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场所:土耳其伊斯坦布尔7个公共结核病防治所。目的:调查伊斯坦布尔新诊断的痰涂片阳性肺结核患者成年家庭接触者(≥15岁)患活动性结核病的风险。设计:对1997—2000年在伊斯坦布尔7家结防所登记的1 570例结核病成年家庭接触者的回顾性分析。结果:研究包括6 188例家庭接触者(平均接触者/线索病例:3.9),其中4 114例(67%)大于15岁(平均接触者/线索病例:2.6);3 310例(80.5%)参加了接触者调查。平均随访时间2.2年(1～4年);发现222例活动性结核病例(5.4%,95%可信区间5.2～5.6),第一年发现171例。活动性结核发病率为2 491/100 000(15～34岁年龄组发病率3 555/100 000,大于35岁年龄组发病率1 195/100 000,P<0.000 1)。活动性结核病发病率最高的在15～24岁(8.5%)和25～34岁(6.5%)年龄组。结论:涂片阳性肺结核患者的成年家庭接触者活动性结核发病率高。这样的高发病率说明化学预防治疗对于所有接触者,特别是年龄为15～34岁的接触者都是必要的,而不应仅仅用于儿童。
Venue: 7 public tuberculosis prevention and control facilities in Istanbul, Turkey. PURPOSE: To investigate the risk of developing active tuberculosis among adult family contacts (≥15 years) in newly diagnosed sputum smear-positive tuberculosis patients in Istanbul. Design: A retrospective review of 1 570 adult TB family contacts registered at seven blisters in Istanbul in 1997-2000. RESULTS: A total of 6,188 family contacts (mean contacts / clue cases: 3.9) were included in the study, of which 4,114 (67%) were older than 15 years (average contact / clues: 2.6) Participated in the contact investigation. The average follow-up time was 2.2 years (1-4 years). A total of 222 active tuberculosis cases were found (5.4%, 95% confidence interval 5.2-5.6). A total of 171 cases were found in the first year. The incidence of active tuberculosis was 2 491/100 000 (incidence rate of 3 555/100 000 in the age group of 15-34 years and incidence of 1 195/100 000 in the group older than 35 years old, P 0.0001). The highest incidence of active TB was in the 15-24 years (8.5%) and 25-34 (6.5%) age groups. Conclusion: The incidence of active tuberculosis among adult family contacts in smear-positive pulmonary tuberculosis patients is high. This high incidence suggests that chemopreventive treatment is necessary for all contacts, especially those aged 15-34, and should not be used exclusively for children.