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目的分析2007—2008年山东省济宁市嘉祥县某中学一起结核病聚集性疫情的情况。方法以线索病例为依据,对该校3254名学生进行PPD试验和症状筛查。对分离培养的Mtb进行24位点分枝杆菌散在重复单位—可变数目串联重复序列(Mycobacterial interspersed repetitive unit-variable number tandem repeat,MIRU-VNTR)基因分型分析。采用logistic回归分析法,分析菌阳患者暴露程度和确诊为活动性结核病患者(active tu-berculosis,ATB)或潜伏感染者(LTBI)的关系。结果筛查该中学学生的Mtb潜伏感染率为28.8%,共确诊10例活动性肺结核患者,其中3例培养阳性。24位点MIRU-VNTR基因分型3株菌株结果显示,2株菌株基因型成簇,1株菌株位点Mutub4、Mtub21和QUB-26拷贝数不同。logistic回归分析结果显示与菌阳患者同班级或同年级是被诊断为ATB或LTBI的危险因素。结论该次结核疫情中,3位菌阳患者在学校引起了一定程度的传播,可能导致了另外7例ATB的暴发。因此对学生结核病患者的及时确诊和有效治疗,以及对学生及时进行结核病筛查对控制学校结核病暴发具有重要意义。
Objective To analyze the epidemic situation of tuberculosis in a middle school in Jiaxiang County, Jining City, Shandong Province from 2007 to 2008. Methods Based on clues, PPD test and symptom screening were conducted on 3254 students in this school. Mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) genotype analysis was performed on the isolated and cultured Mtb. Logistic regression analysis was used to analyze the relationship between exposure to bacillary-positive patients and the diagnosis of active tu-berculosis (ATB) or latent infection (LTBI). Results The high prevalence of Mtb infection among secondary school students was 28.8%. A total of 10 patients with active pulmonary tuberculosis were identified, of which 3 were positive for culture. The results of genotyping MIRU-VNTR at the 24 locus showed that the two strains were clustered in one genotype, and Mutub4, Mtub21 and QUB-26 were different in one strain. Logistic regression analysis showed that the same or the same grade of bacillary positive patients were at risk of being diagnosed with ATB or LTBI. Conclusions In this outbreak of tuberculosis, 3 bacillary positive patients caused a certain degree of spread in school, which may lead to another 7 cases of ATB outbreaks. Therefore, the timely diagnosis and effective treatment of students with tuberculosis patients, as well as timely screening for tuberculosis students to control school tuberculosis outbreak is of great significance.