Liu Y, Huang S, Jiang H, Xiong J, Wang Y, Ou M, Cai J, Yang C, Wang Z, Ge S, Xia N
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, 361102, PR China; National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, Xiamen University, Xiamen, Fujian, 361102, PR China.
Dongtai Center for Disease Control and Prevention, Jiangsu, 224000, PR China.
Public Health. 2017 May;146:39-45. doi: 10.1016/j.puhe.2017.01.008. Epub 2017 Feb 4.
Diagnosis and interventional treatment of latent tuberculosis (TB) infection (LTBI) are important components in tuberculosis control. But systematic studies regarding the epidemic of LTBI are still rare in China. The objective of this study was to assess the prevalence and risk factors associated with LTBI based on the results of a domestic TB-specific gamma interferon (IFN-γ) release assay (TB-IGRA) in rural Jiangsu, China.
Cross-sectional study of subjects registered in eight villages in Jiangsu, China.
This study was conducted in 2012 in eight villages. After recruitment, individuals with active TB or a history of TB were excluded. The TB-IGRA was performed for diagnosis of LTBI.
2169 of 2185 subjects met the requirement and were analysed in this study. 524 (24.3%) had a positive result, and positive rate gradually increased with age (P for trend <0.001). Multivariate analyses showed that increasing age, male gender and a history of TB exposure were risk factors associated with LTBI. Bacillus Calmette-Guérin (BCG) vaccination did not reduce the risk of TB infection in participants (aged ≥20 years).
The findings of this study demonstrate that the prevalence of LTBI in China might be overestimated by tuberculin skin test compared with IFN-γ release assay (IGRA). The degree of TB exposure is related to Mycobacterium tubercuium (MTB) infection, and BCG vaccination offers little protection against MTB infection in adults. The early and effective detection and treatment of active TB patients, and screening and intervention for LTBI patients with a high risk of developing active TB could be cost-effective methods for TB control in China.
潜伏性结核感染（LTBI）的诊断和介入治疗是结核病控制的重要组成部分。但在中国，关于LTBI流行情况的系统研究仍然很少。本研究的目的是基于中国江苏农村地区一项国内结核病特异性γ干扰素（IFN-γ）释放试验（TB-IGRA）的结果，评估LTBI的患病率及相关危险因素。
对在中国江苏八个村庄登记的受试者进行横断面研究。
本研究于2012年在八个村庄开展。招募后，排除活动性结核病患者或有结核病史者。采用TB-IGRA进行LTBI诊断。
2185名受试者中有2169名符合要求并纳入本研究分析。524名（24.3%）结果为阳性，且阳性率随年龄增长而逐渐升高（趋势P<0.001）。多因素分析显示，年龄增加、男性以及有结核接触史是与LTBI相关的危险因素。卡介苗（BCG）接种并未降低参与者（年龄≥20岁）的结核感染风险。
本研究结果表明，与IFN-γ释放试验（IGRA）相比，结核菌素皮肤试验可能高估了中国LTBI的患病率。结核暴露程度与结核分枝杆菌（MTB）感染有关，卡介苗接种对成人MTB感染几乎没有保护作用。对活动性结核病患者进行早期有效检测和治疗，以及对有发展为活动性结核病高风险的LTBI患者进行筛查和干预，可能是中国结核病控制的经济有效方法。
