结核病传播链分子流行病学研究的病例选择方法初探

摘要

目的 对以患者居住地为基础的结核病传播链分子流行病学研究的病例选择方法进行理论性评估.方法 在本院建立的广州地区分枝杆菌菌株库中提取9 234株结核分枝杆菌相应的患者信息资料,以患者居住地假定其间传播关系的有无,分析每条传播链中患者发病时间间隔及年龄组合情况.结果 以县-乡镇-村-组等农村区划、市-区-社区-街道等城市区划为路线,发现387条假定结核病传播链,以2-5病例传播链为主,分别为210、100、35、23条,其它则包括6、7、8、1l、12病例传播链,分别为6、7、4、1、l条.从传播链中患者居住地看,农村地区以同村为主,占农村区划传播链的89.39％(59/66),城市地区以同街道为主,占城市区划传播链的89.10％(286/321);传播链中患者发病时间间隔在半年、1年、1年半、2年、2年半、3年内及大于3年的传播条数分另为131、81,59、59、50、6和1;按少年(＜ 15岁)、青年(15～44岁)、中年(45～64岁)、老年(≥65岁)4个年龄段划分,不同性别跨1年龄段、同性别同年龄段、不同性别跨2年龄段、不同性别同年龄段、同性别跨1年龄段、同性别跨2年龄段、不同性别跨3年龄段的传播链条数分别为94、69、69、67、59、28、l条.结论 以患者居住地为基础的传播链分析所获得的结核病传播链分子流行病学研究的病例比较符合现行结核病传播理论,在结核病传播链分子流行病学研究中切实可行.%Objective To assess the performance of case selection way based on case residence for molecular epidemiology analysis of tuberculosis transmission chain theoretically.Methods The data of cases with tuberculosis,from which 9 234 strains M.tuberculosis were isolated,were extracted from Mycobacteria biobank of Guangzhou in our hospital.In the case of assumed transmission relationship based on the case residence,the time intervals of disease occurring and combinations of gender and age in per transmission chain were analyzed.Results According to rural administrative divisions (including county,town,village,and group) and urban administrative zoning (including city,district,community,and street),a total of 387 presumed tuberculosis transmission chains were found.The transmission chains contained 2-5 cases were major and their number were 210,100,35,and 23 respectively.The numbers of chains contained 6,7,8,11,and 12 cases were 6,7,4,1,and 1 respectively.From case residence,the transmission chains forming in the same village and street were dominated in rural administrative divisions and urban administrative zoning and accounted for 89.39％ (59/66) of rural transmission chains and 89.10％ (286/321) of rural transmission chains.As to the time intervals of disease occurring in per transmission chain,there were the following cases:6 months,1 year,1 year and a half,2 years,2 years and a half,3 years,and more than 3 years.The numbers of the transmission chains were 131,81,59,59,50,6,and 1 in the above cases of time intervals.The numbers of the transmission chains of different sex-across one age group,same sex-same age group,different sex-across two age group,different sex-same age group,same sexacross one age group,same sex-across two age group,and different sex-across three age group were 94,69,69,67,59,28,and 1 if cases were regarded as juvenile (＜1 5 years old),youth (15-44 years old),middle age (45-64 years old),and old age (≥65 years old).Conclusion The cases gained by the patients' residence is in line with the current theory of tuberculosis transmission,and is feasible for study on molecular epidemiology of tuberculosis transmission chain.