Tsukishima Eri, Mitsuhashi Yuu, Yano Koichi, Takase Aiko, Kamada Arisu, Amishima Masaru, Akiyama Yasushi, Fujino Michihiro, Tobise Katsuyuki, Kishi Fujiya
Sapporo Public Health Office, 19 Odori Nishi, Chuo-ku, Sapporo-shi, Hokkaido 060-0042, Japan.
Kekkaku. 2007 May;82(5):459-66.
Isolates of M. tuberculosis were analyzed for their DNA fingerprints to facilitate understanding of ongoing transmission of tuberculosis in Sapporo (population 1.87 million), Japan, where the incidence rate of tuberculosis was 15.0 per 100,000 in 2004.
Out of all tuberculosis patients registered in the city from November 1998 to December 2003, isolates from culture-positive respiratory tuberculosis cases for whom written informed consent had been obtained, were analyzed by restriction fragment length polymorphism (RFLP). The study included 345 cases (249 men and 96 women) whose isolates were available for DNA patterns.
Using standard IS6110-RFLP typing, cases whose isolates shared identical fingerprints were considered to belong to the same cluster. Proportions of clustered cases were evaluated according to their clinical and socio-economical characteristics.
Out of 345 cases, 207 (60.0%) were classified into 59 clusters, and 15% of clustered cases having definite epidemiological links. Multiple logistic regression analysis in men showed that age and infectiousness were significantly related to clustering. The adjusted odds ratios (OR) [95% confidence intervals (CI)] were 0.17 [0.03-0.79] for 30-59 years, 0.15 [0.03-0.69] for 60 years or over and 2.35 [1.17-4.70] for those cases assigned as the highest level of transmission of tuberculosis from the infectiousness index of cases. For women the final model showed the adjusted OR [95% CI] were 0.52 [0.22-1.22] for those with previous history of tuberculosis and 0.33 [0.06-1.85] for diabetics. In male cases with a previous history of tuberculosis, most highly infectious cases were significantly associated with clustering (OR [95% CI], 4.53 [1.16-17.68]).
The results suggest that highly infectious male tuberculosis cases with endogenous reactivation have contributed to recent transmission of tuberculosis in the studied area.
对结核分枝杆菌分离株进行DNA指纹分析，以促进对日本札幌市（人口187万）结核病传播情况的了解，该市2004年结核病发病率为十万分之15.0。
在1998年11月至2003年12月期间在该市登记的所有结核病患者中，对获得书面知情同意的培养阳性呼吸道结核病病例的分离株进行限制性片段长度多态性（RFLP）分析。该研究纳入了345例病例（249名男性和96名女性），其分离株可用于DNA图谱分析。
采用标准的IS6110-RFLP分型方法，分离株指纹相同的病例被认为属于同一簇。根据病例的临床和社会经济特征评估簇状病例的比例。
在345例病例中，207例（60.0%）被分为59个簇，15%的簇状病例有明确的流行病学关联。男性的多因素logistic回归分析显示，年龄和传染性与聚类显著相关。30至59岁患者的调整优势比（OR）[95%置信区间（CI）]为0.17[0.03 - 0.79]，60岁及以上患者为0.15[0.03 - 0.69]，根据病例传染性指数被判定为结核病传播最高水平的患者为2.35[1.17 - 4.70]。对于女性，最终模型显示有结核病既往史的患者调整OR[95%CI]为0.52[0.22 - 1.22]，糖尿病患者为0.33[0.06 - 1.85]。在有结核病既往史的男性病例中，传染性最强的病例与聚类显著相关（OR[95%CI]，4.53[1.16 - 17.68]）。
结果表明，具有内源性再激活的高传染性男性结核病病例促成了研究区域近期的结核病传播。
