台灣中部某醫學中心透析病人潛伏結核感染的流行病學與危險因子

Epidemiology and Risk Factors for Latent Tuberculosis Infection Among Dialysis Patients in a Medical Center in Central Taiwan

結核病是國際間高度重視的傳染病之一，而台灣仍屬於發病率中等的國家，因此建立防治策略非常重要；大多數的活動性結核病來自潛伏結核感染（latent tuberculosis infection, LTBI），對LTBI進行早期診斷和治療，可阻止其進展為活動性結核病並傳播出去。透析病人為罹患LTBI的高風險族群，丙型干擾素釋放試驗（Interferon-gamma release assay, IGRA）可幫助進行診斷。為調查血液和腹膜透析病人感染LTBI的盛行率與風險因子，本研究於2024年1月1日至2024年12月31日在中部一家醫學中心的透析中心進行一項觀察性研究（Observational study），為透析病人安排IGRA檢測並分析其臨床資料。在排除活動性結核病後，最終有238位病人納入研究，其中13位IGRA呈陽性，LTBI的盛行率為5.5%。後續追蹤治療情形，3HP完成治療的比率為71.4%。在多變項邏輯迴歸分析（multivariate logistic regression analysis）中，將IGRA陽性以及無法判定的病人與IGRA陰性的病人比較，結果顯示癌症為具統計顯著差異的風險因子（p =0.016）。與過去的本土研究相比，本研究的透析病人LTBI盛行率較低。癌症為LTBI的顯著風險因子，此結果有助於在高風險患者中優先安排IGRA篩檢，以促進LTBI的早期發現與早期治療，並發展病人能耐受的LTBI治療，以提高完治率，也才能降低日後的發病率和死亡率。

Tuberculosis (TB) remains a major global infectious disease, and Taiwan continues to be classified as a country with a moderate incidence. Therefore, developing effective prevention strategies is essential. Most active TB cases arise from latent tuberculosis infection (LTBI), and early diagnosis and treatment of LTBI can prevent progression to active TB and further transmission. Dialysis patients represent a high-risk group for LTBI, and the interferon-gamma release assay (IGRA) is a useful diagnostic tool. To investigate the prevalence and risk factors of LTBI among hemodialysis and peritoneal dialysis patients, an observational study was conducted from January 1 to December 31, 2024, at the dialysis center of a medical facility in central Taiwan. IGRA testing was performed for dialysis patients, and their clinical data were analyzed. After excluding patients with active tuberculosis, a total of 238 patients were enrolled. Among them, 13 tested positive for IGRA, yielding an LTBI prevalence rate of 5.5%. During follow-up, the treatment completion rate for the 3HP regimen was 71.4%. In multivariate logistic regression analysis, patients with positive or indeterminate IGRA results were compared to those with negative results. Cancer was identified as a statistically significant risk factor for LTBI (p = 0.016). Compared to previous local studies, the prevalence of LTBI among dialysis patients in this study was lower. Cancer was found to be a significant risk factor for LTBI, suggesting that IGRA screening should be prioritized for high-risk populations to enable early detection and timely treatment. Furthermore, developing LTBI treatment regimens with better tolerability may improve completion rates and ultimately reduce future disease incidence and mortality.