南投及花東山地鄉結核菌株基因型盛行現況及地理分布

研究目的：本研究主旨調查南投和花東山地鄉結核菌群株之盛行基因型，藉此了解南投及花東山地鄉是否有社區隱藏性傳播、群聚感染存在。研究方法：透過中央傳染病追蹤管理系統收集2012年1月至2013年12月間目標地區結核病確診個案，南投山地鄉(仁愛鄉、信義鄉)個案痰液檢體可納入研究數131套；花蓮山地鄉(秀林鄉、卓溪鄉、萬榮鄉)和台東山地鄉(海端鄉、延平鄉、達仁鄉、金峰鄉、蘭嶼鄉)，東區山地鄉個案痰液檢體可納入研究數共177套。以電腦軟體EXCEL 建立個案基本資料和菌株流行病學基本資料庫，實驗分析以spoligotyping及MIRU分析肺結核分子流行病學，基因分型研究，並建立此區Genotyping相關資料；以描述性統計學方式敘述山地鄉結核病的發生率變動情況及盛行菌株基因型狀態，並結合地理資訊系統(Geographic Information System,GIS)，描繪病患於地理位置上的分布情況，探討相同菌株基因型的地理分布情形。研究結果：南投縣山地鄉盛行菌株基因型為荷蘭株(Haarlem) (H3共58株，44.27%)，而花東山地鄉盛行菌株基因型為北京株(BEIJING)(共101株，57%)，經由菌株基因型及親緣樹比對，發現於這些山地鄉社區中，確實有隱藏性傳播存在，結合GIS可發現同一鄉村內菌株基因型有較高同質性。結論與建議：本研究發現南投山地鄉結核菌株基因型以荷蘭株為主，花東山地鄉結核菌株基因型以北京株為主，兩區的結核菌株基因型有顯著的差異，造成差異的原因可能與台灣的歷史變革或殖民變遷有關係，於文中有稍作探討，相關結果可再另行探討；若要有效改善山地鄉居民的結核病高發生率及群聚感染問題，除了改善環境生活品質外，最重要的就是克服因地形帶來的醫療可近性問題，著重阻絕及預防群體間的傳染問題，並提供早期介入治療的措施，研究結果供醫療端及公衛端對於山地鄉結核病防治介入之參考。

Objective: To investigate the prevalence of tuberculosis strains and find out whether there is hidden community transmission and clustered infections in Nantou and East Mountain Area of Taiwan. Methods and Information: Data of tuberculosis cases from the Central Infectious Disease Tracing Management System was collected in the target area from January 2012 to December 2013. A total of 131 sputum samples were included from Nantou Mountain Area (Yanai Township, Xinyi Township), and 177 sputum samples were included from Eastern Mountain Area which includes Hualien Mountain Area (show Lin Township, Zhuo Township, Wanrong Township) and Taitung Mountain Area (Haiidong Township, Yanping Township, Da Ren Township, Jinfeng Township, Lan Yu Township).The basic information and epidemiology of strains were recorded by computer software EXCEL. The molecular epidemiology and genotyping of pulmonary tuberculosis were analyzed by spoligotyping and MIRU, and the data of Genotyping in these study areas were established. The incidence rate of tuberculosis in mountainous areas and the genotype status of the strains were investigated and recorded by descriptive statistics. Further, the geographical distribution of the same genotypes strains were analyzed by using the Geographic Information System (GIS). Results: The results showed that the prevalent of genotype strain in Nantou Mountain Area was Haarlem (58 cases, 44.27%), on the other hand, the prevalent genotype strain in East Taiwan Mountain Area was BEIJING (101 strains, 57%). According to the genotype and phylogenetic tree of the strain, it was found that there was a hidden community transmission in these mountainous areas. The genotype of same tuberculosis strain in one village has higher homogeneity as analyzed by the GIS.Conclusions: In this study, we found that that the prevalent of genotype strain in Nantou Mountain Area was Haarlem; the genotype of tuberculosis strain in east Taiwan Mountain Area was mainly BEIJING. There were significant differences in the genotypes of tuberculosis strains in these two districts, historical changes or colonial changes in Taiwan may be the factors causing this difference. Further discussion was described in the context and relevant results can be studied in the future.In order to decrease the incidence of tuberculosis and cluster infection more effectively in mountain areas, issues need to be solved such as how to overcome the medical accessibility problems in the mountain areas, blocking transmission and infection between groups, as well as providing early medical intervention are much more important than improvement of environmental living quality. These study results, for the medical side and public health point of view, can be tuberculosis prevention and control intervention reference in the mountain areas.