both P < 0.05). The Log-rank test for different TST results showed that the difference in TB comulative incidence rate between students with strongly positive TST results (216.55/100 000) and those with negative TST results (81.40/100 000) was statistically significant (χ2=5.85, P < 0.05). Univariate analysis using the Cox proportional hazards model revealed that the risk of TB was lower in students from private schools (HR=0.25, 95%CI=0.10-0.59) and students in medium-epidemic areas (HR=0.46, 95%CI=0.23-0.94); whereas the risk of TB was increased in students with strongly positive TST results (HR=1.39, 95%CI=1.05-1.84) (all P < 0.05). Multivariate Cox regression analysis showed that the risk of TB in students from private schools was lower than that of students from public schools (HR=0.23, 95%CI=0.08-0.62, P < 0.05).

Conclusions

The annual average incidence rate of TB among middle school students in Chongqing is at a relatively high level. It is necessary to strengthen the management and intervention for student groups, including those in public schools, those in schools located in high-epidemic areas, and those with strongly positive TST results, so as to reduce the incidence rate of TB.

, authors=Wen ZHANG1, Qian SU2, Wenping LIAO1, Liyi ZHANG1, Yu XIN1, Juan LÜ1, Jie LUO1, Lin SHI1, Jun FAN*, 3, Yaling SHI*, 3, authorsList=Wen ZHANG, Qian SU, Wenping LIAO, Liyi ZHANG, Yu XIN, Juan LÜ, Jie LUO, Lin SHI, Jun FAN, Yaling SHI, authorCompany=null, correspAuthors=Jun FAN, Yaling SHI, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325530176708428093, articleId=1325530174783242555, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=重庆市中学生结核病发病风险及风险因素随访分析, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

了解重庆市中学生结核病发病风险及风险因素，为制定结核病防控策略提供依据。

方法

2022年9—12月，采用分层整群随机抽样方法从重庆市15个行政区抽取32 181例中学生作为研究队列，对队列成员开展结核菌素皮肤试验(TST)筛查并收集2023年1月1日—2024年12月31日相关信息。在主动筛查的基础上，将随访人员信息与国家结核病管理信息系统比对获取研究对象的发病情况，不同特征中学生发病率比较采用Log-lank法检验；并建立Cox比例风险模型进行结核病发病风险及风险因素的分析。

结果

队列成员TST筛查率为93.0%，2年随访期内共发生结核病36例，累计发病率111.87/10万，发病密度为55.95/10万。其中来自公办学校的学生累计发病率(170.44/10万)高于民办学校(41.16/10万)，学校所在区域为高疫情地区的累计发病率(153.95/10万)高于中疫情地区(69.00/10万)，差异均有统计学意义(χ2值分别为11.49，4.73)(P值均 < 0.05)。对不同TST结果进行Log-rank法检验，TST结果为强阳性与阴性的累计发病率(216.55/10万，81.40/10万)差异有统计学意义(χ2=5.85，P < 0.05)。采用Cox比例风险模型进行单因素分析，民办学校(HR=0.25，95%CI=0.10~0.59)、中疫情地区(HR=0.46，95%CI=0.23~0.94)中学生结核病发病风险均降低；TST结果为强阳性的中学生(HR=1.39，95%CI=1.05~1.84)结核病发病风险增加(P值均 < 0.05)。多因素Cox回归分析结果显示，民办学校学生结核病发病风险低于公办学校(HR=0.23，95%CI=0.08~0.62，P < 0.05)。

结论

重庆市中学生结核病年均发病率处于相对偏高水平。应加强公办学校、学校所在地疫情等级为高疫情地区、TST结果为强阳性的学生人群管理和干预，以降低结核病发病率。

, authors=张文1, 苏倩2, 廖文平1, 张理翌1, 辛玉1, 吕娟1, 罗杰1, 石林1, 范君*, 3, 石亚玲*, 3, authorsList=张文, 苏倩, 廖文平, 张理翌, 辛玉, 吕娟, 罗杰, 石林, 范君, 石亚玲, authorCompany=null, correspAuthors=范君, 石亚玲, authorNote=

