2011-2015年四川省涂阴肺结核流行特征与治疗转归结果分析
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摘要
目的分析四川省登记报告的涂阴肺结核患者的治疗转归结果,为提高涂阴肺结核的防治和管理水平提供科学依据。方法按照病案登记里普通患者病案管理中的登记时间进行统计,收集2011-2015年四川省涂阴肺结核患者的病案信息,对涂阴肺结核患者一般特性进行描述性分析,运用卡方检验比较活动性肺结核和涂阴肺结核及涂阴肺结核中完成疗程和治疗失败在人口学特征、发现方式及管理等方面的差异,检验标准为0.05。结果 2011-2015年,肺结核登记率从78.6/10万(63 210例)下降到61.29/10万(50 277例),下降了22.02%,年均递降率为6.03%;涂阴肺结核登记率从42.05/10万(33 822例)上升到42.79/10万(35 098例),上升了1.76%,年均递增率为0.44%。涂阴肺结核患者中的学生比例(5.41%,9 837/181 881)高于活动性肺结核患者中的学生比例(4.67%,13 274/284 183)(χ2=161.000,P<0.05)、涂阴患者中初治比例(96.38%,175 297/181 881)高于活动性肺结核患者初治比例(92.81%,263 758/284 183)(χ2=2585.163,P<0.05)、涂阴患者中因症就诊的比例(42.67%,77 605/181 881)低于活动性肺结核患者因症就诊比例(44.26%,125 787/284 183)(χ2=2 955.917,P<0.05)。涂阴患者中男性治疗失败比例(3.36%,4 232/126 077)高于女性患者(3.04%,1 697/55 804)(χ2=12.224,P<0.05)、复治患者治疗失败比例(7.02%,462/6 584)高于初治患者(3.12%,5467/175 297)(χ2=305.793,P<0.05)、自服药患者治疗失败比例(36.55%,1 289/3 527)高于督导服药患者(2.60%,4640/178 354)(χ2=12 637.276,P<0.05)、非系统管理患者治疗失败比例(71.54%,1 594/2 228)高于系统管理患者(2.41%,4 335/179 653)(χ2=33 350.859,P<0.05);15~34岁年龄组患者治疗失败比例最低(2.35%,1 284/55 785)、60岁及以上年龄组患者治疗失败比例最高(4.73%,2 199/46 503)(χ2=490.264,P<0.05);学生患者的治疗失败比例最低(2.33%,229/9 837)、其他职业患者治疗失败比例最高(3.84%,1 395/36 302)(χ2=69.567,P<0.05);转诊追踪的患者治疗失败比例最低(3.10%,3 055/98 569)、其他发现方式的患者治疗失败比例最高(4.21%,155/3 684)(χ2=25.153,P<0.05)。结论 "十二五"期间四川省逐步构建了新型结核病防治服务体系,涂阴肺结核治疗失败率有上升趋势,尤其在老年人及复治患者中较为突出。
Objective To analyze the treatment outcome of smear negative pulmonary tuberculosis patients in Sichuan province,provide scientific basis to improve the control and management level of smear negative pulmonary tuberculosis. Methods information was collected according to the registration time of patient's medical record management. Descriptive analysis was made on the medical records of smear negative pulmonary tuberculosis patients in Sichuan province through 2011 to 2015. Chi square test was used to compare the differences in demographic characteristics,findings and management between active pulmonary tuberculosis and smear negative tuberculosis,and the same compared between treatment completed and treatment failure in smear negative tuberculosis. And 0. 05 was set as the criteria of statistical significance. Results Between 2011 and 2015,tuberculosis registration rate dropped from 78. 6/105(63 210 cases) to 61. 29/105(50 277 cases),decreased by 22. 02%,with an average annual reduction rate of 6. 03%. Registration rate of smear negative tuberculosis increased from 42. 05/10 million( 33 822 cases) to 42. 79/105( 35 098 cases),increased by 1. 76%,with an average annual increase rate of 0. 44%. The proportion of students in smear-negative tuberculosis patients(5. 41%,9 837/181 881) was higher than that of active pulmonary tuberculosis patients(4. 67%,13 274/284 183)( χ2= 161. 000,P < 0. 05). The proportion of untreated patients in smear-negative tuberculosis( 96. 38%, 175 297/181 881) was higher than that of active pulmonary tuberculosis patients( 92. 81%,263 758/284 183)( χ2= 2 585. 163, P < 0. 05). The proportion of clinical consultation in smear-negative tuberculosis patients( 42. 67%,77 605/181 881) was lower than that of active pulmonary tuberculosis patients( 44. 26%,125 787/284 183)( χ2= 2 955. 917,P < 0. 05).The proportion of male treatment failure in smear-negative patients( 3. 36%,4 232/126 077) was higher than that in female patients( 3. 04%,1 697/55 804)( χ2= 12. 224,P < 0. 05). The proportion of retreat patients treatment failure in smear-negative( 7. 02%, 462/6 584) was higher than that in untreated patients( 3. 12,5 467/175 297)( χ2= 305. 793, P < 0. 05). The proportion of supervise themselves treatment failure in smear-negative( 36. 55%,1 289/3 527) was higher than that under the supervision of the doctor( 2. 60%,4 640/178 354)( χ2= 12 637. 276, P < 0. 05). The proportion of non-system managed patients treatment failure in smear-negative( 71. 54%,1 594/2 228) was higher than that in system managed patients( 2. 41%,4 335/179 653)( χ2= 33 350. 859,P < 0. 05). Patients aged 15 to 34 had the lowest rates of treatment failure( 2. 35%,1 284/55 785) and patients aged 60 and older had the highest rates of treatment failure( 4. 73%,2 199/46 503)( χ2= 490. 264,P < 0. 