成都市涂陽肺結(jié)核病人密切接觸者篩查

研究與評價(jià)

Theresearchandevaluationofscreeninginclosecontactsofsmear-positivetuberculosispatientsinChengdu

成都市結(jié)核病控制項(xiàng)目辦公室

目的：Objective通過對涂陽肺結(jié)核病人密切接觸者進(jìn)行篩查，以早期發(fā)現(xiàn)并治療結(jié)核病人，這是結(jié)核病控制的重要措施，同時(shí)為政府制定結(jié)核病控制政策措施提供科學(xué)依據(jù)。Toearlydetectionandtreatmentoftuberculosisofsmear-positiveclosecontactsoftuberculosispatientsinscreening,whichisanimportantTBcontrolmeasures,aswellasthedevelopmentofTBcontrolforthegovernmenttoprovidethescientificbasisofpoliciesandmeasures.方法：

Methods

統(tǒng)計(jì)結(jié)防機(jī)構(gòu)2007-2008年登記的涂陽肺結(jié)核病人密切接觸者，對密切接觸者進(jìn)行痰涂片檢查和胸部X檢查，并分析不同篩查方法對結(jié)核病人發(fā)現(xiàn)的影響。Countedcontactsincloseofsmear-positivetuberculosispatientsregisteredbyTuberculosispreventionandcontrolinstitutionsin2007-2008,carriedoutsputumsmearexaminationandcheckedchestX-rayinwhom,andanalyzeddifferentscreeningmethodsfortheimpactofTBfound.結(jié)果：Result07-08年共篩查密切接觸者11357例，發(fā)現(xiàn)肺結(jié)核病人34例，病人發(fā)現(xiàn)率為299/10萬；家屬中篩查病人發(fā)現(xiàn)率為278/10萬，非家屬中篩查病人發(fā)現(xiàn)率為729/10萬；用問診方法篩查病人發(fā)現(xiàn)率為188/10萬，用直接檢查方法篩查病人發(fā)現(xiàn)率為729/10萬。

Thereare11,357casesofscreeninginclosecontacts

in2007-2008,andfound34tuberculosispatientsinwitch.Therateofpatientsfoundis299/100000.Thescreeningdetectionrateis729/100000innon-familymembersofpatientsand278/100000infamilymembersofpatients.Thescreeningdetectionrateis729/100000bydirectexamination,aswellas188/100000byinquiry.結(jié)論：Conclusion對涂陽肺結(jié)核病人密切接觸者篩查是發(fā)現(xiàn)新結(jié)核病人的有效方法。

Itisaneffectivewaytodetectnewtuberculosispatientsbyscreeningofclosecontactsinpatientswithsmear-positive.背景1background1肺結(jié)核是通過呼吸道傳播的慢性傳染病，痰涂片陽性的肺結(jié)核病人是主要的傳染源，與痰涂片陽性病人密切接觸的人群，極易受到傳染和發(fā)病，并且接觸的時(shí)間越長，密切接觸者感染的危險(xiǎn)也就越大。Asachronicdiseases,TBisspreadthroughtherespiratory.Themainsourceofinfectionissputumsmear-positivetuberculosispatients.SopeoplemaybeinfectedwithTBandsickinhighlyvulnerablewhocontactsinclosewithsputumsmear-positivepatients.Andthelongertheycontactwith,thegreaterriskofinfectiontheyshouldbewith.

背景2background2一個(gè)痰涂片陽性的肺結(jié)核病人如果得不到正規(guī)治療，一年中可以傳染10-15個(gè)健康人，被感染者一生中發(fā)生結(jié)核病的可能性約為5-10%。有資料顯示：涂陽結(jié)核病人家庭接觸者中，結(jié)核病發(fā)現(xiàn)率為2836/10萬[1]。Asputumsmear-positivetuberculosispatientintheabsenceofformaltreatment,caninfect10-15healthpeopleoneyear，anditisaboutthe5-10%possibilityofTBincidenceinhislifewhohasbeeninfected.Thereareindications,thedetectionrateofTBis2836/100000infamilycontactswithsmear-positivetuberculosispatients[1].

