摘要
目的 分析四川省9个县（区）主动筛查发现和常规被动发现在肺结核患者发现中的作用和意义。方法 通过对2012—2016年四川省9个县（区）的抽样乡镇开展结核病主动筛查工作,收集主动发现的活动性肺结核患者（以下称“主动发现”）及2012—2016年来源于中国疾病预防控制信息系统结核病管理信息系统上述9个县（区）的抽样乡镇常规被动发现的活动性肺结核患者的资料（“患者来源”为因症就诊、因症推荐、转诊和追踪）,分析两者在社会人口学、临床特征、实验室检查等方面的差异。计数资料采用χ2检验,以P〈0.05为差异有统计学意义。结果 5年来主动发现方式共检出活动性肺结核患者272例,检出率为498.87/10万（272/54523）,其中71例无症状者（26.10%,71/272）;被动发现方式在县级结核病防治机构共登记活动性肺结核患者1868例,2014—2016年的登记率为67.04/10万（347/517584）、78.36/10万（374/472596）、63.76/10万（300/470504）,各年度间活动性肺结核患者登记率总体趋势差异无统计学意义（$／chi^2_{趋势}$=0.288,P=0.591）。主动发现患者平均年龄[（56.76±16.64）岁]高于被动发现的1868例肺结核患者平均年龄[（44.70±18.38）岁]（U=158318.500,P=0.000）。主动发现患者中年龄分布≥60岁者（52.57%,143/272）和所在地为农村的患者（80.51%,219/272）明显高于被动发现中≥60岁（25.37%,474/1868）和农村患者（45.88%,857/1868）;两组比较,差异均有统计学意义（χ2值分别为99.831、113.941,P值均为0.000）。主动发现患者中涂阳患者（19.12%,52/272）、空洞患者（11.03%,30/272）明显低于被动发现患者中的比例（分别为31.16%,582/1868;24.68%,461/1868）;两组比较,差异均有统计学意义（χ2值分别为23.311、25.020,P值均为0.000）。5年间9个县（区）主、被动发现患者构成比差异有统计学意义（χ2=90.000,P=0.000）,农村调查点的被动发现患者构成比（79.65%,857/1076）明显低于城镇调查点（95.02%,1011/1064）,差异有统计学意义（χ2=113.941,P=0.000）。结论 主动发现策略可作为被动发现策略的有益补充,对于促进肺结核患者的发现,特别对农村地区和≥60岁老年人群具有重要价值。
Objective To explore the effects and roles of active and passive methods in detection of patients with pulmonary tuberculosis （PTB） by comparing and analyzing the characteristics of detected TB cases in 9 districts/counties in Sichuan Province.Methods The information and data of active PTB patients, who were detected through active screening method at township level （hereinafter referred to as ＂active case detection＂） in 9 counties in Sichuan Province from 2012 to 2016, were collected; at the same time, the information and data of active PTB patients, who were detected through passive method （such as sought of health care with symptoms, referral and tracing） and notified in the China CDC＇s TB recording and reporting system （hereinafter referred to as ＂passive case detection＂） in the same areas and same period, were also collected. The social and demographical characteristics, clinical features, as well as the results of laboratory examinations, etc. in two groups of patients were compared. The count variables were analyzed by using Chi-square test and P〈0.05 was regarded as a statistically significant difference.Results A total of 272 active PTB patients were detected through active case detection method and the detection rate was 498.87/100000 （272/54523）; among those 272 cases, 71 cases were asymptomatic （26.10%, 71/272）. In the same areas and same period, a total of 1868 active PTB cases were detected through passive case detection method and registered. The registration rate was 67.04/100000 （347/517584） and 78.36/100000 （374/472596）, 63.76/100000 （300/470504） respectively in 2014, 2015 and 2016. The registration rate of active PTB patients in these 3 years was no significantly difference （$／chi^2_{趋势}$=0.288, P=0.591）. The average age of the patients in the active case detection group was （56.76±16.64） years old, which was higher than that of patients in the passive case detecting group （（44.70±18.38） years old） （U=158318.500, P=0.000）. The proportion of patients aged ≥60 years in the active case detection group （52.57%, 143/272） was significantly higher than that of patients in the passive case detection group,（25.37%, 474/1 868） （χ2=99.831, P=0.000）; the proportion of patients living in village in the active case detect group （80.51%, 219/272） was significantly higher than that of patients in the passive case detection group （45.88%, 857/1 868） （χ2=113.941, P=0.000）. In the active case detection group, the proportions of patients with sputum smear positive （19.12%, 52/272） and cavities （11.03%, 30/272） were significantly lower than those of patients in the passive case detection group （31.16%, 582/1 868 and 24.68%, 461/1868 respectively） （χ2=23.311 and 25.020, P=0.000）. The constituent ratios of the patients detected by active and passive case detection methods in 9 counties were significantly different in the 5 years （χ2=90.000, P=0.000）; the constituent ratio of the patients living in villages and detected through passive case detection method （79.65%, 857/1076） was significantly lower than that of patients living in cities （95.02%, 1011/1064）（χ2=113.941, P=0.000）.Conclusion Active case detection method can be a helpful supplement to passive case detection method. It has great value on improving case detection, especially in rural areas and the elderly.
作者
李婷
何金戈
李运葵
李京
肖月
王丹霞
禄嘉
夏勇
陈闯
吴建林
LI Ting, HE Jin-ge, L1 Yun-kni, LI Jing, XIAO Yue, WANG Dan-xia, LUJia, XIA Yong, CHEN Chuang, WUJian-lin(Tuberculosis Prevention and Control Department, Sichuan Center ,for Disease Control and Prevention, Chengdu 610041, China)
出处
《中国防痨杂志》
CAS
2018年第11期1214-1220,共7页
Chinese Journal of Antituberculosis
关键词
结核
肺
流行病学
多相筛查
诊室就医
对比研究
Tuberculosis
pulmonary
Epidemiology
Multiphasic screening
Office visits
Comparative study
