上海市学生中潜伏性结核感染的检出率及预防性治疗对未来结核病负担的影响：一项使用马尔可夫模型的预测研究
Impact of detection rate and preventive treatment of latent tuberculosis infection on the future burden of tuberculosis among students in shanghai: a predictive study using Markov modeling.
作者信息
Xiao Xiao, Li Zhipeng, Chen Jing, Shen Xin
机构信息
Division of Tuberculosis and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, China.
出版信息
BMC Public Health. 2025 Aug 12;25(1):2739. doi: 10.1186/s12889-025-23750-9.
BACKGROUND
Students represent a key demographic for tuberculosis (TB) control in China. This study utilizes a dynamic Markov model to forecast the epidemiological trends of active tuberculosis (ATB) among students in Shanghai through 2035 and evaluate the effectiveness of different control strategies.
METHODS
A Markov model incorporating six distinct states of TB transmission was utilized to simulate disease dynamics within a hypothetical cohort of 100,000 individuals. The model assessed the prevalence of latent tuberculosis infection (LTBI) and ATB, categorizing the cases based on whether they received the recommended treatment regimen.
RESULTS
Under the current measures without any additional interventions, the model projected a marginal decline in ATB prevalence. Specifically, ATB prevalence is predicted to decrease to 14.80 per 100,000 by 2035. With an increase in tuberculosis preventive treatment (TPT) coverage to 20%, 50%, or 80%, the reductions in ATB prevalence were modest. When the detection rate of LTBI was fixed at 12% and combined with TPT coverage levels of 20%, 50%, and 80%, the reductions in ATB prevalence were 17.01%, 36.56%, and 50.68% respectively. Increasing the detection rate of LTBI to 35% alongside TPT coverages of 20%, 50%, and 80% led to more pronounced declines in ATB prevalence, at 40.95%, 69.36%, and 80.46% respectively.
CONCLUSIONS
Under the current TB control measures, the prevalence of ATB among students would result in only marginal decline trajectories through 2035, falling substantially short of achieving the strategic goal of ending TB. Enhanced strategies that simultaneously increase detection rates and coverage of TPT are likely to significantly reduce ATB prevalence in this population.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1186/s12889-025-23750-9.
背景
在中国，学生是结核病防控的关键人群。本研究利用动态马尔可夫模型预测到2035年上海学生中活动性肺结核（ATB）的流行趋势，并评估不同防控策略的效果。
方法
采用一个包含六种不同结核病传播状态的马尔可夫模型，对一个10万人的假设队列中的疾病动态进行模拟。该模型评估潜伏性结核感染（LTBI）和ATB的患病率，并根据病例是否接受推荐治疗方案进行分类。
结果
在当前措施且无任何额外干预的情况下，模型预测ATB患病率将略有下降。具体而言，预计到2035年ATB患病率将降至每10万人14.80例。将结核病预防性治疗（TPT）覆盖率提高到20%、50%或80%时，ATB患病率的下降幅度不大。当LTBI检测率固定为12%并与20%、50%和80%的TPT覆盖率相结合时，ATB患病率的下降幅度分别为17.01%、36.56%和50.68%。将LTBI检测率提高到35%并与20%、50%和80%的TPT覆盖率相结合，导致ATB患病率更显著下降，分别为40.95%、69.36%和80.46%。
结论
在当前的结核病防控措施下，到2035年学生中ATB的患病率只会略有下降，远未达到终结结核病的战略目标。同时提高LTBI检测率和TPT覆盖率的强化策略可能会显著降低该人群中ATB的患病率。
补充信息
在线版本包含可在10.1186/s12889-025-23750-9获取的补充材料。
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