(3.238.96.184) 您好!臺灣時間:2021/05/08 04:19
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:陳湘菁
研究生(外文):Chen,Hsiangching
論文名稱:密切接觸者潛隱性結核感染危險因子之探討
論文名稱(外文):Risk Factors for Latent TB Infection among Close Contacts
指導教授:辜志弘辜志弘引用關係
指導教授(外文):Ku,Chihhung
口試委員:陳宏一張峰義朱紀洪陳秋蓉辜志弘
口試委員(外文):Chen,HongiChang,FengyeeChu,ChihongChen,ChioujongKu,Chihhung
口試日期:2011-04-29
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
語文別:中文
論文頁數:87
中文關鍵詞:密切接觸者潛隱性結核感染Quanti-FERON®-TB Gold In-Tube
外文關鍵詞:close contactslatent TB infectionQuanti-FERON®-TB Gold In-Tube
相關次數:
  • 被引用被引用:1
  • 點閱點閱:190
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:1
於肺結核個案被確診為活動性結核病前,密切接觸者可能因暴露結核分枝桿菌而造成感染。目前國內針對密切接觸者之篩選工具以胸部X光為主、皮膚結核菌素試驗為輔。然此兩種檢驗工具皆難以篩選出潛隱性結核感染者。本研究旨在於評估與活動性結核病確診個案密切接觸之人員其結核感染盛行情形與危險因子,並與一般企業員工年度體檢比較其盛行率。
本研究經人體試驗審議委員會核准,以橫斷型研究設計調查密切接觸者潛隱性結核感染之盛行情形與危險因子。研究對象為結核病確診個案之密切接觸者(與指標個案共同居住或與指標個案於可傳染期間一天內接觸8小時以上或累計達40(含)小時以上之接觸者),並選取與密切接觸者工作性質相似的某機構員工相互比較。針對有意願參與之研究對象使用問卷調查收集結核感染相關危險因子的資訊,並採集血液檢體,以Quanti-FERON®-TB Gold In-Tube檢驗研究對象是否受到結核感染。整合問卷與實驗結果,採用統計軟體SAS 9.2版,以Multiple logistic regression分析探討其相關性與危險因子。
本研究結果為機構內曾有結核病確診個案的員工其結核感染盛行率23.4%顯著高於機構內無結核病確診個案的員工9%。QFT-GIT呈陽性之危險因子為年齡較長(OR=1.03, 95%CI=1.00-1.06)、BMI較低(OR=0.09, 95%CI=0.82-0.99)、結核病史(有vs.無, OR=22.07, 95%CI=2.12-229.98)、密切接觸者(是vs.否, OR=3.62, 95%CI=1.98-6.63)。
密切接觸者結核感染之風險高於未曾暴露至結核病患之員工。根據結果建議針對具上述危險因子者給予結核相關知識之衛生教育宣導,亦建議衛生單位建立結核病接觸者登記與管理系統,以利於後續追蹤。

關鍵詞:密切接觸者、潛隱性結核感染、Quanti-FERON®-TB Gold In-Tube

Prior to being clinically diagnosed with active tuberculosis, the people may have been exposed to Mycobacterium tuberculosis and thus infected. Currently, the primary method of diagnosing close contacts domestically is the chest x-ray or in conjunction with TST. However both test methods are not capable of detecting latent tuberculosis infection. The aim of this study is to assess close contacts of clinically diagnosed active tuberculosis cases and its relationship with the risk factors and prevalence of tuberculosis infection compared to annual physical examinations of general employees.
This is a cross-sectional study of the prevalence and its risk factors of latent TB infection within close contacts and has been approved by the Institutional Review Board. The subjects of this study are close contacts that have been exposed to (living together for 8 hours a day, or exposed for 40 hours or more in total) people diagnosed with active TB and compared with employees in a similar field of work. Questionnaires are given to willing participants in this study to gather risk factor information, then blood samples were taken. Utilizing Quanti-FERON®-TB Gold In-Tube, a patient’s TB infection status was obtained. Results from experiment and questionnaires are analyzed using SAS ver. 9.2 with multiple logistic regression to find correlation and risk factors.
