无结核社区建设中的主动筛查策略

doi:10.19982/j.issn.1000-6621.20230435

摘要/Abstract

摘要：

主动发现肺结核患者和对结核分枝杆菌潜伏感染者开展预防性治疗是无结核社区建设中的主要措施。基于当地实际情况制定有针对性的筛查策略,可及时发现结核病和亚临床结核病患者,及早圈定可实施预防性干预的结核病发病高风险人群。笔者在回顾世界卫生组织结核病系统筛查和潜伏感染者干预相关指南中的推荐意见,以及国内研究者提出的循证指南的基础上,提出在开展无结核社区建设项目中,应在社区高危人群、重点场所人群和到医疗机构就诊者中开展筛查,并提出了筛查策略和后续分类干预措施。

关键词: 结核, 筛查, 社区卫生服务, 社区

Abstract:

Active case finding and tuberculosis (TB) preventive treatment are core elements of zero tuberculosis community project, and a feasible screening strategy based on local TB epidemic and practice will be benefit to find out TB patients/subclinical TB patients and high risk populations. Based on reviewing both the World Health Organization guidelines on active case finding and management of latent TB infection and evidence-based guidelines for screening suggested by domestic scholars, authors suggest that high risk populations in community, peoples living or working in key places, and patients visiting hospitals should be screened for TB in zero tuberculosis community project sites. The specific screening strategy for every kind of target population and the following categorical intervention have been provided by the authors.

Key words: Tuberculosis, Screening, Community health services, Community

中图分类号:

R184
R521

成君, 赵雁林. 无结核社区建设中的主动筛查策略[J]. 中国防痨杂志, 2024, 46(6): 605-612. doi: 10.19982/j.issn.1000-6621.20230435

Cheng Jun, Zhao Yanlin. Screening strategy in zero tuberculosis community project[J]. Chinese Journal of Antituberculosis, 2024, 46(6): 605-612. doi: 10.19982/j.issn.1000-6621.20230435

