Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
The First People's Hospital of Wenling, Zhejiang, China.
Microbiol Spectr. 2022 Dec 21;10(6):e0145122. doi: 10.1128/spectrum.01451-22. Epub 2022 Dec 1.
Silicosis is a well-established risk factor for Mycobacterium tuberculosis infection. This study aimed to estimate the burden and risk factors of M. tuberculosis infection. Silicosis patients from Zhejiang Province were screened for M. tuberculosis by sputum culture, chest radiographs, whole-blood gamma interferon (IFN-γ) release assay (QuantiFERON-TB Gold In-Tube [QFT-GIT]), and tuberculin skin test (TST). Potential risk factors for M. tuberculosis were identified. Data for 1,659 patients were obtained from 1,684 participants. Of these, 1,656 (99.8%) were men, and the average age was 58 (54 to 63) years. The prevalence of active tuberculosis (ATB) was 6,340/100,000 (6.34%) people; the proportion of patients with latent tuberculosis infection (LTBI) was 50.6%. Age (odds ratio [OR] = 1.059, 95% confidence interval [CI] = 1.020 to 1.099, 0.003), being underweight (OR = 2.320, 95% CI = 1.057 to 5.089, 0.036), and having a history of exposure to TB patients (OR = 4.329, 95% CI = 1.992 to 9.434, 0.001) were associated with ATB; BCG vaccination could reduce ATB risk in silicosis patients (OR = 0.541, 95% CI = 0.307 to 0.954, 0.034). Among patients without ATB, the QFT-GIT positivity rate was 40.5%, which was affected by silicosis severity, while that of TST was 57.2%. BCG vaccination was an independent factor for LTBI risk reduction (OR = 0.612, 95% CI = 0.468 to 0.801, 0.001). The quantitative results of QFT-GIT decreased with silicosis stage (=6.037; 0.048). In conclusion, M. tuberculosis prevalence was high in silicosis patients. BCG vaccination reduced the risk of both ATB and LTBI in silicosis patients. This study evaluated the prevalence of Mycobacterium tuberculosis infection in silicosis patients in mainland China and identified the potential risk factors for both active tuberculosis (ATB) and latent tuberculosis infection (LTBI). We believe that our study makes a significant contribution to the literature because we demonstrated that M. tuberculosis prevalence was high among silicosis patients. BCG vaccination was an independent factor that reduced the risk of M. tuberculosis infection in patients with silicosis. Furthermore, we show that the prevalence of LTBI in patients with silicosis may have been underestimated by immunological detection methods. This study can help to identify targeted subgroups prioritized for M. tuberculosis control and to reduce the risk of disease development.
矽肺是结核分枝杆菌感染的既定危险因素。本研究旨在估计结核分枝杆菌感染的负担和危险因素。从浙江省筛选矽肺患者进行结核分枝杆菌培养、胸部 X 线、全血γ干扰素（IFN-γ）释放试验（QuantiFERON-TB Gold In-Tube [QFT-GIT]）和结核菌素皮肤试验（TST）。确定了结核分枝杆菌的潜在危险因素。从 1684 名参与者中获得了 1659 名患者的数据。其中，1656 名（99.8%）为男性，平均年龄为 58（54 至 63）岁。活动性肺结核（ATB）的患病率为 6340/100000（6.34%）；潜伏性结核感染（LTBI）患者比例为 50.6%。年龄（比值比[OR] = 1.059，95%置信区间[CI] = 1.020 至 1.099，0.003）、体重不足（OR = 2.320，95%CI = 1.057 至 5.089，0.036）和有接触结核患者的病史（OR = 4.329，95%CI = 1.992 至 9.434，0.001）与 ATB 相关；BCG 疫苗接种可降低矽肺患者的 ATB 风险（OR = 0.541，95%CI = 0.307 至 0.954，0.034）。在没有 ATB 的患者中，QFT-GIT 阳性率为 40.5%，受矽肺严重程度影响，而 TST 阳性率为 57.2%。BCG 疫苗接种是 LTBI 风险降低的独立因素（OR = 0.612，95%CI = 0.468 至 0.801，0.001）。QFT-GIT 的定量结果随着矽肺阶段的增加而降低（=6.037；0.048）。总之，矽肺患者中结核分枝杆菌的患病率较高。BCG 疫苗接种可降低矽肺患者活动性结核病（ATB）和潜伏性结核病（LTBI）的风险。本研究评估了中国大陆矽肺患者中结核分枝杆菌感染的流行情况，并确定了活动性结核病（ATB）和潜伏性结核病感染（LTBI）的潜在危险因素。我们认为我们的研究对文献做出了重要贡献，因为我们表明矽肺患者中结核分枝杆菌的患病率很高。BCG 疫苗接种是降低矽肺患者结核分枝杆菌感染风险的独立因素。此外，我们表明，免疫检测方法可能低估了矽肺患者 LTBI 的患病率。本研究有助于确定结核分枝杆菌控制的目标亚组，并降低疾病发展的风险。
