潜伏性结核感染、结核菌素皮肤试验与结核患者接触者的维生素 D 状态：一项横断面和病例对照研究。
Latent tuberculosis infection, tuberculin skin test and vitamin D status in contacts of tuberculosis patients: a cross-sectional and case-control study.
机构信息
Epidemiology Division, Public Health Center Castellón, Spain.
出版信息
BMC Infect Dis. 2011 Dec 15;11:349. doi: 10.1186/1471-2334-11-349.
BACKGROUND
Deficient serum vitamin D levels have been associated with incidence of tuberculosis (TB), and latent tuberculosis infection (LTBI). However, to our knowledge, no studies on vitamin D status and tuberculin skin test (TST) conversion have been published to date. The aim of this study was to estimate the associations of serum 25-hydroxyvitamin D3 (25[OH]D) status with LTBI prevalence and TST conversion in contacts of active TB in Castellon (Spain).
METHODS
The study was designed in two phases: cross-sectional and case-control. From November 2009 to October 2010, contacts of 42 TB patients (36 pulmonary, and 6 extra-pulmonary) were studied in order to screen for TB. LTBI and TST conversion cases were defined following TST, clinical, analytic and radiographic examinations. Serum 25(OH)D levels were measured by electrochemiluminescence immunoassay (ECLIA) on a COBAS® 410 ROCHE® analyzer. Logistic regression models were used in the statistical analysis.
RESULTS
The study comprised 202 people with a participation rate of 60.1%. Only 20.3% of the participants had a sufficient serum 25(OH)D (≥ 30 ng/ml) level. In the cross-sectional phase, 50 participants had LTBI and no association between LTBI status and serum 25(OH)D was found. After 2 months, 11 out of 93 negative LTBI participants, without primary prophylaxis, presented TST conversion with initial serum 25(OH)D levels: a:19.4% (7/36): < 20 ng/ml, b:12.5% (4/32):20-29 ng/ml, and c:0%(0/25) ≥ 30 ng/ml. A sufficient serum 25(OH)D level was a protector against TST conversion a: Odds Ratio (OR) = 1.00; b: OR = 0.49 (95% confidence interval (CI) 0.07-2.66); and c: OR = 0.10 (95% CI 0.00-0.76), trends p = 0.019, adjusted for high exposure and sputum acid-fast bacilli positive index cases. The mean of serum level 25(OH)D in TST conversion cases was lower than controls,17.5 ± 5.6 ng/ml versus 25.9 ± 13.7 ng/ml (p = 0.041).
CONCLUSIONS
The results suggest that sufficient serum 25(OH)D levels protect against TST conversion.
背景
血清维生素 D 水平不足与结核病（TB）和潜伏性结核感染（LTBI）的发病率有关。然而，据我们所知，目前尚无关于维生素 D 状态和结核菌素皮肤试验（TST）转化的研究。本研究旨在评估血清 25-羟维生素 D3（25[OH]D）水平与 Castellon（西班牙）活动性 TB 接触者中 LTBI 患病率和 TST 转化的相关性。
方法
该研究分为两个阶段进行：横断面和病例对照。2009 年 11 月至 2010 年 10 月，对 42 例结核病患者（36 例肺部，6 例肺外）的接触者进行研究，以筛查结核病。LTBI 和 TST 转化病例是根据 TST、临床、分析和影像学检查确定的。血清 25（OH）D 水平采用电化学发光免疫分析（ECLIA）在 COBAS®410 ROCHE®分析仪上进行测量。统计分析采用逻辑回归模型。
结果
该研究共纳入 202 人，参与率为 60.1%。只有 20.3%的参与者血清 25（OH）D 水平充足（≥30ng/ml）。在横断面阶段，50 名参与者患有 LTBI，血清 25（OH）D 水平与 LTBI 状态之间无关联。2 个月后，93 名未接受初发预防的 LTBI 阴性参与者中有 11 名出现 TST 转化，初始血清 25（OH）D 水平为：a：19.4%（7/36）：<20ng/ml，b：12.5%（4/32）：20-29ng/ml，c：0%（0/25）≥30ng/ml。血清 25（OH）D 水平充足是 TST 转化的保护因素：a：优势比（OR）=1.00；b：OR=0.49（95%置信区间（CI）0.07-2.66）；c：OR=0.10（95%CI 0.00-0.76），趋势 p=0.019，调整高暴露和痰酸杆菌阳性指数病例后。TST 转化病例的血清 25（OH）D 平均水平低于对照组，17.5±5.6ng/ml 与 25.9±13.7ng/ml（p=0.041）。
结论
结果表明，充足的血清 25（OH）D 水平可预防 TST 转化。
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