参考文献 58

[1]	Maher D, van Gorkom JL, Gondrie PC, et al. Community contribution to tuberculosis care in countries with high tuberculosis prevalence: past, present and future. Int J Tuberc Lung Dis, 1999, 3(9):762-768. pmid: 10488882
[2]	成君, 赵雁林. 创建无结核社区终止结核病流行. 中国防痨杂志, 2021, 43(11):1120-1124. doi:10.3969/j.issn.1000-6621.2021.11.004.
[3]	中国疾病预防控制中心. 关于启动创建无结核社区试点工作的通知. 中疾控结控便函〔2022〕689号. 2022-08-16.
[4]	王宇. 全国第五次结核病流行病学抽样调查资料汇编. 北京: 军事医学科学出版社, 2011.
[5]	张慧, 成君, 于艳玲, 等. 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. 中国防痨杂志, 2021, 43(12):1148-1159. doi:10.3969/j.issn.1000-6621.2021.12.005.
[6]	张灿有, 陈彬, 叶建君, 等. 中国重点人群肺结核患病与发病调查分析. 中国防痨杂志, 2021, 43(12):1160-1162. doi:10.3969/j.issn.1000-6621.2021.12.006.
[7]	World Health Organization. Systematic Screening for Active Tuberculosis: Principles and Recommendations. Geneva: World Health Organization, 2013.
[8]	World Health Organization. WHO consolidated guidelines on tuberculosis.Module 2 Screening. Systematic screening for tuberculosis disease. Geneva: World Health Organization, 2021.
[9]	Velen K, Shingde RV, Ho J, et al. The effectiveness of contact investigation among contacts of tuberculosis patients: a systematic review and meta-analysis. Eur Respir J, 2021, 58(6): 2100266. doi:10.1183/13993003.00266-2021.
[10]	中华人民共和国国家卫生健康委员会办公厅. 中国结核病预防控制工作技术规范(2020年版). 国卫办疾控函〔2020〕279号. 2020-04-02.
[11]	Cavany SM, Sumner T, Vynnycky E, et al. An evaluation of tuberculosis contact investigations against national standards. Thorax, 2017, 72(8): 736-745. doi:10.1136/thoraxjnl-2016-209677. pmid: 28389598
[12]	李婕. 肺结核患者家庭密切接触者筛查策略比较研究. 北京: 中国疾病预防控制中心, 2016.
[13]	World Health Organization. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. Geneva: World Health Organization, 2018.
[14]	Rajagopalan S. Tuberculosis in Older Adults. Clin Geriatr Med, 2016, 32(3): 479-491. doi:10.1016/j.cger.2016.02.006. pmid: 27394018
[15]	张灿有, 陈卉, 张慧, 等. 2011—2020年全国65岁及以上老年人肺结核报告发病情况分析. 中华疾病控制杂志, 2022, 26(11):1252-1258. doi:10.16462/j.cnki.zhjbkz.2022.11.003.
[16]	Cheng J, Sun YN, Zhang CY, et al. Incidence and risk factors of tuberculosis among the elderly population in China: a prospective cohort study. Infect Dis Poverty, 2020, 9(1): 13. doi:10.1186/s40249-019-0614-9. pmid: 32005290
[17]	Gao L, Zhang H, Xin H, et al. Short-course regimensof rifa-pentine plus isoniazid to treat latent tuberculosisinfection in older Chinese: a randomised controlledstudy. Eur Respir J, 2018, 52(6):1801470. doi:10.1183/13993003.01470-2018.
[18]	Korzeniewska-Kosela M, Krysl J, Müller N, et al. Tuberculosis in young adults and the elderly. A prospective comparison study. Chest, 1994, 106(1):28-32. doi:10.1378/chest.106.1.28. pmid: 8020286
[19]	International Union Against Tuberculosis and Lung Disease, World Health Organization. Collaborative framework for care and control of tuberculosis and diabetes. Geneva: World Health Organization, 2011.
[20]	Jeon CY, Murray MB. Diabetes Mellitus Increases the Risk of Active Tuberculosis: A Systematic Review of 13 Observational Studies. PLoS Med, 2008, 5(7): e152. doi:10.1371/journal.pmed.0050152.
