| 摘要: | 目的：
結核病是威脅全球公共衛生的一種重要傳染性疾病。本研究對接觸痰塗片陽性結核病個案的家戶成人接觸者，是否接受潛伏結核感染（Latent tuberculosis infection , LTBI）治療，進行相關原因的探討，期有助於提高結核病防治，減少後續感染的機率。
方法：
利用行政院衛生署疾病管制局『中央傳染病追蹤管理系統』通報結核病資料，自2010年1-12月彰化縣的通報痰塗片陽性結核病個案記錄中，檢視出指標個案共有519人。同時檢視出大於20歲之家戶成人接觸者，共有2,152人，當中有947人結核菌素皮膚測試為陽性反應者(接觸者應接受LTBI治療，簡稱接觸者)。這些接觸者為研究對象，進行回溯性分析研究。以卡方檢定接觸者「接受」和「不接受」LTBI治療兩組的特性，包括指標個案基本資料、就醫層級、治療結果及接觸者個人基本資料、就醫層級、檢查結果等方面之關連。
推論統計方面，運用羅吉斯迴歸分析（logistic regression analysis），估計接觸者「是」「否」接受LTBI治療的勝算比，控制共變數等相關因素後，探討指標個案之基本資料、就醫層級、治療結果及接觸者個人基本資料、就醫層級、痰液培養與X光等檢查結果等因素，是否和接觸者接受LTBI的治療有相關，計算其勝算比(odds ratio, OR)及信賴區間(confidence Interval, CI)。
結果：
在947位接觸者當中，接受LTBI治療有359人（37.9％），而未接受LTBI治療有588人（62.1％）。
羅吉斯迴歸分析家戶成人接觸者接受LTBI治療的相關因素顯示，指標個案較多男性、得病年齡較多45-64歲及65歲以上、銷案原因是完治及死亡等因素；家戶成人接觸者比率較高的變項包括：年齡50-59歲、接觸者接受檢查時間是在指標個案通報後1-15天及16-30天者、X光診斷結果是正常、居住北彰化等；其他相關因素是公衛端積極介入考核成續優等、及考核成續良等。
詳細結果在指標個案方面，接受LTBI治療接觸者的指標個案是男性的OR是1.83、得病年齡45-64歲及65歲以上者之OR分別為 <24歲年輕族群的4.44倍及3.30倍、銷案原因是完治及死亡OR分別為排除診斷者的4.48倍及2.58倍。
家戶成人接觸者方面，接觸者年齡在50-59歲者接受LTBI治療最多、較多接觸者接受檢查時間是在指標個案通報後1-15天及16-30天、接觸者其X光診斷結果是正常者接受LTBI治療者較多(OR=1.90)。以行政區域來畫分，居住北彰化的接觸者有較高的意願接受LTBI治療，其OR為1.64。其他相關因素，公衛端積極介入考核成續優等及良等 OR=2.76及2.35。
結論：
不接受LTBI治療接觸者，其指標個案的年齡較小、或是排除診斷銷案。接觸者年齡小於40歲、接觸者接受檢查時間較晚、有較高的X光檢查診斷異常、較多南彰化的居民。這些資訊可用以調整結核病防治策略，期望提高結核病防治成功的機率。
Objectives:
Tuberculosis (TB) is one of important infectious diseases that threat the global public health. This study was to identify determinants associated with the acceptance of latent tuberculosis infection (LTBI) treatment among adult household contacts with patient with pulmonary tuberculosis. The primary objective of was to improve the campaign of TB control.
Methods and materials:
Data used in this study was the Bulletin TB Data, " National Surveillance Network of Communicable Diseases," obtained from the Centers for Disease Control, R.O.C. (Taiwan).From the records dated from January to December 2010 for Changhua County residents, we identified 519 index cases with the sputum smear-positive TB cases and 2,152 adult household contacts. Both groups were included in this study for retrospective analysis.
Data analyses examined factors associated with the acceptance of LTBI treatment. Descriptive analysis was used first to examine the characteristics of the sputum smear-positive TB cases for the 519 index cases and the 356 index cases with TST positive contacts.Comparisons were also performed between subjects with TST (+) and TST (-). Comparisons were further conducted to exam difference between contacts receiving and not receiving LTBI treatment. We also assessed differences between male and female patients in age and TST finding. The association between LTBI treatment and TST finding, urbanization and effort of intervention were also assessed. Logistic regression analysis was also used to estimate the odds ratio (OR) and confidence interval (CI) to explore factors associated with the acceptance of LTBI treatment.
Results:
Of the 947 TB contacts, 37.9% received the LTBI treatment. Among those receiving LTBI treatment, 73.2% patients completed the treatment. The index cases were older, mainly males and living in the southern county. More than half subjects who had contacted with TB cases were in 40-59years of age (50.5%) and more likely to live with the cases (77.5%).
The results of multivariate logistic regression analysis showed that the LTBI treatment was associated with ,index cases being males (OR = 1.8), patients aged 45-64 years (OR = 4.4) and≧65 years (OR=3.3), patients with completed treatment, and death. Among household contacts, subjects 50-59 years of age were more likely to accept LTBI treatment. Most of the contacts received the X-ray check-up 1-15 and 16-30 days after the index cases had been registered. The contacts with normal X-ray exam had higher LTBI treatment than those with abnormal findings (OR = 1.9). The residents of North Changhua County had higher acceptance of LTBI treatment than those lived in South areas (OR = 1.6).This study also found that active nurses involvement in the TB control program could promote the acceptance of LTBI treatment.
Conclusion:
The close contacts of pulmonary TB patients declining the LTBI treatment are more likely to have younger index cases. They are also reluctant to visit heath care facility for the routine TB check-up. The significant factors associated with the noncompliance of LTBI treatment among the contacts include less than 40 years of age, delayed check-up, abnormal X-ray finding, and residents of southern Changhua. Our findings can be adapted for improving the TB control strategy. |
