Cao Xuefang, Gao Lei, Xin Henan, Zhu Limei, Duan Weitao, Feng Boxuan, Lu Wei, Liu Zisen, He Yijun, Shen Lingyu, Huang Juanjuan, Zhang Bin, Wang Dakuan, Yan Jiaoxia, Chen Cheng, Wang Lihui, Yin Wenhua, Wang Guochen, Guo Tonglei, Di Yuanzhi, Li Zihan, Liang Jianguo, Zhao Yaqi, Li Hongzhi, Shen Fei, Du Jiang, Jin Qi
NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China.
Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China.
Lancet Reg Health West Pac. 2025 Mar 6;56:101509. doi: 10.1016/j.lanwpc.2025.101509. eCollection 2025 Mar.
The incidence of tuberculosis (TB) decreased significantly in recent years in China. However, the declining in the burden of tuberculosis infection (TBI) have not been systematically evaluated. The aim of this study was to elucidate the changes of TBI prevalence during the past decade.
Based on a population-based, multicenter cohort study (LATENTTB-NSTM), a 10-year follow-up survey was conducted among registered residents (≥18 years old) at two study sites (Zhongmu and Danyang) using open-cohort design. After excluding active TB, tuberculin skin test (TST) and interferon-γ release assay (IGRA) were used to determine TBI status of each participant.
Overall, 5924 eligible participants who completed the follow-up survey were included in the analysis. Compared to the age- and gender-standardized TBI prevalence determined by IGRA in 2013, the prevalence of TBI was observed to be decreased by 22·24% (from 15·11% to 11·75%) in Danyang site and by 40·86% (from 16·57% to 9·80%) in Zhongmu site in 2023. A consistently declining trend was observed as well for TBI prevalence determined by TST test. The acquisition of TBI in 10 years was assessed by the conversion rate of IGRA result in 4648 participants who participated in both the 2013 and 2023 surveys. The IGRA conversion rate in Danyang site was significantly higher than that in Zhongmu site (4% vs. 2%, p < 0·0001). The reversion rate of IGRA result was assessed as well, and no statistically significant difference was observed between the two study sites (29% in Danyang site vs. 31% in Zhongmu site, p = 0·577). Male gender was found to be associated with an increased risk of IGRA conversion as compared to female, with adjusted odds ratio (OR) of 1·46 (95% confidence interval [CI]: 1·00-2·13). In addition, never smokers were observed to be associated with significantly higher IGRA reversion rates (OR = 2·91, 95% CI: 1·52-5·57) (p = 0.001) as compared to current smokers. We also found the influence of BCG vaccination at birth on TST positivity was non-significant among individuals aged 15 and above.
Our findings suggest that the prevalence of TBI in rural residents from China has significantly decreased along with the declining of TB incidence in the last decade. The downward trend shows regional differences, which might be partly explained by the difference in new infection rates across regions.
The CAMS Innovation Fund for Medical Sciences and the National Natural Science Foundation of China.
近年来，中国结核病（TB）发病率显著下降。然而，结核感染负担（TBI）的下降情况尚未得到系统评估。本研究旨在阐明过去十年间TBI患病率的变化情况。
基于一项以人群为基础的多中心队列研究（LATENTTB-NSTM），采用开放队列设计，在两个研究地点（中牟和丹阳）对登记居民（≥18岁）进行了为期10年的随访调查。排除活动性结核病后，采用结核菌素皮肤试验（TST）和干扰素-γ释放试验（IGRA）确定每位参与者的TBI状态。
总体而言，5924名完成随访调查的合格参与者纳入分析。与2013年通过IGRA确定的年龄和性别标准化TBI患病率相比，2023年丹阳地区TBI患病率下降了22.24%（从15.11%降至11.75%），中牟地区下降了40.86%（从16.57%降至9.80%）。TST检测确定的TBI患病率也呈现出持续下降趋势。通过对4648名参加了2013年和2023年两次调查的参与者的IGRA结果转化率评估10年期间的TBI获得情况。丹阳地区的IGRA转化率显著高于中牟地区（4%对2%，p<0.0001）。还评估了IGRA结果的逆转率，两个研究地点之间未观察到统计学显著差异（丹阳地区为29%，中牟地区为31%，p=0.577）。发现男性与女性相比，IGRA转化风险增加，调整后的优势比（OR）为1.46（95%置信区间[CI]：1.00-2.13）。此外，与当前吸烟者相比，从不吸烟者的IGRA逆转率显著更高（OR=2.91，95%CI：1.52-5.57）（p=0.001）。我们还发现，出生时接种卡介苗对15岁及以上个体TST阳性的影响不显著。
我们的研究结果表明，随着过去十年结核病发病率的下降，中国农村居民的TBI患病率显著降低。下降趋势存在地区差异，这可能部分由各地区新感染率的差异所解释。
中国医学科学院医学创新基金和国家自然科学基金。