背景3background3所以，對涂陽肺結(jié)核病人的密切接觸者進(jìn)行篩查，以早期發(fā)現(xiàn)并治療結(jié)核病人，這是結(jié)核病控制的重要措施，同時(shí)為政府制定結(jié)核病控制政策提供科學(xué)依據(jù)。Therefore,thescreeninginclosecontactswithsmear-positivetuberculosispatientsinordertoearlydetectionandtreatmentoftuberculosis,whichisanimportantTBcontrolmeasures,aswellasthedevelopmentofTBcontrolforthegovernmentpolicytoprovideascientificbasis.對象與方法

objectsandmethods

1、對象：成都市19個(gè)區(qū)（市）縣結(jié)核病防治機(jī)構(gòu)新登記的涂陽肺結(jié)核病人的直接接觸的家庭成員總數(shù)，包括與痰涂片陽性的肺結(jié)核病人密切接觸的家庭成員、鄰居、同事和同學(xué)等。1objects：thetotalfamilymembersindirectcontactwithnewlyregisteredsmear-positivetuberculosispatientsfrom19TBcontrolandpreventioninstitutionsinChengdu,includingthoserelatedtosputumsmear-positivetuberculosispatientsinclosecontactwithfamilymembers,neighbors,colleaguesandstudentsetc.對象與方法

objectsandmethods2、方法：大邑縣、龍泉驛區(qū)、都江堰市這3個(gè)區(qū)縣對所有涂陽肺結(jié)核病人的密切接觸者均進(jìn)行拍攝X線胸片和三次痰涂片檢查；其他16個(gè)區(qū)（市）縣對密切接觸者先進(jìn)行問診，對有肺結(jié)核可疑癥狀者再進(jìn)行PPD、拍攝X線胸片和三次痰涂片檢查。2MethodsAllcontactsofthreedistricts(Dayi,Longquanyi,Dujiangyan)inclosewithsmear-positivetuberculosispatientswerecarriedoutthechestX-rayandsmearedsputumthreetimes.Otherclosecontactsof16districtswereaskedbydiagnosisfirstandthenexaminedbyvaccinationPPD,carryingoutthechestX-ray,smearingsputumthreetimesinwhichtherearesuspicioussymptomsoftuberculosis.對象與方法

objectsandmethods3、資料來源：2007-2008年成都市19個(gè)區(qū)（市）縣結(jié)防機(jī)構(gòu)核實(shí)上報(bào)的涂陽肺結(jié)核病人密切接觸者的調(diào)查數(shù)據(jù)和方法。3Source:Thesurveydataandmethodsofcontactsinclosewiththesmear-positivetuberculosispatientsfrom19districtsTBcontrolandpreventioninstitutionsinChengduin2007-2008.對象與方法

objectsandmethods4、資料質(zhì)量控制：按《中國結(jié)核病防治規(guī)劃實(shí)施指南》和衛(wèi)生部《關(guān)于結(jié)核病防治工作“五率”相關(guān)技術(shù)方案》的要求。4Dataqualitycontrol:Accordingto“TheimplementationofTBcontrolguideinChina"andTheMinistryofHealth"TheRelatedtechnologyprogramsaboutthefiverateofTuberculosispreventionandcontrol".結(jié)果

Results

1、病人發(fā)現(xiàn)情況2007-2008年涂陽肺結(jié)核病人密切接觸者11624例，共篩查11357例，接觸者篩查率為97.7％，發(fā)現(xiàn)結(jié)核病人34例（其中涂陽肺結(jié)核病人11例，涂陰肺結(jié)核病人23例），病人發(fā)現(xiàn)率為299/10萬。（見表1）1.PatientsfoundIn2007-2008thereis11,624casesinclosecontactsofsmear-positivetuberculosispatientsandscreening11,357cases.Therateofcontactsscreeningis97.7%.Thereare34casesofTBwerebefound(11casessmear-positivetuberculosispatientsand23smear-negativetuberculosispatientsinwhich).TherateofTBpatientsfoundis299/100000(table1)表1密切接觸者篩查人數(shù)和肺結(jié)核病人發(fā)現(xiàn)結(jié)果年份接觸者數(shù)篩查人數(shù)接觸者篩查率（%）發(fā)現(xiàn)結(jié)核病人數(shù)病人發(fā)現(xiàn)率（/10萬）2007年5505530996.40%19358/10萬2008年6119604898.80%15248/10萬合計(jì)116241135797.70%34299/10萬

Table1ThenumberofscreeninginclosecontactsoftuberculosispatientsandtheresultsofTBcasesfound.yearThenumberofContactsThenumberofScreeningTherateofscreeningcontacts（%）ThenumberofTBfound.Therateofpatientsfound（/100000）20075505530996.40%19358/10000020086119604898.80%15248/100000total116241135797.70%34299/1000002、家屬與非家屬篩查情況

Thescreeninginfamiliesandnon-families

在非家屬中篩查病人發(fā)現(xiàn)率為729萬/10萬，家屬中篩查病人發(fā)現(xiàn)率為278/10萬，特別是2008年在非家屬中篩查病人發(fā)現(xiàn)率為1118/10萬，遠(yuǎn)大于在家屬中篩查的病人發(fā)現(xiàn)率131/10萬。Thescreeningdetectionrateis729/100000innon-familymembersofpatientsand278/100000infamilymembersofpatients.Inparticular,thescreeningdetectionrateinnon-familymembersofpatientsis