| Tuberculosis harmed health of human being seriously, and is one of the serious diseases of control in our country and is also the concerned problem to public health and society all over the world. Coal worker's pneumoconiosis (CWP) is a disease that pulmonary tissue occurred fibrosis because of inhaling powder and dust for a long time and a law occupational diseases of harming physical and mental health of coal miners. Occupational epidemiology data showed that CWP patients were the high risk population of tuberculosis. How to control effectively CWP complicated with tuberculosis has become an important problem to public health and society. At present, studies on CWP complicated with tuberculosis were very limited. And there is no sweeping investigation in our country after the reform in 1998. So we selected CWP patients of six main coal mines all over the country as subjects and made an analysis of the prevalence and risk factors, control measure, susceptibility to tuberculosis and genotype character of mycobacterium of tuberculosis of CWP patients so as to provide theory basis for prevention and control of CWP complicated with tuberculosis. The results of the study are as follows:1. The total prevalence of CWP complicated with tuberculosis was 13.63%. The prevalence of PTB varied with the different region (P＜0.0001). The prevalence of PTB in Anhui was the highest (23.26%), and that of Henan was the lowest (1.41%). We made an analysis of the prevalence of CWP combined with tuberculosis and discovered significant difference between the prevalence of CWP of years, type of work, exposure dusty time, cumulative exposure time, sicken years, sicken area, education years, and so on (P<0.05). There was no significant difference between the prevalence of CWP combined with tuberculosis of the inoculation history (P>0.05). Average income monthly every person, average housing area every person, the attack period of CWP, the contact of tuberculosis, type of work, the stage of CWP, the different coal mine and the begin time of exposure were determinants factors by non-condition logistic regression analysis.2. TB knowledge and awareness in CWP is poor, attitude to TB or TB patients is not right and. And it is short of the therapy and management to CWP TB patients. Most of pneumoconiosis patients complicated with tuberculosis were detected by the passive way. 52.24% patients were detected because they had some symptoms to see a doctor. Most of the education years of medical staff were short in institute of Prevention and Control of occupational disease and tuberculosis, and non-professional personnel hold professional post. 3.60 clinical separated strains were classified into two types according to the situation of cluster, including cluster type and non-cluster type. TheⅢ,Ⅳ,Ⅴ,Ⅶgenotype families was most among the cluster type which were classified into 10 types. The main genotype families of tuberculosis strains from CWP and non-CWP was respectivelyⅣandⅤ. The main genotype of families of tuberculosis strains from Anhui and Beijing was respectivelyⅤ,ⅢandⅦ. The distribution nof genotype of strains of CWP complicated with tuberculosis has no significant difference between the different districts after years, marriage status, the situation of therapy and so on (P>0.05). There was significant difference in the genotype between tuberculosis strains of CWP and non-CWP (P＜0.05), but there was no significant difference between them after adjusting years, culture, smoking, the situation of therapy and so on. There were no significant difference in the association of district, years, gender, marriage status, culture, the history of tuberculosis contact, the situation of therapy, the pathological part, the symptoms and the genotype (P>0.05).4. The frequency of TNF-a-308GG, GA, AA genotype in the case group and control group was respectively 53.10%,40.71%,6.19% and 68.14%,28.32%,3.54%. There was no significant difference of TNF-a-308 locus genotype frequency between the case group and the control group (χ2=5.44,P=0.07). There was significant difference of TNF-a-308 A allele frequency between the case and control group and, A allele frequency of case group was higher than that of the control group (χ2=5.14, P=0.02). There was no significant difference of TNF-a-238 locus genotype frequency and allele frequency between the case and control group (P=0.23 and P=0.09). There was no association of polymorphism of TNF-a-238(G→A) and TNF-a-308(G→A) with CWP complicated with tuberculosis (P>0.05). TNF-a-308GG and AA were demonstrated to be risk of factors of tuberculosis (OR=3.959,95%CI: 1.297-12.086), while TNF-a-238GG and AA not to be risk of factors of tuberculosis (OR=4.295,χ2=1.27, P=0.2598) after years, body mass index, the contact history of tuberculosis, the start exposure time of dust and cumulative exposure time were adjusted by logistic regression analysis. It was found that multivariate-adjusted odds ratio (OR; 95% confidence interval) for TNF-a-238GG and.TNF-a-308GA compared with the combination of TNF-a-238GG and TNF-a-308GG were 1.98(1.06-3.71). While there was no significant association between other combination compared with the combination of TNF-a238GG and TNF-a-308GG (P>0.05). A case-control study was used to analyze gene-environment interactions in the CWP complicated with tuberculosis and the pneumoconiosis. There was positive interaction between TNF-a-308GG genotype and body mass index (ORint=26.85). While there was negative interactions between TNF-a-308 GG genotype and the inoculating history of BCG vaccine or the contact history of tuberculosis, and so was between TNF-α-238GG genotype and the mark of BCG vaccine or the contact history of tuberculosis. Conclusions1. The prevalence of CWP complicated with tuberculosis was 13.63% in six coal mines. The prevalence of CWP complicated with tuberculosis varied with the stage of CWP, type of coal mine and type of work and so on. Average income monthly every person, average housing area every person, the attack period of CWP, the contact of tuberculosis, type of work, the stage of CWP, the different coal mine and the begin time of exposure were determinant factors.2. TB knowledge and awareness in CWP is poor, attitude to TB or TB patients is not right and. And it is short of the therapy and management to CWP TB patients. Systematic measures for CWP TB patients and health service providers like strengthening health education and improving TB related health service are necessary. The manage model of CWP tuberculosis is that the special institute of prevention and control of tuberculosis manages tuberculosis..3. The subjects with TNF-α-308 A alleles are associated with susceptibility to pneumoconiosis complicated with tuberculosis, whije TNF-α-238 A alleles are not discovered an association with susceptibility to CWP complicated with tuberculosis. Interaction was found that TNF-α-238GG or TNF-α-308GG and the inoculating history of BCG vaccine or the contact history of tuberculosis or body mass index.4 There is no significant difference in the genotype between the isolated tuberculosis strains from CWP and non-CWP. There is no significant difference in the genotype between the isolated strains from Beijing and Anhui. There were no significant difference in the proportion of genotype cluster of tuberculosis strains between district, years, marriage status, culture, the history of tuberculosis contact, the situation of therapy, the pathological part, the symptoms and the genotype.
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