张文(1985-)，男，甘肃白银人，硕士，副主任医师，主要研究方向为结核病防控

, correspAuthorsNote=
范君，E-mail：
石亚玲，E-mail：
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BMJ, 2020, 368: m549., articleTitle=null, refAbstract=null), Reference(id=1325530186468573606, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=21, rfOrder=32, authorNames=null, journalName=null, refType=null, unstructuredReference=肖海浩, 张言斌. 结核分枝杆菌潜伏感染研究进展[J]. 实用医学杂志, 2022, 38(6): 664-668., articleTitle=null, refAbstract=null), Reference(id=1325530186539876775, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=21, rfOrder=33, authorNames=null, journalName=null, refType=null, unstructuredReference=XlAO H H, ZHANG Y B. Research progress of latent mycobacterium tuberculosis infection[J]. J Pract Med, 2022, 38(6): 664-668. (in Chinese), articleTitle=null, refAbstract=null), Reference(id=1325530186623762856, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=22, rfOrder=34, authorNames=null, journalName=null, refType=null, unstructuredReference=陈淑林, 孙德全, 石俊峰, 等. 高中新生PPD反应程度与结核病发病危险的队列研究[J]. 中华疾病控制杂志, 2013, 17(2): 180-181., articleTitle=null, refAbstract=null), Reference(id=1325530186703454633, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=22, rfOrder=35, authorNames=null, journalName=null, refType=null, unstructuredReference=CHEN S L, SUN D Q, SHI J F, et al. Relationship between PPD reaction extent and tuberculosis risk among senior high school students[J]. Chin J Dis Control Prev, 2013, 17(2): 180-181. (in Chinese), articleTitle=null, refAbstract=null), Reference(id=1325530186778952106, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=23, rfOrder=36, authorNames=null, journalName=null, refType=null, unstructuredReference=梁瑞英, 徐伟, 吴春萍. 北京市朝阳区2013-2015年高校新生结核菌潜伏感染现状及发病情况[J]. 中国学校卫生, 2019, 40(9): 1373-1375, 1379., articleTitle=null, refAbstract=null), Reference(id=1325530186850255275, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=23, rfOrder=37, authorNames=null, journalName=null, refType=null, unstructuredReference=LIANG R Y, XU W, WU C P. Latent tuberculosis infection and tuberculosis incidence college freshmen in Chaoyang District during 2013 to 2015[J]. Chin J Sch Health, 2019, 40(9): 1373-1375, 1379. (in Chinese), articleTitle=null, refAbstract=null)], funds=[Fund(id=1325530182299435397, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, awardId=null, language=CN, fundingSource=重庆市科卫联合医学科研项目(2022MSXM018)；重庆市九龙坡区科技计划项目(No.2024-04-023-Y，No.2024-04-002-Z)；重庆市公共卫生重点专科(学科)科建设经费资助项目, fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325530176947503422, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, xref=1, ext=[AuthorCompanyExt(id=1325530176960086335, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, companyId=1325530176947503422, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Medical Education, Chongqing Municipal Institute of Tuberculosis, Chongqing 400050, China), AuthorCompanyExt(id=1325530176976863552, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, companyId=1325530176947503422, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1重庆市结核病防治所医教科, 400050)]), AuthorCompany(id=1325530177069138241, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, xref=2, ext=[AuthorCompanyExt(id=1325530177077526850, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, companyId=1325530177069138241, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2重庆市结核病防治所综合防治科)]), AuthorCompany(id=1325530177148830019, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, xref=3, ext=[AuthorCompanyExt(id=1325530177157218628, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, companyId=1325530177148830019, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3重庆市结核病防治所行政办公室)])], figs=[ArticleFig(id=1325530181783535999, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, language=EN, label=Tab.1, caption=

