关键词: 学生, 结核,肺, 结核菌素试验, 多相筛查, 数据说明,统计, 预防和防护用药, 对比研究

Abstract:

【Abstract】 Objective To analyze the epidemic and management of tuberculosis among students coming to Beijing from Yushu Tibetan Autonomous Prefecture, Qinghai Province (a region with a high prevalence of tuberculosis in western China) in a senior middle school in Daxing District, so as to provide information for tuberculosis prevention and control in schools. Methods Pulmonary tuberculosis epidemic in a middle school in Daxing District from 2010 to 2019 and relevant management were retrospectively analyzed. Students of this school included 83.19% (10687/12847) of local residents and 16.81% (2160/12847) from Qinghai Tibetan. Preventive measures for this group of Tibetan students consisted of Chest X-ray photography (referred to as “chest radiograph”) on their entering (returning after holidays) to school and preventive medications for those with moderate or above positive PPD tests. The above data was analyzed using SPSS 21.0 software. The enumeration data was tested by χ² or Fisher’s exact test when the theoretical frequency was less than 1, or the total number of analyses was less than 40. P<0.05 was considered as statistically significant. Results From 2010 to 2019, 31 cases of active pulmonary tuberculosis were reported in these senior middle school students, including 23 cases of Tibetan students, with a reported incidence of 1064.81/100000 (23/2160), and eight cases of local students, with a reported incidence of 74.86/100000 (8/10687) (Fisher exact probability method, P=0.000). All 23 Tibetan patients lived in school dormitory, including 13 males (56.52%), 10 females (43.48%) with a male to female ratio of 1.3∶1. As of September 2019, chest X-ray examination was carried out in 1518 Tibetan students among whom 9 were diagnosed as pulmonary tuberculosis after comprehensive clinical evaluation giving a detection rate of 0.59% (9/1518), and accounting for 39.13% (9/23) of all Tibetan students with tuberculosis within the 10 years. Among the 9 students, 6 were diagnosed in February 2017 when returning to school after winter holidays, with a detection rate of 3.03% (6/198). Among the 91 students who were moderate or above positive in PPD test from 2016 to 2019, the incidence of tuberculosis in those received preventive medications (4.17% (3/72)) was lower than those did not (10.53% (2/19)) (Fisher exact probability method, P=0.280). While all the above 5 patients developed symptoms within 1 year after screening or preventive medications. From January 2019 to May 2020, there were no new reported tuberculosis cases among these school students. Conclusion Students are an important population for the prevention and control of tuberculosis. Chest radiograph for students coming or back to Beijing from high prevalent areas of tuberculosis in western China are a proactive measure for prevention and control of the spread of tuberculosis on campus.

Key words: Students, Tuberculosis,pulmonary, Tuberculin test, Multiphasic screening, Data interpretation,statistical, Protective agents, Comparative study