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中国防痨杂志 ›› 2021, Vol. 43 ›› Issue (12): 1248-1259.doi: 10.3969/j.issn.1000-6621.2021.12.005

• 论著 • 上一篇    下一篇

基于社区的重点人群肺结核主动发现干预效果评价:多中心前瞻性队列研究

张慧*, 成君, 于艳玲, 沈鑫, 陆伟, 王晓萌, 要玉霞, 侯双翼, 李建伟, 赵锦明, 夏岚, 许琳, 张灿有, 赵飞, 夏愔愔, 陈卉, 王黎霞()   

  1. 102206 北京,中国疾病预防控制中心结核病预防控制中心(张慧、成君、张灿有、夏愔愔、陈卉);黑龙江省疾病预防控制中心(于艳玲) ;上海市疾病预防控制中心结核病与艾滋病防治所(沈鑫) ;江苏省疾病预防控制中心(陆伟) ;浙江省疾病预防控制中心结核病预防控制所(王晓萌) ;河南省疾病预防控制中心结核病预防控制所(要玉霞) ;湖北省疾病预防控制中心传染病防治研究所(侯双翼) ;广东省结核病控制中心流行病学监测室(李建伟) ;广西壮族自治区疾病预防控制中心结核病防治所(赵锦明) ;四川省疾病预防控制中心结核病预防控制所(夏岚) ;云南省疾病预防控制中心结核病防治所(许琳) ;北京医院临床试验研究中心/国家老年医学中心/中国医学科学院老年医学研究院(赵飞) ;《中国防痨杂志》期刊社(王黎霞)
  • 收稿日期:2021-09-10 出版日期:2021-12-10 发布日期:2021-12-01
  • 通信作者: 王黎霞 E-mail:wanglx@chinacdc.cn
  • 基金资助:
    “十二五”国家科技重大专项(2013ZX10003-004-001);“十三五”国家科技重大专项(2017ZX10201302-001)

Evaluation of the effectiveness of community-based pulmonary tuberculosis active case-finding among key populations: a multicenter prospective cohort study

ZHANG Hui*, CHENG Jun, YU Yan-ling, SHEN Xin, LU Wei, WANG Xiao-meng, YAO Yu-xia, HOU Shuang-yi, LI Jian-wei, ZHAO Jin-ming, XIA Lan, XU Lin, ZHANG Can-you, ZHAO Fei, XIA Yin-yin, CHEN Hui, WANG Li-xia()   

  1. *National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
  • Received:2021-09-10 Online:2021-12-10 Published:2021-12-01
  • Contact: WANG Li-xia E-mail:wanglx@chinacdc.cn

摘要:

目的 评价以社区为基础的结核病重点人群肺结核患者主动发现干预措施的实施效果。方法 采用多中心前瞻性队列研究设计,于2013—2015年在全国东部、中部和西部10个省的27个乡镇(社区),对常住人口中的65岁及以上老年人、已知糖尿病患者、已知HIV/AIDS者、既往结核病患者和活动性肺结核患者密切接触者五类结核病发病重点人群,每年开展1次以结核病防治核心信息健康宣教、肺结核可疑症状筛查和胸部X线检查为主要手段的患者主动发现,分析不同筛查手段的敏感度和特异度,以及在结核病重点人群中开展肺结核主动发现策略的效果和影响主动发现贡献率的相关因素。结果 在2013—2015年期间,健康教育及肺结核症状筛查的干预完成率分别为97.8%(42684/43654)、91.2%(41732/45768)和88.1%(42441/48178);胸部X线检查的干预完成率分别为86.0%(37538/43654)、81.0%(37070/45768)和75.7%(36483/48178)。重点人群的结核病防治核心信息知晓率从2013年的34.2%(73066/213420)增加到2015年的67.2%(142629/212205),呈逐年上升趋势(Z趋势=215.568,P<0.01)。只采用规划可疑症状和研究可疑症状进行筛查发现肺结核的敏感度较低[分别为11.6%(69/596)和11.7%(70/596)],特异度较高[分别为99.1%(125123/126261)和99.0%(125008/126261)];只开展胸部X线检查和同时进行研究症状筛查和胸部X线检查的敏感度均为90.7%(594/655),特异度分别为94.2%(104004/110436)和93.3%(103 062/110436)。在发现的活动性肺结核患者中,三年主动发现的患者占全部发现患者的84.9%(556/655),2013年、2014年和2015年主动发现的贡献率分别为95.7%(244/255)、81.0%(200/247)和73.2%(112/153),呈逐年下降的趋势(Z趋势=-6.403,P<0.01)。多因素分析结果显示,相对于15~24岁年龄组,55~64岁年龄组[OR(95%CI)=7.18(1.59~32.39)]和≥65岁年龄组[OR(95%CI)=13.52(3.31~55.16)]主动发现的贡献率较高;与东部地区相比,在西部地区[OR(95%CI)=2.44(1.38~4.29)]主动发现的贡献率较高。结论 在社区结核病重点人群中开展每年1次肺结核患者主动发现干预与未开展相比能明显提高肺结核患者的发现水平,特别是在高年龄组和和西部地区其贡献率较高,但贡献率在三年的实施中逐年降低,因此,对同一类人群是否需要每年都采取主动发现的措施要考虑其贡献率的高低。

