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研究生:王碩薇
研究生(外文):Shuo-Wei Wang
論文名稱: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
論文名稱(外文):The study of Latent Tuberculosis Infection Screening among close contacts of the Local Community Hospital in Eastern Taiwan
指導教授:陳宏一陳宏一引用關係
學位類別:碩士
校院名稱:長榮大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:78
中文關鍵詞:密切接觸者潛隱性結核感染
外文關鍵詞:close contactslatent TB infectionQuantiFERON-TB Gold In-Tube test
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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。


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


英文縮寫………………………………………………VII
中文摘要………………………………………………VIII
英文摘要………………………………………………IX
壹、導論………………………………………………1
第一節、結核病流行病學……………………………1
第二節、結核病自然史………………………2
第三節、潛隱性結核感染……………………………4
第四節、潛隱性結核感染篩檢………………………5
第五節、台灣結核病接觸者之處置與追蹤…………8
貳、文獻探討..........................10
第一節、國內結核病群聚感染事件......10
第二節、國外結核病群聚感染事件......13
參、研究構想..........................16
肆、研究材料與方法.....................17
第一節、研究設計.......................17
第二節、研究對象..................20
第三節、研究架構..................20
第四節、研究流程.......................21
第五節、研究工具.......................22
第六節、統計方法.......................26
伍、結果..............................27
第一節、QuantiFERON-TB Gold In-Tube檢驗結果之陽性率.27
第二節、基本人口學性...............................28
第三節、研究對象之健康況............................29
第四節、研究對象結核病相關之自覺症....................30
第五節、研究對象生活態..............................31
第六節、QuantiFERON-TB Gold In-Tube 陽性危險子......33
陸、討論...............................................34
第一節、密切接觸者陽性率之比較........................34
第二節、肺結核疾病史(Old TB history)與QuantiFERON-TB
Gold In Tube(QFT-GIT)結果比較.....................36
第三節、結核桿菌感染之危險因素........................38
(一)、年齡.....................................38
(二)、性別.....................................39
(三)、居住環境..................................40
(四)、暴露時間..................................41
(五)、抽菸.....................................42
(六)、喝酒.....................................43
(七)、糖尿病...................................43
(八)、愛滋病...................................45
柒、研究限制...........................................48
捌、結論...............................................49
玖、參考文獻............................................50
拾、表.................................................65
附表一、研究對象基本人口學變相.............................65
附表二、研究對象健康狀況變相...............................66
附表三、研究對象結核病相關之自覺症狀....................67
附表四、研究對象生活型態..............................68
附表五、QuantiFERON-TB Gold In-Tube 陽性危險因子.....69
附表六、肺結核疾病史(Old TB history)與QFT-GIT
結果比較..................................70
附表七、比較潛隱性結核感染及活動性結核病................71

附表八、顯微鏡視野(field)下觀察到的抗酸菌(AFS)數...........72
附表九、QFT-GIT 結果判讀表(選用 Nil+ TB+ Mitogen管)..73
拾壹、附錄一(臨床試驗說明及同意書)........................74


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