农村居民结核病感染流行的动态变化：中国一项基于人群的多中心队列研究的10年随访

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific Pub Date : 2025-03-01 DOI:10.1016/j.lanwpc.2025.101509

Xuefang Cao , Lei Gao , Henan Xin , Limei Zhu , Weitao Duan , Boxuan Feng , Wei Lu , Zisen Liu , Yijun He , Lingyu Shen , Juanjuan Huang , Bin Zhang , Dakuan Wang , Jiaoxia Yan , Cheng Chen , Lihui Wang , Wenhua Yin , Guochen Wang , Tonglei Guo , Yuanzhi Di , Qi Jin

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引用次数: 0

摘要

近年来，中国结核病的发病率显著下降。然而，结核病感染（TBI）负担的下降尚未得到系统评估。本研究的目的是阐明在过去的十年TBI患病率的变化。方法采用开放式队列设计，采用人群为基础的多中心队列研究（LATENTTB-NSTM），对中木和丹阳两个研究点的户籍居民（≥18岁）进行10年随访。排除活动性结核后，采用结核菌素皮肤试验（TST）和干扰素γ释放试验（IGRA）确定每位参与者的TBI状态。总的来说，5924名完成随访调查的合格参与者被纳入分析。与2013年IGRA测定的年龄和性别标准化TBI患病率相比，2023年丹阳站点TBI患病率下降了22.24%（从15.11%降至11.75%），中木站点TBI患病率下降了40.86%（从16.57%降至9.80%）。TST检测的TBI患病率也呈持续下降趋势。通过2013年和2023年分别参与调查的4648名参与者的IGRA结果转化率来评估10年内TBI的获取情况。丹阳样地IGRA转化率显著高于中木样地(4% vs. 2%, p <；0·0001)。两试验点IGRA结果的逆转率比较，差异无统计学意义（丹阳试验点为29%，中木试验点为31%，p = 0.577）。与女性相比，男性与IGRA转化风险增加相关，校正优势比（OR）为1.46（95%可信区间[CI]: 1.00 - 2·13）。此外，与当前吸烟者相比，从不吸烟者的IGRA逆转率显著更高（OR = 2.91, 95% CI: 1.52 - 5.57）（p = 0.001）。我们还发现，出生时接种卡介苗对15岁及以上人群TST阳性的影响不显著。我们的研究结果表明，在过去十年中，随着结核病发病率的下降，中国农村居民的TBI患病率显著下降。下降趋势显示出地区差异，部分原因可能是各地区新感染率的差异。资助CAMS医学创新基金和国家自然科学基金。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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The dynamic change of tuberculosis infection prevalence in rural residents: 10-year follow-up of a population-based, multicentre cohort study from China

Background

The incidence of tuberculosis (TB) decreased significantly in recent years in China. However, the declining in the burden of tuberculosis infection (TBI) have not been systematically evaluated. The aim of this study was to elucidate the changes of TBI prevalence during the past decade.

Methods

Based on a population-based, multicenter cohort study (LATENTTB-NSTM), a 10-year follow-up survey was conducted among registered residents (≥18 years old) at two study sites (Zhongmu and Danyang) using open-cohort design. After excluding active TB, tuberculin skin test (TST) and interferon-γ release assay (IGRA) were used to determine TBI status of each participant.

Findings

Overall, 5924 eligible participants who completed the follow-up survey were included in the analysis. Compared to the age- and gender-standardized TBI prevalence determined by IGRA in 2013, the prevalence of TBI was observed to be decreased by 22·24% (from 15·11% to 11·75%) in Danyang site and by 40·86% (from 16·57% to 9·80%) in Zhongmu site in 2023. A consistently declining trend was observed as well for TBI prevalence determined by TST test. The acquisition of TBI in 10 years was assessed by the conversion rate of IGRA result in 4648 participants who participated in both the 2013 and 2023 surveys. The IGRA conversion rate in Danyang site was significantly higher than that in Zhongmu site (4% vs. 2%, p < 0·0001). The reversion rate of IGRA result was assessed as well, and no statistically significant difference was observed between the two study sites (29% in Danyang site vs. 31% in Zhongmu site, p = 0·577). Male gender was found to be associated with an increased risk of IGRA conversion as compared to female, with adjusted odds ratio (OR) of 1·46 (95% confidence interval [CI]: 1·00–2·13). In addition, never smokers were observed to be associated with significantly higher IGRA reversion rates (OR = 2·91, 95% CI: 1·52–5·57) (p = 0.001) as compared to current smokers. We also found the influence of BCG vaccination at birth on TST positivity was non-significant among individuals aged 15 and above.

Interpretation

Our findings suggest that the prevalence of TBI in rural residents from China has significantly decreased along with the declining of TB incidence in the last decade. The downward trend shows regional differences, which might be partly explained by the difference in new infection rates across regions.

Funding

The CAMS Innovation Fund for Medical Sciences and the National Natural Science Foundation of China.

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来源期刊

The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health

CiteScore

8.80

自引率

2.80%

发文量

305

审稿时长

11 weeks

期刊介绍： The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.