This study found that the QFT-GIT positive rate of close contacts (23.4%) was significantly higher than that of workers who were not exposed to people with clinically diagnosed of active TB (9%). The risk factors for QFT-GIT positivity were older age (OR=1.03, 95%CI=1.00-1.06), lower BMI (OR=0.09, 95%CI=0.82-0.99), history of TB (yes vs. no, OR=22.07, 95%CI=2.12-229.98) and close contacts (yes vs. no, OR=3.62, 95%CI=1.98-6.63).
Our study indicated close contacts had higher risk of Mycobacterium infection than those people who were not exposed to TB patients. Our result indicated that people who have the above mentioned risk factors should be given health education for preventive protection of TB. In addition, institutes of health should establish a registration and management database for close contacts of TB patients to better follow up.

目錄 I
表目錄 III
圖目錄 IV
摘要 1
Abstract 2
緒言 4
第一節 研究背景及重要性 4
第二節 研究動機 10
第三節 研究目的 11
第四節 研究假設 12
第二章 文獻探討 13
第一節 國內結核病群聚感染事件之追蹤調查 13
第二節 國外結核病群聚感染事件之追蹤調查 16
第三章 材料與方法 19
第一節 研究設計 19
第二節 研究族群及對象 20
第三節 研究架構 21
第四節 研究工具 22
第五節 統計分析方法 26
第四章 結果 27
第一節 QFT-GIT檢驗結果之陽性率 27
第二節 基本人口學特性 28
第三節 醫藥狀況 30
第四節 結核病相關之自覺症狀 32
第五節 生活型態 35
第六節 居住環境 37
第七節 工作環境 39
第八節 全模式之變項 42
第九節 Quanti-FERON®-TB Gold In-Tube陽性之危險因子 43
第五章 討論 44
第一節 密切接觸者陽性率之比較 44
第二節 Quanti-FERON®-TB Gold In-Tube陽性之危險因子探討 46
第三節 其他密切接觸者文獻之危險因子探討 54
第四節 研究限制 59
第六章 結論與建議 60
第七章 參考文獻 61


Abubakar, I. and K. Fernandez de la Hoz (2008). "WHO publishes the third edition of guidelines for the prevention and control of air-travel-associated tuberculosis." Euro Surveill 13(23).
Adetifa, I. M., M. D. Lugos, et al. (2007). "Comparison of two interferon gamma release assays in the diagnosis of Mycobacterium tuberculosis infection and disease in The Gambia." BMC Infect Dis 7: 122.
Agarwal, S. and P. J. Busse (2010). "Innate and adaptive immunosenescence." Ann Allergy Asthma Immunol 104(3): 183-90; quiz 190-2, 210.
Arend, S. M., S. F. Thijsen, et al. (2007). "Comparison of two interferon-gamma assays and tuberculin skin test for tracing tuberculosis contacts." Am J Respir Crit Care Med 175(6): 618-27.
ATS (2000). "Diagnostic Standards and Classification of Tuberculosis in Adults and Children. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999." Am J Respir Crit Care Med 161(4 Pt 1): 1376-95.
Baboolal, S., D. Ramoutar, et al. (2010). "Comparison of the QuantiFERON(R)-TB Gold assay and tuberculin skin test to detect latent tuberculosis infection among target groups in Trinidad & Tobago." Rev Panam Salud Publica 28(1): 36-42.
Balasubramanian, V., E. H. Wiegeshaus, et al. (1994). "Pathogenesis of tuberculosis: pathway to apical localization." Tuber Lung Dis 75(3): 168-78.
Borgen, K., B. Koster, et al. (2008). "Evaluation of a large-scale tuberculosis contact investigation in the Netherlands." Eur Respir J 32(2): 419-25.
