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中国防痨杂志 ›› 2022, Vol. 44 ›› Issue (4): 368-374.doi: 10.19982/j.issn.1000-6621.20210682

• 论著 • 上一篇    下一篇

2018—2020年深圳市龙华区某综合医院呼吸科加强住院患者结核病病原学检查的效果分析

王艳1, 房宏霞1, 郑开巧1, 谭晓萍1, 黄冬生2, 粟连辉2, 刘昌伟1()   

  1. 1深圳市龙华区慢性病防治中心,深圳 518110
    2深圳市龙华区中心医院,深圳 518110
  • 收稿日期:2021-11-26 出版日期:2022-04-10 发布日期:2022-04-06
  • 通信作者: 刘昌伟 E-mail:447407874@qq.com
  • 基金资助:
    深圳市科技计划项目(JCY20180306172419505);广东省热带病研究重点实验室开放基金项目(KLTDR202002)

Analysis of the effect of strengthening tuberculosis etiological examination on hospitalized patients from respiratory department of general hospital in Longhua of Shenzhen between 2018 and 2020

WANG Yan1, FANG Hong-xia1, ZHENG Kai-qiao1, TAN Xiao-ping1, HUANG Dong-sheng2, SU Lian-hui2, LIU Chang-wei1()   

  1. 1Longhua Center for Chronic Disease Control, Shenzhen 518110, China
    2Longhua District Central Hospital, Shenzhen 518110, China
  • Received:2021-11-26 Online:2022-04-10 Published:2022-04-06
  • Contact: LIU Chang-wei E-mail:447407874@qq.com
  • Supported by:
    Shenzhen Science and Technology Program Project Fund(JCY20180306172419505);Guangdong Provincial Key Laboratory of Tropical Disease Research Program Open Fund(KLTDR202002)

摘要:

目的: 分析2018—2020年深圳市龙华区某综合医院呼吸科住院的非已知肺结核及疑似肺结核患者中病原学阳性肺结核患者发现的情况,探索在呼吸科住院患者中进行肺结核早期发现的模式。 方法: 2018年1月至2020年12月,龙华区某综合医院设置留痰室,并配备专职留痰宣教人员,对呼吸科住院的非已知肺结核及疑似肺结核患者中有肺结核可疑症状或临床不能排除肺结核的住院患者(342例)采集痰液(或由医务人员采集支气管肺泡灌洗液或胸腔积液),同时进行涂片、培养、GeneXpert MTB/RIF(简称“GeneXpert”)检测,以发现其中病原学阳性的肺结核患者,分析不同检验策略在病原学阳性患者发现中的价值。 结果: 342例患者中,病原学阳性73例,病原学阳性率为21.3%。单一检测方法中,涂片法检出阳性患者24例(32.9%,24/73),培养法检出阳性患者52例(71.2%,52/73),GeneXpert法检出阳性患者54例(74.0%,54/73);检测方法组合中,涂片+培养检查发现阳性患者53例(72.6%,53/73),涂片+GeneXpert检查发现阳性患者58例(79.5%,58/73),培养+GeneXpert检查发现阳性患者73例(100.0%,73/73)。2020年纳入患者的病原学阳性率最高(27.7%,38/137),其次为2018年(20.6%,20/97),2019年最低(13.9%,15/108),差异有统计学意义(χ2=6.941,P=0.031)。结论: 综合医院呼吸科住院患者中,除已知肺结核及胸部影像学检查提示肺结核患者外,仍存在病原学阳性肺结核患者。建议综合医院与当地有检测能力的机构合作,在肺结核诊断性治疗前留痰送检,以实现病原学阳性肺结核患者发现关口的前移。

关键词: 结核,肺, 早期诊断, 医院,综合, 评价研究

Abstract:

Objective: To analyze the status of discovery of pulmonary tuberculosis with positive etiology among unknown pulmonary tuberculosis and suspected patients hospitalized in the respiratory department of a general hospital in Longhua, Shenzhen from 2018 to 2020, and explore the mode of early detection of pulmonary tuberculosis among hospitalized patients in the respiratory department. Methods: From January 2018 to December 2020, a sputum retention room was set up in a general hospital in Longhua, equipped with full-time personnel for sputum retention education to collect sputum from unknown pulmonary tuberculosis and suspected patients who had suspected symptoms or other hospitalized patients with pulmonary tuberculosis could not be excluded clinically (n=342)(or collecting bronchoalveolar lavage fluid or pleural effusion by medical staff). Smear, culture and GeneXpert MTB/RIF (“GeneXpert”) test were conducted at the same time to detect the pulmonary tuberculosis patients with positive etiology, and the value of different test strategies in the detection of patients with positive etiology was analyzed. Results: Of the 342 patients, etiology was positive in 73 (21.3%). With single test method, 24 patients (32.9%, 24/73) were found positive by smears, 52 (71.2%,52/73) by culture, and 54 (74.0%, 54/73) by GeneXpert. With combination of test methods, 53 patients (72.6%, 53/73) were found positive by sputum smear+sputum culture test, 58 patients (79.5%, 58/73) were found positive by sputum smear+GeneXpert test, and 73 patients (100.0%, 73/73) were found positive by sputum culture+GeneXpert. The positive rate of pathogens was the highest in 2020 (27.7%, 38/137), followed by 2018 (20.6%, 20/97) and 2019 (13.9%, 15/108), with statistical significance (χ2=6.941, P=0.031). Conclusion: Among the inpatients in the respiratory department of general hospitals, beside those who with known pulmonary tuberculosis and those who with pulmonary tuberculosis-related images indicated by chest imaging examination, pulmonary tuberculosis patients with positive etiology still existed. It was suggested that the general hospital cooperate with local institutions with detection ability to keep sputum for examination before diagnostic treatment, so as to move forward the detection of pulmonary tuberculosis patients with positive etiology.

Key words: Tuberculosis,pulmonary, Early diagnosis, Hospitals,general, Evaluation studies

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