传染病信息

目的 分析病原学阳性肺结核患者密切接触者的结核菌素试验（tuberculin skin test，又称PPD试验）结果并调查密切接触者预防性治疗的情况。方法 筛查2024年1月至2025年3月在保定市人民医院确诊的105例病原学阳性肺结核患者的密切接触者，共判定2 489例密切接触者，其中2 304例接受了PPD试验。采用整体检验以及Bonferroni校正法两两比较不同性别和不同年龄组的PPD试验结果，随访调查2 489例密切接触者的预防性治疗情况。结果 病原学阳性肺结核患者密切接触者的PPD试验接受率为92.57%，阳性率为39.11%。女性阳性率（43.52%）高于男性阳性率（34.64%），差异有统计学意义（P<0.05）。女性弱阳性率（22.63%）和强阳性率（7.69%）均高于男性（17.80%、4.10%），差异有统计学意义（校正后P均<0.017）；女性与男性的中阳性率比较，差异无统计学意义（校正后P>0.017）。不同年龄组阳性率与阴性率比较，差异无统计学意义（P=0.370）；组间中阳性率比较，差异无统计学意义（P=0.850）；组间弱阳性率比较，差异有统计学意义（P<0.001）；组间强阳性率比较，差异有统计学意义（P<0.001）。≥60岁组的强阳性率为8.39%，高于>18～59岁组（6.18%），也高于≤18岁组（0.36%）,>18～59岁组的强阳性率高于≤18岁组；≤18岁组的弱阳性率为29.93%，高于>18～59岁组（19.05%），也高于≥60岁组（18.41%）；差异均有统计学意义（校正后P均<0.017）。密切接触者预防性治疗率为76.48%，预防性治疗完成率为65.21%。未完成预防性治疗者中出现不良反应的占31.48%。136例PPD试验强阳性的密切接触者中活动性肺结核的发病率为19.85%。2 257例密切接触者随访至2025年12月，随访时间（15.42±2.66）个月。其中，接受预防性治疗者的发病率为0.17%，未接受预防性治疗者的发病率为2.20%，相对危险度为0.08，预防性治疗的保护率为92.3%，差异有统计学意义（P<0.001）。结论 女性和老年人群密切接触病原学阳性肺结核患者后强阳性的风险更高。预防性治疗可降低密切接触者的肺结核发病率，但预防性治疗的不良反应会影响其依从性。

Objective To analyze tuberculin skin test(PPD test) results and preventive treatment among close contacts of patients with bacteriologically confirmed pulmonary tuberculosis. Methods Close contacts of 105 patients with bacteriologically confirmed pulmonary tuberculosis diagnosed at Baoding People's Hospital between January 2024 and March 2025 were screened. A total of 2 489 close contacts were identified. Of these, 2 304 received the PPD test. The test results were analyzed, and the prophylactic treatment status of all 2 489 close contacts was followed up. Results The PPD test uptake rate was 92.57%, and the positive rate was 39.11%. The positive rate among females was 43.52%, which was higher than that among males(34.64%), and the difference was statistically significant(P<0.05). The proportions of weakly positive and strongly positive PPD test results were higher in females than in males(both corrected P<0.017); the difference in the moderate positive rate was not statistically significant(corrected P>0.017). There was no statistically significant difference in the positive and negative rates among different age groups(P=0.370); the difference in the moderate positive rate among groups was not statistically significant(P=0.850); the difference in the weak positive rate among groups was statistically significant(P<0.001); the difference in the strong positive rate among groups was statistically significant(P<0.001). Bonferroni correction for pairwise comparisons: the strong positive rate of those aged ≥60 years was 8.39%, which was higher than that of those aged >18-59 years(6.18%) and those aged ≤18 years(0.36%); the strong positive rate of those aged >18-59 years was higher than that of those aged ≤18 years; the weak positive rate of those aged ≤18 years was 29.93%, which was higher than that of those aged >18-59 years(19.05%) and those aged ≥60 years(18.41%); all differences were statistically significant(corrected P<0.017). The rate of prophylactic treatment for close contacts was 76.48%, and the completion rate of prophylactic treatment was 65.21%. The reasons for incomplete prophylactic treatment included adverse reactions, accounting for 31.48%. Among the 136 individuals with a strongly positive result, the incidence of active pulmonary tuberculosis was 19.85%. 2 257 individuals were followed up until December 2025, with a follow-up duration of(15.42±2.66) months. Among them, the incidence rate of those who received prophylactic treatment was 0.17%, and that of those who did not receive prophylactic treatment was 2.20%, with a relative risk of 0.08. The protective rate of prophylactic treatment was 92.3%, and the difference was statistically significant(P<0.001). Conclusion Females and older individuals were more likely to have strongly positive PPD test results. Prophylactic treatment can reduce the incidence of pulmonary tuberculosis, but adverse reactions to prophylactic treatment may affect compliance.