中国社区肺结核主动筛查循证指南

doi:10.19982/j.issn.1000-6621.20220321

摘要/Abstract

摘要：

为实现终止结核病流行策略目标,迫切需要实施更强有力的措施来改善结核病患者的发现和治疗管理,而主动筛查作为实现目标的重要组成部分,旨在确保结核病患者的早期诊断。中国防痨协会结核病控制专业分会和老年结核病防治专业分会与《中国防痨杂志》编辑委员会共同组织专家,在解读吸收世界卫生组织2021年最新指南证据和建议的基础上,补充了后续新发表的文献和我国国内的相关文献和研究证据,结合中国结核病防治实践和研究结果制订了本指南。本指南系统总结了症状筛查、胸部影像学检查、C反应蛋白检测等筛查技术的特点,提出了在肺结核患者密切接触者、既往结核病患者、HIV/AIDS者、老年人、糖尿病患者和高疫情地区的一般人群等社区人群中开展肺结核主动筛查的方式,为国家和各地完善和优化重点人群肺结核主动筛查策略提供循证依据。

关键词: 分枝杆菌,结核, 主动筛查, 社区网络, 人群监测, 总结性报告(主题)

Abstract:

To achieve the goals of the End Tuberculosis Strategy, stronger measures are urgently needed to improve the detection and treatment of tuberculosis, and active screening is an important part of achieving the goals to ensure early diagnosis of tuberculosis. Tuberculosis Control Branch and Elderly Tuberculosis Control Branch of Chinese Antituberculosis Association, and Editorial Board of Chinese Journal of Antituberculosis organized experts to develop the Chinese guidelines for active screening of pulmonary tuberculosis in communities based on the evidence and recommendations of the latest World Health Organization guidelines in 2021. The guidelines also supplemented follow-up newly published literature and relevant literature and research evidence in China. The guidelines systematically summarized the characteristics of active screening techniques such as symptom screening, chest imaging and C-reactive protein, and proposed to conduct pulmonary tuberculosis active screening among close contacts of pulmonary tuberculosis patients, former tuberculosis patients, HIV/AIDS patients, the elderly, diabetic patients, and the general population in epidemic areas. It would provide a basis for the country and localities to improve and optimize the active tuberculosis screening strategy of key populations.

Key words: Mycobacterium tuberculosis, Active screening, Community networks, Public health surveillance, Consensus development conferences as topic

中图分类号:

R521
R81

中国防痨协会结核病控制专业分会, 中国防痨协会老年结核病防治专业分会, 《中国防痨杂志》编辑委员会. 中国社区肺结核主动筛查循证指南[J]. 中国防痨杂志, 2022, 44(10): 987-997. doi: 10.19982/j.issn.1000-6621.20220321

Tuberculosis Control Branch of Chinese Antituberculosis Association, Elderly Tuberculosis Control Branch of Chinese Antituberculosis Association, Editorial Board of Chinese Journal of Antituberculosis. Evidence-based guidelines for active screening of pulmonary tuberculosis in Chinese communities[J]. Chinese Journal of Antituberculosis, 2022, 44(10): 987-997. doi: 10.19982/j.issn.1000-6621.20220321

图/表 2

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症状	应用人群	敏感度(%)		特异度(%)
症状	应用人群	估计值	95%CI	估计值	95%CI
长期(慢性)咳嗽	一般人群/高危人群	42	36~48	94	92~96
任意时长咳嗽	一般人群/高危人群	51	43~60	88	82~92
任一结核病症状	一般人群/高危人群	71	62~79	64	52~74
WHO推荐的4种主要结核病症状	HIV感染者	83	74~89	38	25~53

人群	研究数(项)	样本量(例)	敏感度[%(95%CI)]	特异度[%(95%CI)]
所有HIV感染者	6	3971	90(78~96)	50(29~71)
住院患者	1	400	98(93~100)	12(9~17)
正在进行抗病毒治疗的门诊患者	1	381	40(10~80)	80(75~84)
未进行抗病毒治疗的门诊患者	4	3186	89(85~92)	54(45~62)
CD4⁺ T细胞≤200个/μl者	6	1829	93(87~97)	40(22~62)
感染HIV的孕妇	2	62	70(12~97)	41(12~78)