05). Student patients had the lowest rates of treatment failure( 2. 33%, 229/9 837) and other occupational patients had the highest rates of treatment failure( 3. 84%,1 395/36 302)( χ2= 69. 567, P < 0. 05). Referral tracking patients had the lowest rates of treatment failure( 3. 10%,3 055/98 569) and other discoveries patients had the highest rates of treatment failure( 4. 21%,155/3 684)( χ2= 25. 153,P < 0. 05). Conclusion During The Twelfth Five-Year Guideline, the treatment and management system of smear negative pulmonary tuberculosis in Sichuan province has achieved certain results,but the treatment and management of retreat patients and elderly patients still need to be strengthened.
Objective To analyze the treatment outcome of smear negative pulmonary tuberculosis patients in Sichuan province,provide scientific basis to improve the control and management level of smear negative pulmonary tuberculosis. Methods information was collected according to the registration time of patient's medical record management. Descriptive analysis was made on the medical records of smear negative pulmonary tuberculosis patients in Sichuan province through 2011 to 2015. Chi square test was used to compare the differences in demographic characteristics,findings and management between active pulmonary tuberculosis and smear negative tuberculosis,and the same compared between treatment completed and treatment failure in smear negative tuberculosis. And 0. 05 was set as the criteria of statistical significance. Results Between 2011 and 2015,tuberculosis registration rate dropped from 78. 6/105(63 210 cases) to 61. 29/105(50 277 cases),decreased by 22. 02%,with an average annual reduction rate of 6. 03%. Registration rate of smear negative tuberculosis increased from 42. 05/10 million( 33 822 cases) to 42. 79/105( 35 098 cases),increased by 1. 76%,with an average annual increase rate of 0. 44%. The proportion of students in smear-negative tuberculosis patients(5. 41%,9 837/181 881) was higher than that of active pulmonary tuberculosis patients(4. 67%,13 274/284 183)( χ2= 161. 000,P < 0. 05). The proportion of untreated patients in smear-negative tuberculosis( 96. 38%, 175 297/181 881) was higher than that of active pulmonary tuberculosis patients( 92. 81%,263 758/284 183)( χ2= 2 585. 163, P < 0. 05). The proportion of clinical consultation in smear-negative tuberculosis patients( 42. 67%,77 605/181 881) was lower than that of active pulmonary tuberculosis patients( 44. 26%,125 787/284 183)( χ2= 2 955. 917,P < 0. 05).The proportion of male treatment failure in smear-negative patients( 3. 36%,4 232/126 077) was higher than that in female patients( 3. 04%,1 697/55 804)( χ2= 12. 224,P < 0. 05). The proportion of retreat patients treatment failure in smear-negative( 7. 02%, 462/6 584) was higher than that in untreated patients( 3. 12,5 467/175 297)( χ2= 305. 793, P < 0. 05). The proportion of supervise themselves treatment failure in smear-negative( 36. 55%,1 289/3 527) was higher than that under the supervision of the doctor( 2. 60%,4 640/178 354)( χ2= 12 637. 276, P < 0. 05). The proportion of non-system managed patients treatment failure in smear-negative( 71. 54%,1 594/2 228) was higher than that in system managed patients( 2. 41%,4 335/179 653)( χ2= 33 350. 859,P < 0. 05). Patients aged 15 to 34 had the lowest rates of treatment failure( 2. 35%,1 284/55 785) and patients aged 60 and older had the highest rates of treatment failure( 4. 73%,2 199/46 503)( χ2= 490. 264,P < 0. 05). Student patients had the lowest rates of treatment failure( 2. 33%, 229/9 837) and other occupational patients had the highest rates of treatment failure( 3. 84%,1 395/36 302)( χ2= 69. 567, P < 0. 05). Referral tracking patients had the lowest rates of treatment failure( 3. 10%,3 055/98 569) and other discoveries patients had the highest rates of treatment failure( 4. 21%,155/3 684)( χ2= 25. 153,P < 0. 05). Conclusion During The Twelfth Five-Year Guideline, the treatment and management system of smear negative pulmonary tuberculosis in Sichuan province has achieved certain results,but the treatment and management of retreat patients and elderly patients still need to be strengthened.
