東台灣某地區醫院之密切接觸者潛隱性結核感染之研究探討

王碩薇

doi:10.6833/CJCU.2012.00043

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東台灣某地區醫院之密切接觸者潛隱性結核感染之研究探討

The study of Latent Tuberculosis Infection Screening among close contacts of the Local Community Hospital in Eastern Taiwan

王碩薇 , Masters　　Advisor：陳宏一　　

繁體中文 DOI： 10.6833/CJCU.2012.00043

密切接觸者；潛隱性結核感染； close contacts ； latent TB infection ； QuantiFERON-TB Gold In-Tube test

Abstract │ Reference (113) │ Altmetrics

Abstract 〈TOP〉

背景：肺結核群聚感染在台灣仍然是一個不容忽視的問題，尤其是在某些特定的密閉場合，例如:學校，監獄，醫院，軍事基地等，儘管醫療或公共衛生相關單位對於肺結核採取嚴密的監控和追蹤，但肺結核的群聚感染仍一直不斷的再發生。由於肺結核的潛伏期長且胸部X光、痰液塗片培養，這些方法僅能診斷病發之活動性結核病患，無法及早診斷潛隱性結核感染(Latent Tuberculosis Infection , LTBI)。而結核菌素皮膚試驗(Tuberculosis Skin Test ,TST)為目前主要診斷潛隱性結核感染的工具，但容易受到卡介苗(Bacilli Calmette-Guerin , BCG)及大部分的非結核分枝桿菌(Nontuberculous Mycobacterium , NTM)的干擾。美國食品藥物管理局(Food and Drug Administration , FDA)於2007年核准第三代診斷方法QuantiFERON-TB Gold In Tube Test (QFT-GIT)的使用，其不受卡介苗及大部分的非結核分枝桿菌的影響。本研究主旨為探討東台灣某地區醫院潛隱性結核感染之情形。
方法：本研究為橫斷性研究並通過人體試驗委員會之審核，研究對象為開放性肺結核確診的指標個案之密切接觸者，以問卷和病歷調查方式探討基本的人口學變相及相關危險因子並以QFT-GIT的方法檢驗研

究對象是否受到結核感染。本研究採用統計軟體SAS9.2版分析問卷。
收案時間於100年6月至100年12月，收案地點為台灣東部某地區醫院。此外，本研究另於花蓮追蹤7位正在醫院接受肺結核治療的指標個案，並有25位家庭接觸者接受採集血液檢體及胸部X光檢查。
結果：本研究有115位密切接觸者參與研究，分別於100年06月、09月、12月採集血液檢體，第一次有47位為陽性個案，潛隱性結核感染之陽性率為40.86%(47/115)；第二次有40為陽性個案，陽性率為34.78%(40/115)；第三次有40為陽性個案，陽性率34.78%(40/115)。三次檢驗結果之平均陽性率為36.81%。研究對象的平均年齡為55歲(25歲-97歲)。所有的研究對象其胸部X光檢驗均無異常，但有9位個案曾經有old TB的紀錄。47位陽性個案之痰抹片均呈現陰性。所有的研究對象有86位(75%)曾經注射過卡介苗且HIV檢驗全呈現陰性。花蓮家庭接觸者之QFT-GIT呈現陽性者有4位，陽性率為16% (4/25)；25位研究對象之胸部X光檢查結果，均無發現異常者。群聚感染為QFT-GIT呈陽性之危險因子(OR=3.659¸ 95%CI=1.178-11.367)
結論：本研究發現有三分之一的密切接觸者有潛隱性結核感染，表示密閉空間群聚感染結核菌的問題值得重視。臺灣有許多相似的機構，如何建立良好的感染控制程序及通報系統需要內外單位相應扶持，也
建議衛生單位在未來可以建立更完善的結核病接觸者及潛隱性結核感
染的管理系統，以利後續的追蹤治療。

Parallel Abstract 〈TOP〉

The outbreak of tuberculosis disease is still a serious problem in Taiwan, especially in some special closed settings, such as  schools, prisons, hospitals, and military camps. Although there are some medical or public health units take the cautious monitors and tracing, the outbreak of tuberculosis have been reported continuously. Because of the long-term latent period and the X-ray, sputum smear and culture are just for the diagnosis of active TB mostly, excluding latent TB infection. Tuberculin Skin Test (TST) is the usual clinical tool for diagnosing latent TB infection in every country；however, TST results are prone to confounded by the Bacilli Calmette-Guerin (BCG) vaccination and the most of Nontuberculous mycobacterium. The Food and Drug Administration (FDA) in the United States has certified the usage of a third generation diagnostic method QuantiFERON-TB Gold In-Tube Test(QFT-GIT) in 2007, it doesn’t affected by BCG and NTM. The purpose of this study is to understand the prevalent situation and risk factors for LTBI among close contacts of the Local Community Hospital  in Eastern Taiwan.
Methods: This is a cross-sectional study and was approved by the Institutional Review Board. The subjects of this study were close contacts that had been exposed to the index patients with active TB. The study use questionnaires and anamnesis to investigate the risk factors about their 
demographics, previous history of TB, smoking status, and other factors for latent TB infection. This study was conducted from June to December
2011 in the community hospital located in the Eastern Taiwan , Additionally, this study followed up the seven index patients in Hualian Hospital and there were twenty-five household contacts accept the QFT-GIT test and Chest X ray and the questionnaires are analyzed by SAS ver. 9.2. 
Results: There were 115 patients held in this study . The first QFT-G test was conducted on June, with 47( 40.86%) positive. A second QFT-G test, a further three month later, with 34.78%(40/115)positive. And a third QFT-G test on December, with 34.78%(40/115) positive. The average rate of the QFT-GIT positive was 36.81% . The median age of the 115 patients was 55 years (range , 25-97). All of them had no any abnormal lesions on simple chest radiograph (CXR) but there were nine cases had the old TB history. 
In addition, the 47 positive cases were all show the sputum 
smear- negative. All of the participants, there were 86 person (75%) had BCG scars. All participants show the HIV negative. The Clustered infection (OR=3.659¸ 95%CI=1.178-11.367)
was associated with the risk of QFT-GIT positive rate.
Conclusion: This study showed that one third of the close contacts had positive QFT-GIT ,probably had latent tuberculosis infection. Evidently, the issue of M. tuberculosis infection at the closed institution is worth of concerning. Setting up the thorough infection control regulations and reporting system need the cooperation ,and also recommend the medical institution can establish the registration and management interface for monitoring the close contacts of TB patients

Reference ( 113 ) 〈TOP〉

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Pathogenesis of tuberculosis: pathway to apical localization. Tuber Lung Dis(75):168-178.
連結：

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