[21]	Cheng J, Yu Y, Ma Q, et al. Prevalence,incidence and characteristics of tuberculosis among known diabetes patients-A prospective cohort studyin 10 sites, 2013—2015. China CDC Wkly, 2022, 4(3):41-46. doi:10.46234/ccdcw2022.004.
[22]	Heo EY, Choi NK, Yang BR, et al. Tuberculosis is frequently diagnosed within 12 months of diabetes mellitus. Int J Tuberc Lung Dis, 2015, 19(9):1098-1101. doi:10.5588/ijtld.14.0772. pmid: 26260832
[23]	Vega V, Rodríguez S, Van der Stuyft P, et al. Recurrent TB: a systematic review and meta-analysis of the incidence rates and the proportions of relapses and reinfections. Thorax, 2021, 76(5): 494-502. doi:10.1136/thoraxjnl-2020-215449. pmid: 33547088
[24]	成君, 赵飞, 夏愔愔, 等. 既往结核病患者中肺结核患病状况及发现策略研究. 中国防痨杂志, 2015, 37(10):1024-1029. doi:10.3969/j.issn.1000-6221.2015.10.005.
[25]	地尔木拉提·吐孙, 麦维兰江·阿不力米提, 刘振江, 等. 2011—2020年新疆喀什地区初治肺结核患者复发影响因素分析. 中国防痨杂志, 2021, 43(11): 1176-1182. doi:10.3969/j.issn.1000-6621.2021.11.013.
[26]	彭红, 虞浩, 姜洁, 等. 江苏省初治结核病复发流行病学特征及影响因素. 江苏预防医学, 2019, 30(4): 355-359. doi:10.13668/j.issn.1006-9070.2019.04.001.
[27]	陈卉, 张灿有, 张慧, 等. 2014—2021年全国学校肺结核疫情分析. 中国防痨杂志, 2022, 44(8):768-776. doi:10.19982/j.issn.1000-6621.20220200.
[28]	国家卫生和计划生育委员会办公厅, 教育部办公厅. 学校结核病防控工作规范(2017版). 国卫办疾控发〔2017〕22号. 2017-06-26.
[29]	国家卫生健康委, 教育部. 中小学生健康体检管理办法(2021年版). 国卫医发〔2021〕29号. 2021-09-30.
[30]	成君, 赵雁林. 亟需系统开展矿工结核病防治工作. 中国防痨杂志, 2022, 44(4):310-314. doi:10.19982/j.issn.1000-6621.20210664.
[31]	Barboza CE, Winter DH, Seiscento M, et al. Tuberculosis and silicosis: epidemiology, diagnosis and chemoprophylaxis. J Bras Pneumol, 2008, 34(11): 959-966. doi:10.1590/s1806-37132008001100012. pmid: 19099104
[32]	Thrupp L, Bradley S, Smith P, et al. Tuberculosis prevention and control in long-term-care facilities for older adults. Infect Control Hosp Epidemiol, 2004, 25(12): 1097-1108. doi:10.1086/502350.
[33]	罗兴能, 刘雄娥, 李廷荣. 精神病医院结核病防控工作现状与对策. 中国民康医学, 2015, 27(18):77-80. doi:10.3969/j.issn.1672-0369.2015.18.046.
[34]	Cords O, Martinez L, Warren JL, et al. Incidence and prevalence of tuberculosis in incarcerated populations: a systematic review and meta-analysis. Lancet Public Health, 2021, 6(5):e300-e308. doi:10.1016/S2468-2667(21)00025-6. pmid: 33765455
[35]	Baussano I, Williams BG, Nunn P, et al. Tuberculosis incidence in prisons: a systematic review. PLoS Med, 2010, 7(12):e1000381. doi:10.1371/journal.pmed.1000381.
[36]	王宇. 全球基金结核病控制项目在中国——成就与经验. 北京: 人民卫生出版社, 2015.
[37]	陈丽萍, 苏文, 胡永峰, 等. 1997—2003年湖北省武昌监狱肺结核病控制效果分析. 中国防痨杂志, 2005, 27(3):148-150.
[38]	傅衍勇, 李尚伦, 魏文亮, 等. 2000—2009年天津市监狱系统在押犯人中结核病患者发现情况分析. 中国防痨杂志, 2011, 33(8): 480-485.
[39]	Uden L, Barber E, Ford N, et al. Risk of Tuberculosis Infection and Disease for Health Care Workers: An Updated Meta-Analysis. Open Forum Infect Dis, 2017, 4(3): x137. doi:10.1093/ofid/ofx137.
[40]	Chen B, Gu H, Wang X, et al. Prevalence and determinants of latent tuberculosis infection among frontline tuberculosis healthcare workers in southeastern China: A multilevel analysis by individuals and health facilities. Int J Infect Dis, 2019, 79: 26-33. doi:10.1016/j.ijid.2018.11.010. pmid: 30471404