Cacho, J., A. Perez Meixeira, et al. (2007). "Recurrent tuberculosis from 1992 to 2004 in a metropolitan area." Eur Respir J 30(2): 333-7.
Calder, L., J. Rivers, et al. (2008). "A school and community outbreak of tuberculosis in Palmerston North, New Zealand." N Z Med J 121(1278): 50-61.
Chan-Yeung, M., D. L. Dai, et al. (2007). "Tuberculin skin test reaction and body mass index in old age home residents in Hong Kong." J Am Geriatr Soc 55(10): 1592-7.
Choi, C. M., S. S. Hwang, et al. (2007). "Latent tuberculosis infection in a military setting diagnosed by whole-blood interferon-gamma assay." Respirology 12(6): 898-901.
Choo, V. (2002). "WHO reassesses appropriate body-mass index for Asian populations." Lancet 360(9328): 235.
Chun, J. K., C. K. Kim, et al. (2008). "The role of a whole blood interferon-gamma assay for the detection of latent tuberculosis infection in Bacille Calmette-Guerin vaccinated children." Diagn Microbiol Infect Dis 62(4): 389-94.
Crofts, J. P., N. J. Andrews, et al. (2010). "Risk factors for recurrent tuberculosis in England and Wales, 1998-2005." Thorax 65(4): 310-4.
del Corral, H., S. C. Paris, et al. (2009). "IFNgamma response to Mycobacterium tuberculosis, risk of infection and disease in household contacts of tuberculosis patients in Colombia." PLoS One 4(12): e8257.
Detjen, A. K., L. Loebenberg, et al. (2009). "Short-term reproducibility of a commercial interferon gamma release assay." Clin Vaccine Immunol 16(8): 1170-5.
Diel, R., R. Loddenkemper, et al. (2009). "Comparative performance of tuberculin skin test, QuantiFERON-TB-Gold In Tube assay, and T-Spot.TB test in contact investigations for tuberculosis." Chest 135(4): 1010-8.
Diel, R., R. Loddenkemper, et al. (2008). "Predictive value of a whole blood IFN-gamma assay for the development of active tuberculosis disease after recent infection with Mycobacterium tuberculosis." Am J Respir Crit Care Med 177(10): 1164-70.
Diel, R., R. Loddenkemper, et al. (2010). "Evidence-based comparison of commercial interferon-gamma release assays for detecting active TB: a metaanalysis." Chest 137(4): 952-68.
Diel, R., A. Nienhaus, et al. (2006). "Tuberculosis contact investigation with a new, specific blood test in a low-incidence population containing a high proportion of BCG-vaccinated persons." Respir Res 7: 77.
Duthie, S., C. Black, et al. (2008). "Tuberculosis outbreak associated with a mosque: challenges of large scale contact tracing." Euro Surveill 13(51).
El Sahly, H. M., J. A. Wright, et al. (2004). "Recurrent tuberculosis in Houston, Texas: a population-based study." Int J Tuberc Lung Dis 8(3): 333-40.
Elenga, N., K. A. Kouakoussui, et al. (2005). "Diagnosed tuberculosis during the follow-up of a cohort of human immunodeficiency virus-infected children in Abidjan, Cote d'Ivoire: ANRS 1278 study." Pediatr Infect Dis J 24(12): 1077-82.
Ferrara, G., M. Losi, et al. (2009). "Interferon-gamma-release assays detect recent tuberculosis re-infection in elderly contacts." Int J Immunopathol Pharmacol 22(3): 669-77.
Ferrara, G., M. Losi, et al. (2006). "Use in routine clinical practice of two commercial blood tests for diagnosis of infection with Mycobacterium tuberculosis: a prospective study." Lancet 367(9519): 1328-34.
Frieden, T. R., T. R. Sterling, et al. (2003). "Tuberculosis." Lancet 362(9387): 887-99.
