河南省新密市重点地区的重点人群肺结核主动筛查研究

目的: 评价在结核病重点人群中开展肺结核主动发现的效果。方法: 在河南省新密市的32个重点行政村,对14岁以上居民均进行肺结核可疑症状筛查,对发现的肺结核可疑症状者和正在治疗的糖尿病患者、年龄≥65岁的居民、有3年以上粉尘接触史的人员、精神病患者、近10年内家庭中有肺结核患者的居民,以及外来务工人员等7类重点人群进行胸部数字X线摄影(digital radiography;简称“胸片”)检查,有可疑症状者或胸部影像学异常者到新密市结核病防治所进行痰涂片、痰结核分枝杆菌培养和GeneXpert MTB/RIF(简称“Xpert”)检查,以发现重点人群中的肺结核患者。结果: 在32个行政村共登记7类人群,共计7368名。对 7265名(98.60%)进行了问卷调查,存在肺结核可疑症状者2750名(37.85%);7111名(96.51%)拍摄了胸片,肺内存在异常者456名(6.41%),确诊肺结核患者5例(0.07%,5/7111),肺癌患者8 例(0.11%,8/7111),陈旧性肺结核(含陈旧性结核性胸膜炎)者152例(2.14%,152/7111)。有粉尘接触史、≥65岁老年人、有结核病接触史、外来务工人员、有肺结核症状者、糖尿病患者、精神病患者胸片异常的比例依次为8.71%(75/861)、8.42%(330/3919)、7.59%(12/158)、4.23%(19/449)、3.57%(47/1315)、3.24%(28/863)、1.64%(1/61),差异有统计学意义(χ²=68.111,P<0.001);检出的5例活动性肺结核患者中,3例Xpert检测结果为阳性。活动性肺结核患者总检出率为70.31/10万(5/7111),有粉尘接触史者检出率最高(116.14/10万,1/861),其他分别为≥65岁老年人(76.55/10万,3/3919)和有肺结核症状者(76.05/10万,1/1315),差异有统计学意义(χ²=36.131,P<0.001)。结论: 在结核病重点人群中主动筛查肺结核,是对转诊和因症就诊发现患者的重要补充,可以提高肺结核患者的发现率。

Study on active screening of pulmonary tuberculosis among key population in key areas of Xinmi,He’nan

Objective: To evaluate the effect of active detection of pulmonary tuberculosis in key population. Methods: In 32 key administrative villages in Xinmi, He’nan, residents over 14 years old were screened for suspicious symptoms of pulmonary tuberculosis. In order to screen out pulmonary tuberculosis patients in key populations, chest digital radiography (DR) was performed on 7 key groups such as those who with suspected symptoms of pulmonary tuberculosis, diabetes patients being treated, residents over 65 years old, people with dust exposure history of more than 3 years, mental patients, residents with pulmonary tuberculosis patients in their families in recent 10 years, and migrant workers, and people who with suspicious symptoms or abnormal chest imaging were examined by sputum smear, Mycobacterium tuberculosis culture and GeneXpert MTB/RIF (Xpert) in the Municipal Tuberculosis Prevention and Control Institute. Results: A total of 7368 people in 7 categories were registered from 32 administrative villages. Among them, 7265 (98.60%) were investigated by questionnaire, 2750 (37.85%) had suspicious symptoms of pulmonary tuberculosis, 7111 (96.51%) had DR images, 456 (6.41%) had abnormalities in their lungs, 5 (0.07%) were diagnosed as pulmonary tuberculosis, 8 (0.11%) were with lung cancer, and old pulmonary tuberculosis (including old tuberculous pleurisy was found in 152 people (2.14%). The proportions of dust exposure history, aged over 65 years, tuberculosis exposure, migrant workers, pulmonary tuberculosis symptoms, diabetes and mental disease were 8.71% (75/861), 8.42% (330/3919), 7.59% (12/158), 4.23% (19/449), 3.57% (47/1315), 3.24% (28/863), 1.64% (1/61), respectively, the difference was statistically significant (χ²=68.111, P<0.001). Of the 5 detected active pulmonary tuberculosis patients, 3 were positive in Xpert. The total detection rate of active pulmonary tuberculosis was 70.31/100000 (5/7111), the highest detection rate was found in those who with dust exposure history (116.14/100000, 1/861), and the detection rates of people who aged over 65 years and those with pulmonary tuberculosis symptoms were 76.55/100000 (3/3919) and 76.05/100000 (1/1315), the difference was statistically significant (χ²=36.131, P<0.001). Conclusion: Active screening of pulmonary tuberculosis among key population is an important supplement to detect patients in referral and symptomatic visits, and therefore to improve the detection rate of tuberculosis patients.