Tuberculosis incidence among middle school students in different groups in Chongqing (2023-2024)

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数发病数累计发病率/10-5年均发病率/10-5随访人年发病密度/10-5
性别
  男17 26419110.0655.0334 52155.04
  女14 91717113.9656.9829 82657.00
年龄/岁
   < 131 3250002 6500
  13~157 23514193.5096.7514 46796.77
  16~1823 3522294.2147.1146 69247.12
  >182690005380
学段
  初中2 6940005 3880
  高中29 48736122.0961.0458 95961.06
学校属性
  公办17 60230170.4485.2235 19385.24
  民办14 579641.1620.5829 15420.58
区域疫情等级a
  高疫情地区16 23925153.9576.9832 46577.01
  中疫情地区15 9421169.0034.5031 88234.50
TST筛查
  接受29 92535116.9658.4859 83558.49
  未接受2 256144.3322.164 51222.16
TST结果
  阴性17 1991481.4040.7034 39540.70
  一般阳性3 7835132.1766.097 56666.09
  中度阳性4 7877146.2373.119 56973.15
  强阳性4 1569216.55108.288 305108.37
), ArticleFig(id=1325530181880004992, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, language=CN, label=表1, caption=

重庆市2023—2024年不同组别中学生结核病发病情况

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数发病数累计发病率/10-5年均发病率/10-5随访人年发病密度/10-5
性别
  男17 26419110.0655.0334 52155.04
  女14 91717113.9656.9829 82657.00
年龄/岁
   < 131 3250002 6500
  13~157 23514193.5096.7514 46796.77
  16~1823 3522294.2147.1146 69247.12
  >182690005380
学段
  初中2 6940005 3880
  高中29 48736122.0961.0458 95961.06
学校属性
  公办17 60230170.4485.2235 19385.24
  民办14 579641.1620.5829 15420.58
区域疫情等级a
  高疫情地区16 23925153.9576.9832 46577.01
  中疫情地区15 9421169.0034.5031 88234.50
TST筛查
  接受29 92535116.9658.4859 83558.49
  未接受2 256144.3322.164 51222.16
TST结果
  阴性17 1991481.4040.7034 39540.70
  一般阳性3 7835132.1766.097 56666.09
  中度阳性4 7877146.2373.119 56973.15
  强阳性4 1569216.55108.288 305108.37
), ArticleFig(id=1325530181951308161, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, language=EN, label=Tab.2, caption=

Univariate Cox proportional hazards model analysis of tuberculosis incidence risk among middle school students in Chongqing (n=32 181)

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量β值标准误Wald χ2值P值HR值(95%CI)
性别
  女0.030.330.010.931.03(0.54~1.99)
年龄/岁
  13~153.263.201.040.3126.05(0.05~13 864.79)
  16~181.542.090.550.464.68(0.08~279.87)
  >18----
-
学段
  高中3.142.631.420.2323.00(0.13~3 996.40)
学校属性
  民办-1.400.459.78< 0.010.25(0.10~0.59)
区域疫情等级
  中疫情地区-0.770.364.500.030.46(0.23~0.94)
TST筛查
  未接受0.961.010.900.342.62(0.36~19.09)
TST结果
  一般阳性0.490.520.900.341.64(0.59~4.55)
  中度阳性0.300.231.660.201.35(0.86~2.12)
  强阳性0.330.145.390.021.39(1.05~1.84)
), ArticleFig(id=1325530182026805634, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, language=CN, label=表2, caption=

重庆市中学生结核病发病风险的单因素Cox比例风险模型分析(n=32 181)

