Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Mongolian Health Initiative, Ulaanbaatar.
Clin Infect Dis. 2019 Aug 16;69(5):813-819. doi: 10.1093/cid/ciy975.
There is controversy regarding the potential influence of vitamin D deficiency, exposure to environmental tobacco smoke, BCG vaccination, season, and body habitus on susceptibility to Mycobacterium tuberculosis (MTB) infection.
We conducted a cross-sectional analysis to identify determinants of a positive QuantiFERON-TB Gold (QFT) assay result in children aged 6-13 years attending 18 schools in Ulaanbaatar, Mongolia. Data relating to potential risk factors for MTB infection were collected by questionnaire, physical examination, and determination of serum 25-hydroxyvitamin D (25[OH]D) concentrations. Risk ratios (RRs) were calculated with adjustment for potential confounders, and population attributable fractions (PAFs) were calculated for modifiable risk factors identified.
Nine hundred forty-six of 9810 (9.6%) participants had a positive QFT result. QFT positivity was independently associated with household exposure to pulmonary tuberculosis (adjusted RR [aRR], 4.75 [95% confidence interval {CI}, 4.13-5.46, P < .001]; PAF, 13.1% [95% CI, 11.1%-15.0%]), vitamin D deficiency (aRR, 1.23 [95% CI, 1.08-1.40], P = .002; PAF, 5.7% [95% CI, 1.9%-9.3%]), exposure to environmental tobacco smoke (1 indoor smoker, aRR, 1.19 [95% CI, 1.04-1.35]; ≥2 indoor smokers, aRR, 1.30 [95% CI, 1.02-1.64]; P for trend = .006; PAF, 7.2% [95% CI, 2.2%-12.0%]), and increasing age (aRR per additional year, 1.14 [95% CI, 1.10-1.19], P < .001). No statistically significant independent association was seen for presence of a BCG scar, season of sampling, or body mass index.
Vitamin D deficiency and exposure to environmental tobacco smoke are potentially modifiable risk factors for MTB infection.
维生素 D 缺乏、接触环境烟草烟雾、卡介苗接种、季节和体型等因素对结核分枝杆菌（MTB）感染的易感性有潜在影响，这方面存在争议。
我们进行了一项横断面分析，以确定在蒙古乌兰巴托的 18 所学校中，6-13 岁儿童中定量干扰素 -TB 黄金（QFT）检测结果阳性的决定因素。通过问卷调查、体格检查和血清 25-羟维生素 D（25[OH]D）浓度测定收集与 MTB 感染潜在危险因素相关的数据。在调整潜在混杂因素后，计算风险比（RR），并为确定的可改变危险因素计算人群归因分数（PAF）。
在 9810 名参与者中，946 名（9.6%）的 QFT 检测结果为阳性。QFT 阳性与家庭接触肺结核（调整 RR [aRR]，4.75 [95%置信区间 {CI}，4.13-5.46，P<0.001]；PAF，13.1%[95%CI，11.1%-15.0%]）、维生素 D 缺乏（aRR，1.23 [95%CI，1.08-1.40]，P=0.002；PAF，5.7%[95%CI，1.9%-9.3%]）、接触环境烟草烟雾（1 个室内吸烟者，aRR，1.19 [95%CI，1.04-1.35]；≥2 个室内吸烟者，aRR，1.30 [95%CI，1.02-1.64]；趋势 P 值=0.006；PAF，7.2%[95%CI，2.2%-12.0%]）和年龄增长（每增加 1 岁的 RR，1.14 [95%CI，1.10-1.19]，P<0.001）有关。BCG 疤痕的存在、采样季节或体重指数与 MTB 感染无统计学显著独立关联。
维生素 D 缺乏和接触环境烟草烟雾是 MTB 感染的潜在可改变危险因素。
