摘要目的 描述江苏省阜宁县活动性肺结核病患者的分布及空间聚集性,并结合结核分枝杆菌基因分型结果,探讨结核患者在人群和地理上近期传播的规律,为制订结核病控制策略提供参考.方法 以江苏省阜宁县20个乡镇2009年6月1日至2010年11月30日报告的所有新诊断和复治病例为研究对象,通过地理信息系统分析病例在空间上的聚集性,并应用散在分布重复单位(MIRU)基因分型对分离株进行成簇分析.结果 共连续纳入活动性肺结核患者681例,全局MoranI值提示阜宁县结核病患者不存在全局空间聚集性,结核病患者呈随机散发的态势.空间扫描统计量法在郭墅镇识别到唯一的局部空间聚集簇(RR=1.85,P=0.036).169株结核分枝杆菌中,有27株成簇,分别分布在12个簇,提示簇内患者之间存在近期传播.结论 在结核病高发的农村地区,结核病发病存在近期传播且以散发为主,发生大规模结核病暴发的可能性较小,偶然接触传播可能为结核病传播的主要方式.

abstractsObjective To describe the distribution and spatial clustering of active pulmonary tuberculosis patients in Funing county of Jiangsu Province,China,and to determine the rules of recent transmission in TB patients and help establish the strategy of TB control with the results of genetic typing of Mycobacterium tuberculosis (M.TB).Methods Newly reported and retreated tuberculosis patients registered in Funing county,Jiangsu Province between Jun 1,2009 and Nov 30,2010 were recruited as research subjects.Geographic information system was applied to analysis the spatial clustering of tuberculosis patients.The M.TB isolates were genotyped by mycobacterial interspersed repetitive units (MIRU).Cluster was defined as two or more patients' M.TB isolates harboring identical MIRU genotype.Results During the study period,there were a total of 681 active pulmonary tuberculosis patients reported.Global Moran's I value and local Moran's I value indicated a random and sporadical manner instead of global spatial clustering of tuberculosis patients in Funing county.Spatial scan statistics (SaTScan) showed that the patients in Guoshu town was statistically significant in spatial clustering (RR=1.85,P=0.036).Among 169 strains of M.TB,27 strains distributed in 12 clusters,which indicated recent transmission among patients within the cluster.Conclusions In rural areas with high tuberculosis incidence,it is less likely to have massive tuberculosis outbreak.Sporadic transmission of tuberculosis may have played an important role in the transmission of tuberculosis in high prevalence area.