关键词: 结核,肺, 人群监测, 社区参与研究, 干预性研究

Abstract:

Objective To evaluate the implementation effectiveness of community-based pulmonary tuberculosis (PTB) active case-finding(ACF) interventions among key populations. Methods A multi-center prospective cohort study was conducted in 2013-2015 among five key populations of tuberculosis (1.Residents aged 65 and above; 2.Residents with diabetes mellitus; 3.Residents with HIV/AIDS; 4.Residents with a history of TB; 5.Close contacts of active PTB patients) in selected 27 townships/communities in 10 provinces located in eastern, central and western regions of China. TB health promotion and education, TB symptom screening, and chest X-ray examination were carried out annually. The sensitivity and specificity of different screening approaches, the effectiveness of ACF among different key populations, and factors that influenced ACF contributions were analyzed. Results During 2013-2015, the intervention coverage of health education and TB symptom screening were 97.8% (42684/43654), 91.2% (41732/45768), and 88.1% (42441/48178) respectively; the intervention coverage of chest X-ray examination were 86.0% (37538/43654), 81.0% (37070/45768), and 75.7% (36483/48178), respectively. The TB key message awareness rate increased from 34.2% (73066/213420) in 2013 to 67.2% (142629/212205) in 2015, showing an upward trend year by year (Ztrend=215.568, P<0.01). The sensitivities of symptom screening only were low which could find 11.6% (69/596)of TB cases by using national TB control program defining symptoms and 11.7% (70/596) by using symptoms defined by this study, while specificities were quite high (99.1% (125123/126261) and 99.0% (125008/126261) respectively). The sensitivities of only using chest X-ray examination and study-defined symptom screening plus chest X-ray were both 90.7% (594/655),the specificities were 94.2% (104004/110436) and 93.3% (103 062/110436), respectively. Among all diagnosed PTB cases, 84.9% (556/655) were detected through ACF. The contribution rates of ACF in 2013, 2014, and 2015 were 95.7% (244/255), 81.0% (200/247), and 73.2% (112/153), showing a downward trend year by year (Ztrend=-6.403, P<0.01). The results of multi-variable analysis showed that compared with age group 15-24, the contribution rates of ACF in age group 55-64 (OR=7.18; 95%CI: 1.59-32.39) and age group ≥65 (OR=13.52; 95%CI: 3.31-55.16) were higher; compared with eastern regions, the contribution rate of ACF in western regions (OR=2.44; 95%CI: 1.38-4.29) was higher. Conclusion Carrying out an annual community-based ACF activity among key populations could significantly increase PTB case detection. The contribution rates of ACF were significantly higher in older people and western regions. However, they showed decreasing trends year by year in the three years’ implementation phase. Therefore, whether to take ACF activities every year for the same group of people should be considered under this group’s specific ACF contribution rate.

Key words: Tuberculosis,pulmonary, Population surveillance, Community-based participatory research, Intervention studies