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2018-2022年四川省病原学阳性肺结核患者密切接触者筛查情况分析OACSTPCD

Analysis of screening of close contacts of pathogenic positive pulmonary tuberculosis patients in Sichuan Province from 2018 to 2022

中文摘要英文摘要

目的:分析2018-2022年四川省病原学阳性肺结核患者密切接触者的结核病筛查情况,为密切接触者的筛查和管理工作开展提供理论依据.方法:选取"结核病管理信息系统"中登记日期在2018年1月1日至2022年12月30日期间的病原学阳性肺结核患者及其密切接触者(与病原学阳性肺结核患者在确诊3个月至开始抗结核治疗后14d内直接接触的人员)作为调查对象,其中,2018年1月1日至2022年12月30日登记的病原学阳性肺结核患者的密切接触者均为筛查对象;2022年登记的病原学阳性肺结核患者的密切接触者为随访对象.分析不同时间、不同类型密切接触者结核病筛查及活动性肺结核检出情况.结果:2018-2022年四川省共报告病原学阳性肺结核患者99 273例,登记其密切接触者260 661名,其中260 291名密切接触者进行了结核病可疑症状筛查,症状筛查率为99.86%,共检出活动性肺结核患者2623例,平均检出率为1.01%.有结核病可疑症状的密切接触者的结核病检查率(98.50%,6425/6523)和检出率(4.54%,292/6425)均明显高于无结核病可疑症状密切接触者的结核病检查率(86.40%,219 247/253 768)和检出率(1.06%,2331/219 247),差异均有统计学意义(x2值分别为807.587和658.621,P值均<0.001).家庭外密切接触者结核病检查率(96.53%,82 173/85 129)明显高于家庭内密切接触者(81.92%,143 499/175 162),差异有统计学意义(x2=10 595.710,P<0.001);家庭内密切接触者活动性肺结核检出率(1.58%,2264/143 499)明显高于家庭外密切接触者(0.44%,359/82 173),差异有统计学意义(x2=591.968,P<0.001).对2022年新登记的42 078名病原学阳性肺结核患者密切接触者在患者诊断时开展症状筛查,39 056名(92.82%)开展了结核病检查,检出719例(1.84%)活动性肺结核患者;35.39%(9705/27 423)完成第2次随访(首次筛查6个月后),55.31%(5368/9705)接受结核病检查,检出2例(0.04%)活动性肺结核患者;仅7.08%(4072/57 474)完成第3次随访(首次筛查1年后),38.33%(1561/4072)接受了结核病检查,检出1例(0.06%)活动性肺结核患者.结论:2018-2022年四川省病原学阳性肺结核患者密切接触者筛查比例较高,但筛查效果不理想,应重视家庭外密切接触者结核病筛查工作,以及重视密切接触者首次筛查后6个月及1年后的随访工作.

Objective:To analyze the tuberculosis screening of close contacts of pathogenic positive pulmonary tuberculosis patients in Sichuan Province from 2018 to 2022,and to provide a theoretical basis for the screening and management of close contacts.Methods:The pathogenic positive pulmonary tuberculosis patients and the close contacts(those who have direct contact with the pathogenic positive pulmonary tuberculosis patients from within 3 months after the diagnosis to 14 days after the start of anti-tuberculosis treatment)registered in the"Tuberculosis Information Management System"between January 1,2018 and December 30,2022 were selected as the survey objects.Of them,the close contacts were all screened,and the close contacts registered in 2022 were the follow-up subjects.The screening of tuberculosis and the detection of active tuberculosis in close contacts at different times and of different types were analyzed.Results:From 2018 to 2022,a total of 99 273 pathogenic positive pulmonary tuberculosis patients were reported in Sichuan Province,and 260 661 close contacts were registered,of which 260 291(99.86%)were screened for suspected symptoms of tuberculosis,and 2623 active pulmonary tuberculosis patients were detected,with an average detection rate of 1.01%.The tuberculosis inspection rate(98.50%,6425/6523)and detection rate(4.54%,292/6425)of close contacts with suspected tuberculosis symptoms were significantly higher than those of close contacts without suspected tuberculosis symptoms(86.40%,219 247/253 768)and detection rate(1.06%,2331/219 247),with a statistically significant difference(x2 values were 807.587 and 658.621,respectively,both P<0.001).The examination rate of tuberculosis in close contacts outside the family(96.53%,82 173/85 129)was significantly higher than that in close contacts inside the family(81.92%,143 499/175 162),with a statistically significant difference(x2=10 595.710,P<0.001).The detection rate of active pulmonary tuberculosis in close contacts within the family(1.58%,2264/143 499)was significantly higher than that of close contacts outside the family(0.44%,359/82 173),and the difference was statistically significant(x2=591.968,P<0.001).The 42 078 close contacts of newly registered pathogenic positive pulmonary tuberculosis patients in 2022 were screened for symptoms at the time of diagnosis,39 056(92.82%)were examined for tuberculosis,and 719(1.84%)active pulmonary tuberculosis patients were detected;35.39%(9705/27 423)completed the second follow-up(6 months after the first screening);55.31%(5368/9705)received tuberculosis examination,and 2(0.04%)active tuberculosis patients were detected;only 7.08%(4072/57 474)completed the third follow-up(one year after the first screening),38.33%(1561/4072)received tuberculosis examination,and one(0.06%)active tuberculosis patient was detected.Conclusion:From 2018 to 2022,the screening proportion of close contacts of pathogenic positive pulmonary tuberculosis patients in Sichuan Province was relatively high,but the screening effect was unsatisfactory.We should pay attention to the screening of tuberculosis of close contacts outside the home,and pay attention to the follow-up work of close contacts 6 months and 1 year after the first screening.

夏岚;刘双;李婷;逯嘉;王丹霞;张灵麟

四川省疾病预防控制中心结核病预防控制所,成都 610041

临床医学

结核,肺接触者追踪人群监测传染病控制

Tuberculosis,pulmonaryContact tracingPublic health surveillanceCommunicable disease control

《中国防痨杂志》 2024 (002)

178-182 / 5

10.19982/j.issn.1000-6621.20230315

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