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量β值标准误Wald χ2值P值HR值(95%CI)
性别
  女0.030.330.010.931.03(0.54~1.99)
年龄/岁
  13~153.263.201.040.3126.05(0.05~13 864.79)
  16~181.542.090.550.464.68(0.08~279.87)
  >18----
-
学段
  高中3.142.631.420.2323.00(0.13~3 996.40)
学校属性
  民办-1.400.459.78< 0.010.25(0.10~0.59)
区域疫情等级
  中疫情地区-0.770.364.500.030.46(0.23~0.94)
TST筛查
  未接受0.961.010.900.342.62(0.36~19.09)
TST结果
  一般阳性0.490.520.900.341.64(0.59~4.55)
  中度阳性0.300.231.660.201.35(0.86~2.12)
  强阳性0.330.145.390.021.39(1.05~1.84)
), ArticleFig(id=1325530182098108803, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, language=EN, label=Tab.3, caption=

Multivariable Cox proportional hazards model analysis of tuberculosis incidence risk among middle school students in Chongqing (n=32 181)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β值标准误Wald χ2值P值HR值(95%CI)
年龄/岁0.260.152.820.091.29(0.96~1.74)
学校属性
  民办-1.480.518.28< 0.010.23(0.08~0.62)
区域疫情等级
  中疫情地区-0.510.391.690.190.60(0.28~1.30)
TST
  一般阳性-0.870.434.140.040.42(0.18~0.97)
  中度阳性-0.420.560.570.450.66(0.22~1.97)
  强阳性-0.340.510.440.510.72(0.27~1.93)
), ArticleFig(id=1325530182181994884, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530174783242555, language=CN, label=表3, caption=

重庆市中学生结核病发病风险的多因素Cox比例风险模型分析(n=32 181)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β值标准误Wald χ2值P值HR值(95%CI)
年龄/岁0.260.152.820.091.29(0.96~1.74)
学校属性
  民办-1.480.518.28< 0.010.23(0.08~0.62)
区域疫情等级
  中疫情地区-0.510.391.690.190.60(0.28~1.30)
TST
  一般阳性-0.870.434.140.040.42(0.18~0.97)
  中度阳性-0.420.560.570.450.66(0.22~1.97)
  强阳性-0.340.510.440.510.72(0.27~1.93)
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重庆市中学生结核病发病风险及风险因素随访分析
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张文 1 , 苏倩 2 , 廖文平 1 , 张理翌 1 , 辛玉 1 , 吕娟 1 , 罗杰 1 , 石林 1 , 范君 *, 3 , 石亚玲 *, 3
中国学校卫生 | 疾病控制 2025,46(9): 1351-1354
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中国学校卫生 |疾病控制 2025 , 46 (9) : 1351 -1354
重庆市中学生结核病发病风险及风险因素随访分析
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张文1, 苏倩2, 廖文平1, 张理翌1, 辛玉1, 吕娟1, 罗杰1, 石林1, 范君*, 3 , 石亚玲*, 3
作者信息
  • 1重庆市结核病防治所医教科, 400050
  • 2重庆市结核病防治所综合防治科
  • 3重庆市结核病防治所行政办公室
通讯作者:
范君，E-mail：
石亚玲，E-mail：
作者简介:

张文(1985-)，男，甘肃白银人，硕士，副主任医师，主要研究方向为结核病防控

Follow-up analysis of tuberculosis incidence risk and risk factors among middle school students in Chongqing
Wen ZHANG1, Qian SU2, Wenping LIAO1, Liyi ZHANG1, Yu XIN1, Juan LÜ1, Jie LUO1, Lin SHI1, Jun FAN*, 3 , Yaling SHI*, 3
Affiliations
  • 1Department of Medical Education, Chongqing Municipal Institute of Tuberculosis, Chongqing 400050, China
出版时间: 2025-09-25 doi: 10.16835/j.cnki.1000-9817.2025280
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摘要
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目的

了解重庆市中学生结核病发病风险及风险因素，为制定结核病防控策略提供依据。

方法

2022年9—12月，采用分层整群随机抽样方法从重庆市15个行政区抽取32 181例中学生作为研究队列，对队列成员开展结核菌素皮肤试验(TST)筛查并收集2023年1月1日—2024年12月31日相关信息。在主动筛查的基础上，将随访人员信息与国家结核病管理信息系统比对获取研究对象的发病情况，不同特征中学生发病率比较采用Log-lank法检验；并建立Cox比例风险模型进行结核病发病风险及风险因素的分析。