Fukazawa, K. (2007). "[Application and problems of quantiFERON TB-2G for tuberculosis control programs--(1) tuberculosis outbreak in a Cram School]." Kekkaku 82(1): 53-9.
Ghare, S., M. Patil, et al. (2011). "Ethanol Inhibits Lipid Raft-Mediated TCR Signaling and IL-2 Expression: Potential Mechanism of Alcohol-Induced Immune Suppression." Alcohol Clin Exp Res.
Gillman, A., I. Berggren, et al. (2008). "Primary tuberculosis infection in 35 children at a Swedish day care center." Pediatr Infect Dis J 27(12): 1078-82.
Hadjichristodoulou, C., A. Vasilogiannakopoulos, et al. (2005). "Mycobacterium tuberculosis transmission among high school students in Greece." Pediatr Int 47(2): 180-4.
Hart, P. D. and I. Sutherland (1977). "BCG and vole bacillus vaccines in the prevention of tuberculosis in adolescence and early adult life." Br Med J 2(6082): 293-5.
Hauck, F. R., B. H. Neese, et al. (2009). "Identification and management of latent tuberculosis infection." Am Fam Physician 79(10): 879-86.
Hesseling, A. C., A. M. Mandalakas, et al. (2009). "Highly discordant T cell responses in individuals with recent exposure to household tuberculosis." Thorax 64(10): 840-6.
Higuchi, K., N. Harada, et al. (2007). "Use of QuantiFERON-TB Gold to investigate tuberculosis contacts in a high school." Respirology 12(1): 88-92.
Higuchi, K., S. Kondo, et al. (2009). "Contact investigation in a primary school using a whole blood interferon-gamma assay." J Infect 58(5): 352-7.
Huang, Y. W., G. H. Shen, et al. (2010). "Latent tuberculosis infection among close contacts of multidrug-resistant tuberculosis patients in central Taiwan." Int J Tuberc Lung Dis 14(11): 1430-5.
Kaufmann, S. H. and A. J. McMichael (2005). "Annulling a dangerous liaison: vaccination strategies against AIDS and tuberculosis." Nat Med 11(4 Suppl): S33-44.
Khalilzadeh, S., H. Masjedi, et al. (2006). "Transmission of Mycoba cterium tuberculosis to households of tuberculosis patients: a comprehensive contact tracing study." Arch Iran Med 9(3): 208-12.
Kik, S. V., W. P. Franken, et al. (2009). "Interferon-gamma release assays in immigrant contacts and effect of remote exposure to Mycobacterium tuberculosis." Int J Tuberc Lung Dis 13(7): 820-8.
Kik, S. V., W. P. Franken, et al. (2009). "Predictive value for progression to tuberculosis by IGRA and TST in immigrant contacts." Eur Respir J 35(6): 1346-53.
Kilicaslan, Z., E. Kiyan, et al. (2009). "Risk of active tuberculosis in adult household contacts of smear-positive pulmonary tuberculosis cases." Int J Tuberc Lung Dis 13(1): 93-8.
Kipfer, B., M. Reichmuth, et al. (2008). "Tuberculosis in a Swiss army training camp: contact investigation using an Interferon gamma release assay." Swiss Med Wkly 138(17-18): 267-72.
Kornylo-Duong, K., C. Kim, et al. (2010). "Three air travel-related contact investigations associated with infectious tuberculosis, 2007-2008." Travel Med Infect Dis 8(2): 120-8.
Kunimoto, D., E. Der, et al. (2009). "Use of the QuantiFERON-TB Gold test to confirm latent tuberculosis infection in a Canadian tuberculosis clinic." Int J Tuberc Lung Dis 13(6): 726-30.
Lalvani, A. and M. Pareek (2010). "Interferon gamma release assays: principles and practice." Enferm Infecc Microbiol Clin 28(4): 245-52.
