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中国防痨杂志 ›› 2022, Vol. 44 ›› Issue (4): 397-402.doi: 10.19982/j.issn.1000-6621.20220018

• 论著 • 上一篇    下一篇

天津市综合医疗机构在四种高危人群中开展结核病确诊相关检查现况调查

高丽, 庞学文, 万莹, 杨光伟, 李丹, 张文倩, 陈盛玉()   

  1. 天津市结核病控制中心研究室,天津 300000
  • 收稿日期:2022-01-28 出版日期:2022-04-10 发布日期:2022-04-06
  • 通信作者: 陈盛玉 E-mail:chenshengyu@tj.gov.cn

A survey on TB screening among four high-risk groups in general medical institutions in Tianjin City

GAO Li, PANG Xue-wen, WAN Ying, YANG Guang-wei, LI Dan, ZHANG Wen-qian, CHEN Sheng-yu()   

  1. Research Room of Tianjin Center for Tuberculosis Control and Prevention,Tianjin 300000, China
  • Received:2022-01-28 Online:2022-04-10 Published:2022-04-06
  • Contact: CHEN Sheng-yu E-mail:chenshengyu@tj.gov.cn

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摘要：

目的: 了解天津市综合医疗机构在单侧胸腔积液、咯血、拟应用免疫抑制剂和拟长期应用糖皮质激素住院患者中开展结核病确诊相关检查的现况。方法: 采用方便抽样法,选取天津市31家疑似结核病报告数量较大的综合医疗机构作为研究现场。每种高危人群先分别从每家医疗机构指定科室各抽取住院患者病案10份,共纳入1240份患者病案。查阅病案病程记录,提取符合高危人群定义的患者作为研究对象,最终纳入419例研究对象,其中单侧胸腔积液住院患者164例,咯血住院患者97例,拟应用免疫抑制剂住院患者86例,拟长期应用糖皮质激素住院患者72例。结果: 31家综合医疗机构以三级为主,占80.6%(25/31)。4种高危人群完成结核病确诊相关检查的比例为46.1%(193/419),单侧胸腔积液、咯血、拟应用免疫抑制剂和拟长期应用糖皮质激素住院患者完成检查的比例分别为57.3%(94/164)、52.6%(51/97)、29.1%(25/86)、31.9%(23/72)。涂片、培养、GeneXpert MTB/RIF、结核菌素皮肤试验(TST)、γ-干扰素释放试验(IGRA)和结核抗体检查比例分别为64.8%(125/193)、16.6%(32/193)、10.9%(21/193)、8.3%(16/193)、18.1%(35/193)和34.2%(66/193)。三级综合医疗机构IGRA检测比例为21.1%(35/66),高于二级综合医疗机构的0.0%(0/27),差异有统计学意义(χ2=6.954, P=0.005);结核抗体检测比例为31.3%(52/166),低于二级综合医疗机构的51.9%(14/27),差异有统计学意义(χ 2=4.348, P=0.049)。结论: 天津市综合医疗机构高危人群开展结核病确诊相关检查的比例较低,需进一步提高检查水平。

关键词: 结核, 胸腔积液, 咯血, 免疫抑制剂, 糖皮质激素类, 医院,综合, 天津市

Abstract:

Objective: To investigate the current status of tuberculosis screening in inpatients with unilateral pleural effusion, hemoptysis and inpatients prescribed with immunosuppressant or long-term glucocorticoid in general medical institutions of Tianjin City. Methods: Convenient sampling was used to select 31 general medical institutions with large number of TB cases in Tianjin City as study sites, then 10 inpatients’ medical records were selected from designated department of each medical institution, a total of 1240 patients were included and finally records of 419 patients meeting definition of the 4 high-risk groups were extracted as research objects, including 164, 97, 86 and 72 patients for each of the unilateral pleural effusion group, hemoptysis group, immunosuppressant group and long-term glucocorticoid group. Results: The 31 general medical institutions were mainly tertiary hospitals, accounting for 80.6% (25/31).46.1% (193/419) of the 4 high-risk groups completed examination for TB diagnosis. 57.3% (94/164), 52.6% (51/97), 29.1% (25/86), 31.9% (23/72) of inpatients completed the examination for each of the unilateral pleural effusion group, hemoptysis group, immunosuppressant group and long-term glucocorticoid group.The proportions of patients taking smear, culture, GeneXpert, TST, IGRA and tuberculosis antibody examination were 64.8% (125/193), 16.6% (32/193), 10.9% (21/193), 8.3% (16/193), 18.1% (35/193) and 34.2% (66/193), respectively. The proportion of IGRA examination was 21.1% (35/66) in tertiary general medical institutions, higher than 0.0% (0/27) in secondary general medical institutions with statistically significant difference (χ2=6.954, P=0.005), while the proportion of tuberculosis antibody examination was 31.3% (52/166) in tertiary institutions, lower than that of secondary institutions(51.9%, 14/27), the difference was statistically significant (χ 2=4.348, P=0.049) too. Conclusion: In Tianjin City, the proportion of high-risk population undergoing tuberculosis examinations in general medical institutions was quite low which should be further improved.

Key words: Tuberculosis, Pleural effusion, Haemoptysis, Immunosuppressant, Glucocorticoids, Hospital,general, Tianjin city

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