结果

队列成员TST筛查率为93.0%，2年随访期内共发生结核病36例，累计发病率111.87/10万，发病密度为55.95/10万。其中来自公办学校的学生累计发病率(170.44/10万)高于民办学校(41.16/10万)，学校所在区域为高疫情地区的累计发病率(153.95/10万)高于中疫情地区(69.00/10万)，差异均有统计学意义(χ2值分别为11.49，4.73)(P值均 < 0.05)。对不同TST结果进行Log-rank法检验，TST结果为强阳性与阴性的累计发病率(216.55/10万，81.40/10万)差异有统计学意义(χ2=5.85，P < 0.05)。采用Cox比例风险模型进行单因素分析，民办学校(HR=0.25，95%CI=0.10~0.59)、中疫情地区(HR=0.46，95%CI=0.23~0.94)中学生结核病发病风险均降低；TST结果为强阳性的中学生(HR=1.39，95%CI=1.05~1.84)结核病发病风险增加(P值均 < 0.05)。多因素Cox回归分析结果显示，民办学校学生结核病发病风险低于公办学校(HR=0.23，95%CI=0.08~0.62，P < 0.05)。

结论

重庆市中学生结核病年均发病率处于相对偏高水平。应加强公办学校、学校所在地疫情等级为高疫情地区、TST结果为强阳性的学生人群管理和干预，以降低结核病发病率。

结核  /  发病率  /  因素分析，统计学  /  学生
Objective

To understand the incidence risk and risk factors of tuberculosis (TB) among middle school students in Chongqing, so as to provide a basis for formulating TB prevention and control strategies.

Methods

From September to December 2022, 32 181 middle school students were selected as the study cohort from 15 administrative districts in Chongqing by using the stratified cluster random sampling method. All cohort members were screened with the tuberculin skin test (TST), and relevant information was collected from January 1, 2023 to December 31, 2024. On the basis of active screening, the follow-up data of the participants were compared with the National Tuberculosis Management Information System to obtain the incidence status of the study subjects. The Log-rank test was used to compare the TB incidence rates among students with different characteristics, and a Cox proportional hazards model was established to analyze the incidence risk and risk factors of TB.

Results

The TST screening rate of the cohort members was 93.0%. During the 2-year follow-up period, a total of 36 TB cases occurred, with a cumulative incidence rate of 111.87/100 000 and an incidence density of 55.95/100 000. Among them, the cumulative incidence rate of students from public schools (170.44/100 000) was higher than that of students from private schools (41.16/100 000), the cumulative incidence rate of students in schools located in high-epidemic areas (153.95/100 000) was higher than that in medium-epidemic areas (69.00/100 000), and the difference was statistically significant (χ2=11.49, 4.73, both P < 0.05). The Log-rank test for different TST results showed that the difference in TB comulative incidence rate between students with strongly positive TST results (216.55/100 000) and those with negative TST results (81.40/100 000) was statistically significant (χ2=5.85, P < 0.05). Univariate analysis using the Cox proportional hazards model revealed that the risk of TB was lower in students from private schools (HR=0.25, 95%CI=0.10-0.59) and students in medium-epidemic areas (HR=0.46, 95%CI=0.23-0.94); whereas the risk of TB was increased in students with strongly positive TST results (HR=1.39, 95%CI=1.05-1.84) (all P < 0.05). Multivariate Cox regression analysis showed that the risk of TB in students from private schools was lower than that of students from public schools (HR=0.23, 95%CI=0.08-0.62, P < 0.05).

Conclusions

The annual average incidence rate of TB among middle school students in Chongqing is at a relatively high level. It is necessary to strengthen the management and intervention for student groups, including those in public schools, those in schools located in high-epidemic areas, and those with strongly positive TST results, so as to reduce the incidence rate of TB.

