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中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (6): 583-588.doi: 10.3969/j.issn.1000-6621.2018.06.007

• 论著 • 上一篇    下一篇

柳州市和喀什地区推广应用结核病新诊断技术的效果分析

阮云洲,李仁忠(),苏伟,赵雁林,王黎霞,魏旭,刘一垚,廖奇志   

  1. 102206 北京,中国疾病预防控制中心结核病预防控制中心(阮云洲、李仁忠、苏伟、赵雁林、王黎霞);法国梅里埃基金会(魏旭、刘一垚、廖奇志)
  • 收稿日期:2018-03-08 出版日期:2018-06-20 发布日期:2018-07-24
  • 基金资助:
    中华人民共和国卫生部-法国梅里埃基金会第二轮结核病防治合作项目(卫国际欧美便函[2012]688号)

Exploration of the application of new diagnostic techniques for tuberculosis in Liuzhou and Kashi Region

Yun-zhou RUAN,Ren-zhong LI(),Wei SU,Yan-lin ZHAO,Li-xia WANG,Xu WEI,Yi-yao LIU,Qi-zhi. LIAO   

  1. Chinese Center for Diseases Control and Prevention, National Center for Tuberculosis Control and Prevention, Beijing 102206, China
  • Received:2018-03-08 Online:2018-06-20 Published:2018-07-24

摘要: 目的

探索我国边疆少数民族地区推广应用发光二级管荧光显微镜(简称“LED荧光显微镜”)和线性探针耐药检测技术的可行性。

方法

采用典型调查,选择广西壮族自治区柳州市和新疆维吾尔自治区喀什地区作为研究现场,研究对象为2013年1月1日至2016年12月31日期间,所有初次到当地结核病防治机构(简称“结防机构”)就诊的肺结核可疑症状者。推广新技术前(2013年)柳州市和喀什地区分别纳入肺结核可疑症状者14337和32022例;推广新技术后(2014—2016年)柳州市和喀什地区分别纳入肺结核可疑症状者年平均12796和36649例。推广的新技术主要为研究地区县级结防机构配备LED荧光显微镜,对初诊患者的痰标本进行涂片镜检,以诊断涂片阳性肺结核和活动性肺结核;地市级结防机构配备线性探针耐药检测设备和试剂,检测痰涂片阳性标本对一线抗结核药物利福平和异烟肼的耐药性。回顾性收集推广新技术前的数据,并前瞻性收集推广新技术后的数据,对比分析推广新技术前后初诊患者查痰率和耐药高危人群耐药筛查率的变化情况。

结果

柳州市和喀什地区初诊患者查痰率分别从推广新技术前的54.15%(7763/14337)和65.36%(20930/32022)增加到推广新技术后的年平均64.25%(8221/12796)和74.34%(27246/36649),差异均有统计学意义(χ 2=285.00,P<0.001;χ 2=658.00,P<0.001);其中,LED荧光显微镜查痰比率从均为0.00%分别增加到79.36%(6524/8221)和92.88%(25307/27246),差异均有统计学意义(Fisher精确检验法,P值均<0.001)。2个地区耐药高危人群筛查率从均为0.00%分别增加到94.61%(158/167)和74.96%(494/659),差异均有统计学意义(Fisher精确检验法,P值均<0.001);其中使用线性探针检测的比率从均为0.00%分别增加到80.38%(127/158)和52.83%(261/494),发现的利福平耐药肺结核和(或)耐多药肺结核患者例数占总例数的比率从均为0.00%分别增加到81.82%(9/11)和53.06%(26/49)。

结论

结核病新诊断技术有助于边疆少数民族地区实现结核病防治规划目标,应用于边疆少数民族地区具有现实可行性,但需要长期持续的保障。

关键词: 结核, 肺, 结核, 抗多种药物性, 少数民族, 贫困区, 分子探针技术, 显微镜检查, 荧光

Abstract: Objective

To explore the application of light-emitting diode fluorescence (LED) microscope and linear probe resistance detection in China frontier minority areas.

Methods

A typical survey was conducted. Liuzhou of Guangxi Zhuang Autonomous Region and Kashi of Xinjiang Uygur Autonomous Region were selected as two research sites. The subjects were all tuberculosis (TB) suspects who first visited the local TB prevention and treatment centers from January 1, 2013 to December 31, 2016. There were 14337 suspected pulmonary TB cases in Liuzhou and 32022 in Kashi before the application of new diagnostic techniques (2013), while after the application of new diagnostic techniques for 3 years (2014-2016), the average annual number of suspected cases in Liuzhou and Kashi was 12796 and 36649, respectively. The measures of new diagnostic techniques were based on the LED microscopes equipped at the county level centers to diagnose spear positive cases and active cases through examination of sputum specimens of suspects, and the linear probe resistance detection equipment and reagents in the city level centers for detection of resistance to first-line anti-TB drugs (rifampicin and isoniazid) through examination of sputum spear positive specimens. The data before the application of new diagnostic techniques were retrospectively collected, and the data after the application of new diagnostic techniques were prospectively collected. The changes in the sputum examination rate of TB suspects and the screening rate of drug resistant in high-risk populations were compared before and after the application of new diagnostic techniques.

Results

The sputum examination rate of TB suspects was increased from 54.15% (7763/14337) to 64.25% (8221/12796) in Liuzhou and 65.36% (20930/32022) to 74.34% (27246/36649) in Kashi after the application of new diagnostic techniques, respectively; the differences were statistically significant (χ 2=285.00, P<0.001 and χ 2=658.00, P<0.001). Among them, the proportion of sputum examination with LED microscope was increased from 0.00% to 79.36% (6524/8221) and 92.88% (25307/27246), showing significant differences (Fisher exact test, Ps<0.001). The screening rate of drug resistant in high-risk populations was increased from 0.00% to 94.61% (158/167) and 74.96% (494/659) in the two cities, respectively; the differences were statistically significant (Fisher exact test, Ps<0.001). The proportion detected by linear probes was increased from 0.00% to 80.38% (127/158) and 52.83% (261/494). The proportion of rifampicin resistance (multidrug resistance included) diagnosed by linear probes was increased from 0.00% to 81.82% (9/11) and 53.06% (26/49).

Conclusion

The new diagnostic technologies for TB helps the frontier minority areas achieve the TB prevention and control goals. They are feasible but still require long-term support.

Key words: Tuberculosis, pulmonary, Tuberculosis, multidrug-resistant, Minority groups, Poverty areas, Molecular probe techniques, Microscopy, fluorescence