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单位:日本东京市新宿区。目的:通过对新宿区的结核分枝杆菌的传染状况的评估,以便有效合理地分配卫生资源,从而成功地实施结核控制规划。设计:将结核分枝杆菌的基因型资料和结核患者资料结合起来的观察描述性研究。结果:男性、年龄小于40岁的患者和无家可归者的基因型成簇率显著较高,他们的调整比值比和95%可信区间分别是(aOR 1.94,95%CI 1.04—3.65,P=0.038),(aOR 2.09,95%CI 1.17—3.71,P=0.012),(aOR 2.72,95%CI 1.42—5.20,P=0.002),而国外出生患者的基因型成簇率却较低(aOR 0.21,95%CI 0.06—0.76,P= 0.017)。在152例结核患者的45个基因型簇中, 102(67.1%)例患者的26个簇是由无家可归者和非无家可归混合而成,其中一个混合簇包括1个在日本出生的8个月的婴儿。结论:此研究显示结核分枝杆菌在无家可归人群的传播要比在非无家可归人群中更常发生。然而,偶然的接触也会引起结核分枝杆菌在无家可归者和普通人群之间的传播。
Unit: Shinjuku City, Tokyo, Japan. OBJECTIVE: To assess the status of TB infection in Shinjuku City in order to effectively and rationally allocate health resources so as to successfully implement TB control programs. Design: An observational descriptive study that combines genotypic data of Mycobacterium tuberculosis and TB patient data. Results: The genotype clustering rate was significantly higher for males, patients younger than 40 years and those who were homeless, with adjusted odds ratios and 95% confidence intervals (aOR 1.94, 95% CI 1.04-3.65, P = 0.038), (aOR 2.09, 95% CI 1.17-3.71, P = 0.012), (aOR 2.72, 95% CI 1.42-5.20, P = 0.002) (aOR 0.21, 95% CI 0.06-0.76, P = 0.017). Of the 45 genotypes of 152 TB patients, 26 of 102 (67.1%) patients were mixed by homeless and non-homeless, one of which included 1 in Japan Born 8 months old baby. Conclusion: This study shows that Mycobacterium tuberculosis spread more frequently in homeless people than in non-homeless people. However, incidental exposure can also cause the spread of M. tuberculosis between the homeless and the general population.