Tuberculosis  /  Incidence  /  Factor analysis, statistical  /  Students
张文, 苏倩, 廖文平, 张理翌, 辛玉, 吕娟, 罗杰, 石林, 范君, 石亚玲. 重庆市中学生结核病发病风险及风险因素随访分析. 中国学校卫生, 2025 , 46 (9) : 1351 -1354 . DOI: 10.16835/j.cnki.1000-9817.2025280
Wen ZHANG, Qian SU, Wenping LIAO, Liyi ZHANG, Yu XIN, Juan LÜ, Jie LUO, Lin SHI, Jun FAN, Yaling SHI. Follow-up analysis of tuberculosis incidence risk and risk factors among middle school students in Chongqing[J]. Chinese Journal of School Health, 2025 , 46 (9) : 1351 -1354 . DOI: 10.16835/j.cnki.1000-9817.2025280
正文
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作为青少年人群高度集中的场所，学校是结核病传播的高风险区域[1]，而青少年又是肺结核易感染和发病的高危人群[2]。由于学校师生接触频繁、人员密集，一旦出现结核病患者，极易暴发疫情、造成公共卫生事件[3]。因此，学校是我国结核病防治工作的重点场所[4]，采取有效的学校肺结核防控措施对保护学生身心健康、减少结核病流行具有重要作用。近年来，由重庆市结核病防治所制定主动肺结核筛查标准化质量控制流程[5]，在市内部分地区开展针对学生人群的示范筛查工作并构建随访观察队列。本研究依托该随访观察队列，旨在明确重庆市学生人群结核病发病风险及发病风险因素，为制定学校结核病防控策略提供依据。
1　对象与方法
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1.1　对象
2022年9—12月，采用分层整群随机抽样方法，根据重庆市各区县结核病疫情高低选择15个区县，每个区县采用直接抽选法选取1~2所初/高中学校，将抽取到的学校所有初一、初二，高一、高二年级学生作为研究对象，以此建立学生人群结核病发病风险和风险因素研究队列。本次共筛查中学生32 190名，确诊结核病患者9例，排除基线调查时筛查发现的活动性结核病患者，最终共纳入32 181人；观察期为2023年1月1日—2024年12月31日。其中男生17 264名，女生14 917名； < 13岁1 325名，13~15岁7 235名，16~18岁23 352名，>18岁269名；初中生2 694名，高中生29 487名；入组年龄为(15.75±1.19)岁。所有随访成员均已签署知情同意书，本研究经重庆市结核病防治所伦理委员会审核批准(审批号：202202)。
1.2　方法
采用队列研究方法，对纳入研究的学生进行为期2年的跟踪调查。基线调查内容包括：基于重庆市学生人群结核病示范筛查工作，由课题组成员在现场收集研究对象的性别、年级和学校属性等信息；以2023年学校所处区县的结核病报告发病率确定区域疫情等级；结核菌素皮肤试验(tuberculin skin test, TST)检测由重庆市结核病防治所医护人员在学校现场开展，并在72 h后用直尺准确测量并记录结果。跟踪调查均由本课题组成员完成；为确保不遗漏病例，在主动筛查的基础上，将所有随访人员信息与国家结核病管理信息系统比对。
1.3　结核病的判定
肺结核诊断参照《肺结核诊断》(WS 288—2017)[6]。结核病属于法定乙类传染病，所有病例均在国家结核病管理信息系统进行登记。将2023年1月1日—2024年12月31日在国家结核病管理信息系统登记的所有结核病患者与纳入队列的研究对象进行比对，获取研究对象的发病情况，计算结核病发病密度，进行结核病发病风险及风险因素的分析。
1.4　相关定义
