儿童重症结核影响因素及卡介苗预防效果研究

发布时间：2018-04-13 06:35

本文选题：BCG + 结核性脑膜炎　；参考：《中国疾病预防控制中心》2009年硕士论文

【摘要】： 背景结核病是全球重要的公共卫生问题,是世界卫生组织(WHO)重点控制的疾病之一。我国结核疫情呈现出高感染率、高患病率、高耐药率、死亡人数多、中青年患病率高、合并艾滋病病毒(人类免疫缺陷病毒,HIV)感染、流动人口等新特点。卡介苗(BCG)是世界上应用最广泛的疫苗之一,接种BCG是控制结核病的一种措施,但BCG对结核病的保护效果却存在争论:国内外多数学者与专家认为BCG接种对预防普通肺结核的效果很差,但对预防由血行播散引起的儿童结核性脑膜炎(结脑)和粟粒性结核等重症结核有一定作用。国内有关BCG对结脑保护效果的研究资料有限,即便如此,对于BCG保护结脑等重症结核的效果仍然不一致。随着防治结核病新形势的出现,在一些结核疾病负担较低的国家(如美国、瑞典等国),仅选择那些已被确认对结核高危的新生儿和婴儿以及皮试阴性且年龄较大的儿童接种BCG,在某些结核疾病负担较低的人群中,不再接种BCG,而代之以加强病例发现和督导早期治疗。我国是否执行现行BCG免疫策略,须进一步探讨,为此,很有必要进行BCG预防儿童结脑等重症结核效果方面的研究。目的了解儿童重症结核致病的危险因素;了解BCG对儿童重症结核的预防效果;为完善或修订现有的BCG免疫策略和预防儿童重症结核提供依据。方法采取以社区为基础的病例对照流行病学研究方法,筛选出儿童结脑等重症结核病例,根据病例的年龄、性别、来源地信息按1:3比例选取合适的对照,填写问卷调查表。采用Epi Info软件对资料进行卡方检验,单因素、多因素条件Logistic回归分析,采用疫苗效力(VE)=[1-比值比(OR)]*100计算疫苗的保护率。结果纳入42例结脑,126名对照。两组间家庭人口、家庭年总收入、家庭总居住面积、住宅状况、慢性疾病史,差异无统计学意义。肺结核病接触史(x~2=18.1668,P=0.0001)和接触程度(x~2=47.4479,P=0.0000)、与肺结核病人有接触史的人与肺结核病人的关系(x~2=48.0535,P=0.0000)、肺结核病史(x~2=42.8406,P=0.0000)、BCG接种史(x~2=25.4873,P=0.0000)与儿童结脑发病有统计学显著性关联,BCG的VE=89.42%,95%可信区间(CI)为(69%,97%)。多因素条件logistic回归分析拟合的模型:logit(P)=1.4611X_(15)+2.8620X_(19)-4.8094X_(201) 结论家庭人口总数、家庭年总收入、家庭总居住面积、居住地状况、住宅状况,有无慢性病史等因素与儿童结脑等重症结核的发病无关。肺结核病人接触史、接触密切程度是儿童结脑等重症结核的危险因素。BCG接种是儿童结脑等重症结核的保护因素。BCG对结脑等重症结核的保护率为89.24%。积极发现肺结核病人;做好肺结核患者的治疗和管理工作;继续在新生儿中实施BCG接种措施;积极研发新型BCG,提高BCG对儿童普通结核的保护效果。
[Abstract]:BackgroundTuberculosis is an important public health problem in the world and one of the most important diseases controlled by the World Health Organization (WHO).The tuberculosis epidemic situation in China shows new characteristics such as high infection rate, high prevalence rate, high drug resistance rate, high death toll, high prevalence rate of young and middle-aged people, combined with HIV infection, floating population and so on.BCG is one of the most widely used vaccines in the world, and vaccination with BCG is a measure to control TB.However, the protective effect of BCG on tuberculosis is controversial: most scholars and experts at home and abroad think that BCG vaccination is very effective in the prevention of common tuberculosis.But it can prevent tuberculous meningitis (tuberculous meningitis) and miliary tuberculosis in children.Domestic research on the protective effect of BCG on nodular brain is limited. Even so, the effect of BCG on the protection of severe tuberculosis such as nodular brain is still inconsistent.With the emergence of a new situation in the fight against tuberculosis, in some countries with lower TB burden (such as the United States,Countries such as Sweden have chosen only those newborns and infants who have been identified as at high risk of tuberculosis, as well as children with negative skin tests and older children, who are vaccinated against BCGs, in certain populations with lower TB disease burdens.Instead of inoculating BCGs, it was replaced by enhanced case detection and supervision of early treatment.Whether the current BCG immunization strategy should be carried out in China should be further explored. Therefore, it is necessary to study the effect of BCG on the prevention of severe tuberculosis in children.PurposeTo understand the risk factors of severe tuberculosis in children, to understand the preventive effect of BCG on children with severe tuberculosis, and to provide evidence for perfecting or revising the existing BCG immunization strategy and preventing severe tuberculosis in children.MethodA community-based case-control epidemiological study was used to screen out children with severe tuberculosis such as nodular encephalopathy. According to the age, sex and source information of the cases, the appropriate control was selected according to the 1:3 scale, and the questionnaire was completed.Epi Info software was used to carry out chi-square test, univariate and multivariate conditional Logistic regression analysis, and the vaccine potency was calculated by [1- ratio to OR] 100 to calculate the protective rate of vaccine.ResultA total of 126 controls were included in 42 patients with nodular ganglia.There was no significant difference between the two groups in terms of family population, annual total family income, total household living area, housing status and history of chronic disease.Multivariate conditional logistic regression fitting Model: 1. 4611XStamp; 2. 8620X / s; 19- 4.8094XStamp / 2010)ConclusionThe total family population, total family income, total household living area, residence status, housing status and history of chronic diseases were not related to the incidence of severe tuberculosis in children.The exposure degree of pulmonary tuberculosis patients was the risk factor of severe tuberculosis in children. BCG inoculation was the protective factor of severe tuberculosis in children. The protective rate of BCG to severe tuberculosis such as nodular brain was 89.24%.Positive detection of pulmonary tuberculosis patients; do a good job in the treatment and management of tuberculosis patients; continue to implement BCG vaccination measures in the newborn; actively develop new type of BCGs to improve the protective effect of BCG on children with common tuberculosis.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R186

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