[41]	He G, Li Y, Zhao F, et al. The Prevalence and Incidence of Latent Tuberculosis Infection and Its Associated Factors among Village Doctors in China. PLoS One, 2015, 10(5): e124097. doi:10.1371/journal.pone.0124097.
[42]	World Health Organization. Global tuberculosis report 2021. Geneva: World Health Organization, 2021.
[43]	李乐, 周子豪, 吴群红, 等. HIV感染者/AIDS患者中结核病检出率的meta分析. 职业与健康, 2019, 35(24): 3437-3441.
[44]	杨蕊, 邱玉冰, 苏玮玮, 等. 云南省TB/HIV双重感染患者抗结核治疗死亡危险因素生存分析. 中华疾病控制杂志, 2016, 20(12): 1212-1215, 1226. doi:10.16462/j.cnki.zhjbkz.2016.12.007.
[45]	Torre-Cisneros J, Doblas A, Aguado JM, et al. Tuberculosis after solid-organ transplant: incidence, risk factors, and clinical characteristics in the RESITRA (Spanish Network of Infection in Transplantation) cohort. Clin Infect Dis, 2009, 48(12):1657-1665. doi:10.1086/599035. pmid: 19445585
[46]	Al-Efraij K, Mota L, Lunny C, et al. Risk of active tuberculosis in chronic kidney disease: a systematic review and meta-analysis. Int J Tuberc Lung Dis, 2015, 19(12):1493-1499. doi:10.5588/ijtld.15.0081. pmid: 26614191
[47]	Redelman-Sidi G, Sepkowitz KA. IFN-γ release assays in the diagnosis of latent tuberculosis infection among immunocompromised adults. Am J Respir Crit Care Med, 2013, 188(4):422-431. doi:10.1164/rccm.201209-1621CI.
[48]	Tubach F, Salmon D, Ravaud P, et al. Risk of tuberculosis is higher with anti-tumor necrosis factor monoclonal antibody therapy than with soluble tumor necrosis factor receptor therapy: The three-year prospective French Research Axed on Tolerance of Biotherapies registry. Arthritis Rheum, 2009, 60(7):1884-1894.
[49]	Cheng J, Wang L, Zhang H, et al. Diagnostic Value of Symptom Screening for Pulmonary Tuberculosis in China. PLoS One, 2015, 10(5): e0127725. doi:10.1371/journal.pone.0127725.
[50]	王彦富, 孙彦波, 闫兴录, 等. 数字化X线胸片人工智能辅助诊断系统在肺结核筛查中的应用价值. 中国公共卫生管理, 2022, 38(6):871-874. doi:10.19568/j.cnki.23-1318.2022.06.0041.
[51]	王晓林, 王晓炜, 雷娟, 等. 宁夏回族自治区肺结核人工智能影像筛查系统的应用. 中国数字医学, 2020, 15(4):39-41. doi:10.3969/j.issn.1673-7571.2020.04.012.
[52]	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. 中国防痨杂志, 2022, 44(10):987-997. doi:10.19982/j.issn.1000-6621.20220321.
[53]	赵雁林, 陈明亭. 中国结核病防治工作技术指南. 北京: 人民卫生出版社, 2021.
[54]	刘二勇, 周林, 成君, 等. 健康检查与被动就诊在肺结核患者发现中的对比研究. 中国防痨杂志, 2014, 36(5):327-330. doi:10.3969/j.issn.1000-6621.2014.05.006.
[55]	王涵飞, 赵雁林, 徐彩红. 亚临床结核病研究进展. 中国防痨杂志, 2023, 45(8):808-813. doi:10.19982/j.issn.1000-6621.20230159.
[56]	Warsinske HC, Rao AM, Moreira FMF, et al. Assessment of Validity of a Blood-Based 3-Gene Signature Score for Progression and Diagnosis of Tuberculosis, Disease Severity, and Treatment Response. JAMA Netw Open, 2018, 1(6):e183779. doi:10.1001/jamanetworkopen.2018.3779.
[57]	Andama A, Whitman GR, Crowder R, et al. Accuracy of Tongue Swab Testing Using Xpert MTB-RIF Ultra for Tuberculosis Diagnosis. J Clin Microbiol, 2022, 60(7):e0042122. doi:10.1128/jcm.00421-22.
[58]	Ramos-Sono D, Laureano R, Rueda D, et al. An electrochemical biosensor for the detection of Mycobacterium tuberculosis DNA from sputum and urine samples. PLoS One, 2020, 15(10):e0241067. doi:10.1371/journal.pone.0241067.