Truong D H, Hedemark L L, Mickman J K, Mosher L B, Dietrich S E, Lowry P W
Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis 55454-1015, USA.
JAMA. 1997 Mar 5;277(9):735-8.
To study screening outcomes among a group of Tibetan immigrants at high risk for developing active tuberculosis (TB) after arrival in Minnesota.
Retrospective cohort study.
A total of 191 Tibetan immigrants undergoing medical screening.
Occurrence and treatment outcomes of active TB.
A health maintenance organization and a public TB clinic in Minneapolis, Minn.
Positive (induration, > or =10 mm) tuberculin skin test results were documented in 98% of Tibetans, compared with 44% of Vietnamese, 10% of Hmong, and 51% of Russian refugees in Minnesota (P<.001 for each group). Sixteen active cases (8.4%) were confirmed by isolation of Mycobacterium tuberculosis; however, 5 (31%) were culture-negative on initial screening in Minnesota. Seven cases (44%) were diagnosed during initial screening efforts, and 9 cases (56%) were diagnosed a mean of 19 months (range, 10-27 months) after their initial medical evaluation. Of these 9 cases, 6 (38% of all Tibetan cases) had isolates resistant to 1 or more antituberculous drugs, and 3 (19% of all Tibetan cases) were multidrug resistant (MDR TB). All 3 MDR TB cases were culture-negative on initial screening; these cases constituted 75% of the MDR TB isolates in Minnesota in 1994. The presence of MDR TB was associated with a known history of active TB in Asia (P<.02). Any abnormality on chest radiograph noted either during the Immigration and Naturalization Service screening evaluation in India (relative risk [RR], 5.2; P=.006) or on arrival in Minnesota (RR, 6.8; P=.005) was associated with an increased risk of subsequent active TB.
Tuberculosis infection is nearly universal among Tibetans settling in Minnesota. A single screening evaluation failed to detect the majority of TB cases among Tibetans. Even in the face of negative M tuberculosis cultures, persons with a history of active TB require particularly close follow-up.
研究一批抵达明尼苏达州后有发生活动性结核病（TB）高风险的藏族移民的筛查结果。
回顾性队列研究。
总共191名接受医学筛查的藏族移民。
活动性TB的发生情况及治疗结果。
明尼阿波利斯市的一家健康维护组织和一家公共结核病诊所。
98%的藏族人结核菌素皮肤试验结果呈阳性（硬结≥10毫米），相比之下，明尼苏达州44%的越南人、10%的苗族人和51%的俄罗斯难民呈阳性（每组P<0.001）。通过结核分枝杆菌分离确诊了16例活动性病例（8.4%）；然而，在明尼苏达州初次筛查时有5例（31%）培养结果为阴性。7例（44%）在初次筛查时被诊断出来，9例（56%）在初次医学评估后平均19个月（范围10 - 27个月）被诊断出来。在这9例中，6例（占所有藏族病例的38%）分离株对1种或更多种抗结核药物耐药，3例（占所有藏族病例的19%）为耐多药（MDR - TB）。所有3例耐多药结核病病例初次筛查时培养结果均为阴性；这些病例占1994年明尼苏达州耐多药结核病分离株的75%。耐多药结核病的存在与在亚洲有活动性TB的已知病史相关（P<0.02）。在印度移民和归化局筛查评估期间（相对危险度[RR]，5.2；P = 0.006）或抵达明尼苏达州时（RR，6.8；P = 0.005）胸部X线片上发现的任何异常都与随后发生活动性TB的风险增加相关。
定居在明尼苏达州的藏族人中结核病感染几乎普遍存在。单次筛查评估未能检测出大多数藏族人中的TB病例。即使面对结核分枝杆菌培养结果为阴性，有活动性TB病史的人也需要特别密切的随访。
