잠복결핵 치료에 따른 결핵 발생 위험도와 관련요인
Incidence of tuberculosis and related factors according to latent tuberculosis treatment
- 주제(키워드) tuberculosis , latent tuberculosis , contact tracing , cohort study , incidence
- 발행기관 고려대학교 보건대학원
- 지도교수 천병철
- 발행년도 2022
- 학위수여년월 2022. 8
- 학위명 석사
- 학과 및 전공 보건대학원 역학및보건정보학과
- 세부분야 해당없음
- 원문페이지 69 p
- 실제URI http://www.dcollection.net/handler/korea/000000269455
- UCI I804:11009-000000269455
- DOI 10.23186/korea.000000269455.11009.0001330
- 본문언어 한국어
초록/요약
Objectives: This study aimed to estimate the incidence of tuberculosis (TB) among latent tuberculosis infection (LTBI) cases by LTBI treatment behavior. The risk factors affecting the initiation and discontinuation of preventive treatment (PT) for LTBI were identified. Methods: This study was a retrospective cohort study of the contacts of TB cases who were enrolled in the Korean National Tuberculosis Surveillance System TB registry operated by the Korea Disease Control and Prevention Agency (KDCA). The study included 96,193 contacts in Seoul and Gyeonggi-do in South Korea identified during the contact investigation from January 1, 2015 to December 31, 2018. The end of follow-up period was when TB(event) was diagnosed, and if no event occurred, the last follow-up date was December 31, 2020. Log binomial model was performed to identify factors affecting LTBI, non-PT and discontinuation of PT. Cox proportional hazards regression model was conducted to estimate the incidence of tuberculosis according to LTBI treatment. Results: During the average observation period of 3.97 (±1.17) years, 288 (0.3%) of 96,193 contacts developed tuberculosis, of which 48 (0.05%) were prevalent tuberculosis, and 240 (0.25%) were incident tuberculosis. The incidence of those completed, discontinued and non-preventive treatment was 45.50, 387, 368.38 per 100,000 person years respectively. The risk of active TB development among contacts with medical facilities (aHR 2.10, 95% CI: 1.35-3.26), LTBI who completed PT (aHR 2.10, 95% CI: 1.05-4.19), discontinued PT (aHR 18.61, 95% CI: 11.58-29.92), without PT(aHR 21.29, 95% CI: 15.51-29.24) were higher than those without LTBI. Conclusion: Among contacts of tuberculosis who were diagnosed with latent tuberculosis infection, completion of preventive treatment effectively reduced the risk of developing tuberculosis than those discontinued or non-preventive treatment groups.
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Abstract i
I. 서론 1
1. 연구 배경 및 필요성 1
II. 방법 5
1. 연구 설계 및 연구 대상 5
1) 연구대상자 정의 및 제외기준 5
2) 추적관찰 기간 선정 7
3) 접촉자 위험요인. 7
2. 연구방법 8
1) 접촉자조사 8
2) 잠복결핵 치료 및 추적 9
3) 결핵 유병률 및 결핵 평균 발생률 계산 10
3. 자료분석 11
4. 윤리적 고려 11
Ⅲ. 결과 12
1. 연구대상자 인구통계학적 특성 12
2. 잠복결핵감염의 위험요인 15
3. 잠복결핵 치료 미실시의 위험요인 19
4. 잠복결핵 치료 중단의 위험요인 23
5. 잠복결핵감염 검사 결과와 치료에 따른 결핵 유병률과 결핵 평균 발생률 27
6. 잠복결핵감염 검사 결과와 치료에 따른 결핵 발생의 위험비 29
7. 집단시설 결핵역학조사 접촉자의 결핵 발생 위험요인 33
Ⅳ. 고찰 36
Ⅴ. 요약 및 결론 46
참고문헌 49
부록 58
