Incidence of active tuberculosis in individuals with latent tuberculosis infection in rural China: follow-up results of a population-based, multicentre, prospective cohort study
Incidence of active tuberculosis in individuals with latent tuberculosis infection in rural China: follow-up results of a population-based, multicentre, prospective cohort study
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中国农村潜伏性结核感染个体中活动性结核病的发病率：一项基于人群的多中心前瞻性队列研究的随访结果
DOI：
10.1016/s1473-3099(17)30402-4
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发表时间：
2017-10-01
影响因子：
56.3
通讯作者：
Jin, Qi
中科院分区：
文献类型：
--
作者：
Gao, Lei;Li, Xiangwei;Jin, Qi
背景 潜伏结核分枝杆菌感染的管理是世界卫生组织终止结核病（TB）战略的一项新的优先行动。然而，中国尚未制定潜伏性结核感染检测和治疗的国家指南。在此，我们展示了一项研究的 2 年随访结果，该研究旨在追踪潜伏性结核感染个体的活动性疾病发展情况，确定潜伏性感染管理的优先人群，并探索最合适的潜伏性感染诊断方法。方法 2013 年至 2015 年间，在中国农村的四个地点进行了一项基于人群的多中心前瞻性研究。2013 年的基线调查使用以下方法测量了潜伏性结核感染的患病率：对符合条件的参与者进行 QuantiFERON-TB Gold In-Tube (QFT) 和结核菌素皮试 (TST)。在 2014-15 年间的随访阶段，我们通过积极的病例发现，评估了基线时患有结核病感染的个体（QFT 阳性或 TST 结核菌素反应大小 [硬结] >= 10 毫米）的活动性疾病发展情况。符合追踪调查条件的受试者出生日期在2008年6月1日之前（2013年为5岁或以上），并且过去一年在研究地点连续居住6个月或以上。基线调查时当前患有活动性结核病的参与者被排除在外。 结果在2013年9月1日至2015年8月31日之间，基线检查后，7505名符合条件的参与者（5岁或以上）被纳入结核感染测试阳性队列（4455名QFT阳性，6404名TST硬结≥10毫米，3354名两项测试均呈阳性）。在2年的随访期间，诊断出84例活动性结核病病例。在患有活动性结核病的参与者中，75 人通过 QFT 诊断为潜伏感染，62 人通过 TST 诊断，53 人通过两项测试诊断。对于 QFT 检测呈阳性的个体，观察到的发病率为每 100 人年 0.87 (95% CI 0.68-1.07)，对于 TST 检测呈阳性的个体，发病率为每 100 人年 0.50 (0.38-0.63) (p
Background The management of latent Mycobacterium tuberculosis infection is a new priority action for the WHO End Tuberculosis (TB) Strategy. However, national guidelines on latent tuberculosis infection testing and treatment have not yet been developed in China. Here, we present the results from the 2-year follow-up of a study that aimed to track the development of active disease in individuals with latent tuberculosis infection, identify priority populations for latent infection management, and explore the most suitable latent infection diagnostic approach.Methods A population-based multicentre prospective study was done in four sites in rural China, between 2013 and 2015. The baseline survey in 2013 measured the prevalence of latent tuberculosis infection using QuantiFERON-TB Gold In-Tube (QFT) and tuberculin skin test (TST) in eligible participants. During the follow-up phase between 2014-15, we assessed individuals who had tuberculosis infection at baseline (QFT-positivity or TST tuberculin reaction size [induration] of >= 10 mm) for the development of active disease through active case finding. Eligible participants included in follow-up survey had a birth date before June 1, 2008 (5 years or older in 2013), and continuous residence at the study site for 6 months or longer in the past year. Participants with current active tuberculosis at baseline survey were excluded.Findings Between Sept 1, 2013, and Aug 31, 2015, 7505 eligible participants (aged 5 years or older) were included in tuberculosis infection test positive cohorts (4455 were QFT positive, 6404 had TST induration >= 10 mm, and 3354 were positive for both tests) after baseline examination. During the 2-year follow-up period, 84 incident cases of active tuberculosis were diagnosed. Of participants who developed active tuberculosis, 75 were diagnosed with latent infection by QFT, 62 were diagnosed by TST, and 53 were diagnosed by both tests. An incidence rate of 0.87 (95% CI 0.68-1.07) per 100 person-years was observed for individuals who tested positive with QFT, 0.50 (0.38-0.63) per 100 person-years for those who tested positive with TST (p