关键词: 结核,肺, 病人转诊, 评价研究(主题), 小地区分析

Abstract:

Objective: To evaluate the effect of active detection of pulmonary tuberculosis in key population. Methods: In 32 key administrative villages in Xinmi, He’nan, residents over 14 years old were screened for suspicious symptoms of pulmonary tuberculosis. In order to screen out pulmonary tuberculosis patients in key populations, chest digital radiography (DR) was performed on 7 key groups such as those who with suspected symptoms of pulmonary tuberculosis, diabetes patients being treated, residents over 65 years old, people with dust exposure history of more than 3 years, mental patients, residents with pulmonary tuberculosis patients in their families in recent 10 years, and migrant workers, and people who with suspicious symptoms or abnormal chest imaging were examined by sputum smear, Mycobacterium tuberculosis culture and GeneXpert MTB/RIF (Xpert) in the Municipal Tuberculosis Prevention and Control Institute. Results: A total of 7368 people in 7 categories were registered from 32 administrative villages. Among them, 7265 (98.60%) were investigated by questionnaire, 2750 (37.85%) had suspicious symptoms of pulmonary tuberculosis, 7111 (96.51%) had DR images, 456 (6.41%) had abnormalities in their lungs, 5 (0.07%) were diagnosed as pulmonary tuberculosis, 8 (0.11%) were with lung cancer, and old pulmonary tuberculosis (including old tuberculous pleurisy was found in 152 people (2.14%). The proportions of dust exposure history, aged over 65 years, tuberculosis exposure, migrant workers, pulmonary tuberculosis symptoms, diabetes and mental disease were 8.71% (75/861), 8.42% (330/3919), 7.59% (12/158), 4.23% (19/449), 3.57% (47/1315), 3.24% (28/863), 1.64% (1/61), respectively, the difference was statistically significant (χ²=68.111, P<0.001). Of the 5 detected active pulmonary tuberculosis patients, 3 were positive in Xpert. The total detection rate of active pulmonary tuberculosis was 70.31/100000 (5/7111), the highest detection rate was found in those who with dust exposure history (116.14/100000, 1/861), and the detection rates of people who aged over 65 years and those with pulmonary tuberculosis symptoms were 76.55/100000 (3/3919) and 76.05/100000 (1/1315), the difference was statistically significant (χ²=36.131, P<0.001). Conclusion: Active screening of pulmonary tuberculosis among key population is an important supplement to detect patients in referral and symptomatic visits, and therefore to improve the detection rate of tuberculosis patients.

Key words: Tuberculosis,pulmonary, Patient transfer, Evaluation studies as topic, Small-area analysis