(1) TST检测：采用结核菌素纯蛋白衍生物(purified protein derivative of tuberculin, TB-PPD)皮肤试验。在左前臂掌侧皮内注射5 IU TB-PPD，于注射48~96 h后，测量皮肤硬结的横向和纵向直径后取其平均值。其中，硬结直径 < 5 mm或者无反应为阴性，硬结直径5~ < 10 mm为一般阳性，10~ < 15 mm为中度阳性，≥15 mm或局部出现水泡、双圈、坏死、淋巴管炎判定为强阳性[6-8]。(2)发病密度：发病密度=观察期内的发病人数/随访人年×10-5。(3)区域疫情等级：依据《重庆市结核病防治行动方案(2024—2035年)》[9]，以2023年全市结核病报告发病率为基线，参考全国平均水平划分区县级疫情等级，报告发病率≥50/10万的区县为高疫情地区，≥30/10万~ < 50/10万的区县为中疫情地区， < 30/10万的区县为低疫情地区。
1.5　统计学分析
采用Excel 2019软件收集数据，使用SPSS 25.0软件进行数据统计分析。不同特征研究对象的发病率比较采用Log-rank法检验；使用Cox比例风险模型评估活动性结核病的发病风险，用风险比(hazard ratio, HR)和95%CI评价各变量对结核病的发病风险。把单因素Cox比例风险模型中P < 0.2的变量纳入多因素Cox比例风险模型中，分析各变量对结核发病的影响。以P < 0.05为有统计学意义。
2　结果
收起
2.1　重庆市2023—2024年中学生结核病发病情况
纳入的32 181例中学生，TST筛查率为93.0%(29 925名)。2023—2024年随访期内共计发生结核病36例，累计发病率111.87/10万，年均发病率为55.93/10万，发病密度为55.95/10万。结果显示，不同学校属性和学校所在区域疫情等级中学生结核病累计发病率差异均有统计学意义(χ2值分别为11.49，4.73，P值均 < 0.05)；不同性别、年龄段、学段、TST结果和TST筛查等组间累计发病率差异均无统计学意义(χ2值分别为0.01，6.47，3.35，5.97，0.97，P值均>0.05)。见表1。接受TST筛查29 925名队列成员中，在随访期内TST结果为阴性累计发病率最低，为81.40/10万；其次为一般阳性(132.17/10万)和中度阳性(146.23/10万)，TST结果为强阳性的累计发病率最高(216.55/10万)。对不同TST结果进行Log-rank法检验，TST结果为强阳性与阴性的累计发病率差异有统计学意义(χ2=5.85，P=0.02)；其余各组之间差异均无统计学意义(阴性组与一般阳性、中度阳性组的χ2值分别为0.91，1.71；一般阳性与中度阳性、强阳性组的χ2值分别为0.03，0.82；中度阳性与强阳性组的χ2值为0.62，P值均>0.05)。见表1。
2.2　重庆市中学生结核病发病风险单因素分析
见表2。
以中学生是否诊断结核病(否=0，是=1)为因变量，纳入性别、年龄、学段、学校属性、区域疫情等级、TST筛查情况、TST结果7个因素为自变量。采用Cox比例风险模型进行单因素分析，结果显示，民办学校(HR=0.25，95%CI=0.10~0.59)、中疫情地区(HR=0.46，95%CI=0.23~0.94)中学生结核病发病风险均降低；TST结果为强阳性中学生(HR=1.39，95%CI=1.05~1.84)结核病发病风险增加(P值均 < 0.05)。
2.3　重庆市中学生结核病发病风险多因素分析
将单因素分析中P < 0.2的变量(学校属性、区域疫情等级、TST结果，考虑到卡介苗保护效果随年龄增长而减弱，将年龄纳入)纳入Cox回归模型进行多因素回归分析，结果显示，学校属性为中学生结核病发病的风险因素(P < 0.05)。见表3。
3　讨论
收起
2004—2021年，全国学生肺结核平均发病率为19.26/10万[10-11]。本研究队列学生人群年均发病率为55.93/10万，发病密度为55.95/10万，高于全国水平，提示学生群体防控压力较大。一方面可能与重庆学校结核病疫情较重有关[12]，另一方面队列人群以高中学生为主有关。随着年龄增长，学生学习负担不断加重；同时免疫系统发育尚未成熟，卡介苗保护效力下降，因此学生群体与其他群体比较更容易发生结核病的传播流行[13-14]。在2006—2018年全国报告的80多起学校结核病突发事件中，有70%的疫情发生在高中或中专[15]；各学龄阶段中，高中阶段报告肺结核例数占比最高(43.9%)[16]；此外，刘毅等[17]研究发现，国内高中生、初中生结核病发病率分别为38.17/10万、33.84/10万。