Lambert, M. L., E. Hasker, et al. (2003). "Recurrence in tuberculosis: relapse or reinfection?" Lancet Infect Dis 3(5): 282-7.
Leung, C. C., T. H. Lam, et al. (2007). "Lower risk of tuberculosis in obesity." Arch Intern Med 167(12): 1297-304.
Lienhardt, C., K. Fielding, et al. (2010). "Evaluation of the prognostic value of IFN-gamma release assay and tuberculin skin test in household contacts of infectious tuberculosis cases in Senegal." PLoS One 5(5): e10508.
Lin, J. C., T. Y. Lin, et al. (2008). "An outbreak of tuberculosis in a bacillus Calmette-guerin-vaccinated military population." Mil Med 173(4): 388-92.
Ling, D. L., Y. P. Liaw, et al. (2011). "Contact investigation for tuberculosis in Taiwan contacts aged under 20 years in 2005." Int J Tuberc Lung Dis 15(1): 50-5.
Mahan, C. S., D. F. Johnson, et al. (2011). "Concordance of a positive tuberculin skin test and an interferon gamma release assay in bacille Calmette-Guerin vaccinated persons." Int J Tuberc Lung Dis 15(2): 174-8, i.
Mahomed, H., T. Hawkridge, et al. (2011). "Predictive factors for latent tuberculosis infection among adolescents in a high-burden area in South Africa." Int J Tuberc Lung Dis 15(3): 331-6.
Mfinanga, G. S., E. Ngadaya, et al. (2007). "The quality of sputum smear microscopy diagnosis of pulmonary tuberculosis in Dar es Salaam, Tanzania." Tanzan Health Res Bull 9(3): 164-8.
Moran-Mendoza, O., S. A. Marion, et al. (2010). "Risk factors for developing tuberculosis: a 12-year follow-up of contacts of tuberculosis cases." Int J Tuberc Lung Dis 14(9): 1112-9.
Munro, W. T. and I. Leitch (1945). "Diet and tuberculosis." Proc Nutr Soc 3: 155-64.
Neely, F., H. Maguire, et al. (2009). "High rate of transmission among contacts in large London outbreak of isoniazid mono-resistant tuberculosis." J Public Health (Oxf) 32(1): 44-51.
Nnoaham, K. E. and A. Clarke (2008). "Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis." Int J Epidemiol 37(1): 113-9.
Pednekar, M. S., M. Hakama, et al. (2008). "Association of body mass index with all-cause and cause-specific mortality: findings from a prospective cohort study in Mumbai (Bombay), India." Int J Epidemiol 37(3): 524-35.
Phillips, L., J. Carlile, et al. (2004). "Epidemiology of a tuberculosis outbreak in a rural Missouri high school." Pediatrics 113(6): e514-9.
Robin Wood, H. L., Hulin Wu, Keren Middelkoop, Tollulah Oni, Molebogeng X, Rangaka, Robert J. Wilkinson, Linda-Gail Bekker, and Stephen D. Lawn (2010). "Changing prevalence of TB infection with increasing age in high TB burden townships in South Africa." Int J Tuberc Lung Dis. 14(4): 406-412.
Salinas, C., A. Capelastegui, et al. (2007). "[Longitudinal incidence of tuberculosis in a cohort of contacts: factors associated with the disease]." Arch Bronconeumol 43(6): 317-23.
Selassie, A. W., C. Pozsik, et al. (2005). "Why pulmonary tuberculosis recurs: a population-based epidemiological study." Ann Epidemiol 15(7): 519-25.
Sia, I. G., R. B. Orillaza, et al. (2009). "Tuberculosis attributed to household contacts in the Philippines." Int J Tuberc Lung Dis 14(1): 122-5.
Singh, M., M. L. Mynak, et al. (2005). "Prevalence and risk factors for transmission of infection among children in household contact with adults having pulmonary tuberculosis." Arch Dis Child 90(6): 624-8.
Stein-Zamir, C., I. Volovik, et al. (2006). "Tuberculosis outbreak among students in a boarding school." Eur Respir J 28(5): 986-91.
Stewart, G. R., B. D. Robertson, et al. (2003). "Tuberculosis: a problem with persistence." Nat Rev Microbiol 1(2): 97-105.
Tagarro, A., S. Jimenez, et al. (2011). "[Tuberculosis outbreak in a primary school: description and reflections on the value of gastric juice in the management of micro-epidemics.]." Enferm Infecc Microbiol Clin 29(2): 90-95.
Talat, N., S. Perry, et al. (2010). "Vitamin d deficiency and tuberculosis progression." Emerg Infect Dis 16(5): 853-5.
Taylor Z, N. C., Blumberg HM, for the American Thoracic Society;, C. f. D. C. a. P. a. I. Diseases, et al. (2005). "Controlling tuberculosis in the United States." MMWR Morb Mortal Wkly Rep 54: 1-81.
Tsuchiya, T. (2006). "[Exogenous re-infection in tuberculosis]." Kekkaku 81(2): 79-91.
Tverdal, A. (1986). "Body mass index and incidence of tuberculosis." Eur J Respir Dis 69(5): 355-62.
Wang, J.-Y., L.-N. Lee, et al. (2011). Predicting latent infection and active disease of Mycobacterium tuberculosis in household contacts. Taiwan-Australia Workshop on Tuberculosis. Taipei International Convention Center: 13.
Whalen, C. C., A. Chiunda, et al. (2006). "Immune correlates of acute Mycobacterium tuberculosis infection in household contacts in Kampala, Uganda." Am J Trop Med Hyg 75(1): 55-61.
WHO (2010). "Global tuberculosis control."
Zachariah, R., M. P. Spielmann, et al. (2002). "Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death." Trans R Soc Trop Med Hyg 96(3): 291-4.
內政部統計處 (2010). "內政統計年報."
王培東、曾懷萱 (2000). "家庭中結核病的傳染." 台灣醫界 43(8).
行政院衛生署疾病管制局 (2008). "結核病診治指引(第三版)."
疾病管制局 (2004). "醫院及學校結核病抽樣篩檢報告." 第 20 卷(第 8 期).
疾病管制局 (2005). "花蓮縣高中肺結核個案之流行病學關連性探討."
疾病管制局 (2006). "台北市某啟能中心發生疑似肺結核群聚事件." 疫情報導 22(5): 302-305.
疾病管制局 (2006). " 某醫院外包司機罹患肺結核及其家庭聚集感染事件 " 第22卷(第4期): 224-226.
疾病管制局 (2008). "一位因結核病死亡之十四歲少女 --- 我們應該如何為具傳染性之結核病個案的接觸者進行衛教?" 疫情報導 24(3): 177-183.
疾病管制局 (2009). "台灣結核病防治年報2009."
疾病管制局 (2009). "南投縣某家庭結核病聚集感染事件之調查與處理." 第 25 卷(第 2 期).
疾病管制局 (2009 ). "2007 年 某校學生結核病群聚事件調 查." 第 25 卷(第 2 期).
疾病管制局 (2010). "CDC Annual Report 2010."
疾病管制局 (2010). "台灣地區法定傳染病統計(98年)年報-年齡別."
疾病管制局 (2010). "台灣地區法定傳染病統計(98年)年報-縣市別."
疾病管制局 (2010). "結核病防治工作手冊-第二版."
疾病管制局 (2010). "傳染病防治法."
疾病管制局 (2010). "傳染病統計資料查詢."
疾病管制局 (2010). "傳染病統計暨監視年報."
張恆誠 (2010). "潛隱性結核感染之環境相關因素."
陳頤之, 劉薏蓉, et al. (2005). "微生物學."
衛生署統計處 (2010). "98年死因統計表."

QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
系統版面圖檔 系統版面圖檔