本研究发现，民办学校学生发病风险低于公办学校，可能原因有：一是民办学校办学资金充足，卫生工作经费相对充裕，其学校卫生技术人员配备情况优于公立学校[18-19]，对政府防疫政策的执行力度更强、且倾向于制定额外防控措施。二是民办学校学生升学等压力相对公办学校较小、营养补充较好，其自身免疫力状况良好，可能减少发病风险。
本研究证实学校所处区域的结核病疫情等级情况会增加学生结核病发病风险的推论。高疫情地区发病风险是中等疫情地区的2.17倍。可能与区域传染源密度有关，高疫情地区社区内潜伏感染者和活动性患者密度更高，学生通过家庭接触或社区活动感染后输入校园，形成传播链。
有研究报道，以每1 000人年计算结核病发病率，TST≥10 mm的普通人群为0.3(95%CI=0.1~1.1)[20]，肖海浩等[21]提出，结核分枝杆菌潜伏感染率与结核病发病率呈正相关。陈淑林等[22]研究发现高中新生PPD反应≥15 mm或有水泡者为高中期间结核病的高发人群。本研究也证实TST结果与学生结核病发病风险存在关联。采用Cox比例风险模型进行单因素分析发现，TST强阳性人群发病风险增加39.0%，印证潜伏感染者是结核病复燃的重要储备库；而TST中度阳性人群未显示显著风险，提示临界值人群需结合γ-干扰素释放试验二次筛查。此外，本次研究发现单纯PPD强阳性者随访观察2年，年均发病率为108.28/10万，低于北京市高校新生的129.29/10万[23]。
综合认为公办学校是结核病防控的关键，加强公办学校结核病防控措施落实，对于预防学校结核病疫情暴发和学生结核病感染至关重要。因此，应重点关注公办学校、高疫情地区的学校结核防治工作，关口前移对学生群体开展结核病筛查，并将TST结果为强阳性的学生人群进行重点管理和干预，以降低结核病发病率。
本研究也存在一定的局限性：(1)研究为固定队列研究，因队列规模较大，针对单个对象开展了1次TST检测，可能会存在漏诊。(2)单因素Cox回归分析发现TST一般阳性无统计学意义，但多因素分析时却存在意义，可能与随访时间仅2年而难以捕捉结核杆菌潜伏感染的长期转化规律有关，后续会进一步延长随访时间、持续分析具体原因及长期转化规律。
基金
收起
  • 重庆市科卫联合医学科研项目(2022MSXM018)；重庆市九龙坡区科技计划项目(No.2024-04-023-Y，No.2024-04-002-Z)；重庆市公共卫生重点专科(学科)科建设经费资助项目
文献
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2025年第46卷第9期
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doi: 10.16835/j.cnki.1000-9817.2025280
  • 接收时间：2025-04-22
  • 首发时间：2026-11-06
  • 出版时间：2025-09-25
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  • 收稿日期：2025-04-22
  • 修回日期：2025-07-07
基金
重庆市科卫联合医学科研项目(2022MSXM018)；重庆市九龙坡区科技计划项目(No.2024-04-023-Y，No.2024-04-002-Z)；重庆市公共卫生重点专科(学科)科建设经费资助项目
作者信息
    1重庆市结核病防治所医教科, 400050
    2重庆市结核病防治所综合防治科
    3重庆市结核病防治所行政办公室

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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