引文
[1]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[2]Behr MA,Warren SA,Salamon H,et al.Transmission of Mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli[J].Lancet,1999,353(9165):444-449.
[3]World Health Organization.Global tuberculosis control 2011[R].Geneva:World Health Organization,2011.
[4]World Health Organization.Global tuberculosis control 2012[R].Geneva:World Health Organization,2012.
[5]World Health Organization.Global tuberculosis control 2013[R].Geneva:World Health Organization,2013.
[6]马艳,李亮,刘二勇,等.涂阴肺结核流行传播特点与随访预后的文献结果分析[J].中国防痨杂志,2015,37(5):520-525.
[7]中华人民共和国卫生部疾病控制司.初治涂阴活动性肺结核病人免费治疗管理指南(试行)[J].中华结核和呼吸杂志,2005,28(10):667-669.
[8]中华人民共和国卫生部疾病预防控制局,中华人民共和国卫生部医政司,中国疾病预防控制中心.中国结核病防治规划实施工作指南(2008年版)[M].北京:中国协和医科大学出版社,2009.
[9]辛云巧,于洁.654例涂阴肺结核患者诊疗情况分析[J].中国防痨杂志,2013,35(3):210-212.
[10]中华人民共和国国务院办公厅.全国结核病防治规划(2011-2015年)的通知(国办发[2011153号)[EB/OL].[2011-12-06],http://www.gov.cn/zwgk/2011-12/06/content-2012869.htm.
[11]中华人民共和国卫生部.结核病防治管理办法[Z].2013.
[12]腾燕,刘飞鹰.我国定点医院结核病防治模式实施现状综述[J].中国防痨杂志,2014,36(4):290-293.
[13]赵津,李仁忠.结核病定点医院肺结核诊断治疗管理现况分析[J].中国健康教育,2011,27(1):13-17.
[14]陈伟,陈秋兰,成诗明,等.2008-2012年全国学生结核病疫情特征分析[J].中国防痨杂志,2013,35(12):949-954.
[15]中华人民共和国卫生部办公厅,中华人民共和国教育部办公厅.关于印发《学校结核病防控工作规范(试行)》的通知[Z].卫办疾控发[2010]10号.
[16]张忠顺,肖和平.上海市肺科医院首次复治肺结核临床调查分析[J].中国防痨杂志,2010,32(1):1-5.
[17]Choi H,Lee M,Chen RY,et al.Predictors of pulmonary tuberculosis treatment outcomes in South Korea:a prospective cohort study,2005-2012[J].BMC Infectious Diseases,2014,14:360.
[18]Ananthakrishnan R,Kumar K,Ganesh M,et al.The profile and treatment outcomes of the older(aged 60 years and above)tuberculosis patients in Tamilnadu.South India[J].PLo S One,2013,8(7):e67288.
[19]Noubom M,Nembot FD,Donfack H,et al.Characteristics of TB patients in west Cameroon:20002009[J].Pan Afr Med J,2013,16:39.
[20]Yamaguchi Y,Kawabe Y,Nagayama N,et al.A study on the clinical features of pulmonary tubercu Iosis in elderly patients[J].Kekkaku,2001.76:447-454.
[21]成诗明,刘二勇,杜昕.老年结核病患者对中国结核病控制的影响[J].中国防痨杂志,2004,25(8):655-657.
[22]Hong Kong Chest Service/Tuberculosis Research Centre,Madras/British Medical Research Council.A study of the characteristics and course of sputum smear-negative pulmonary tuberculosis[J].Tubercle,1981,62(3):155-167.
[2]Behr MA,Warren SA,Salamon H,et al.Transmission of Mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli[J].Lancet,1999,353(9165):444-449.
[3]World Health Organization.Global tuberculosis control 2011[R].Geneva:World Health Organization,2011.
[4]World Health Organization.Global tuberculosis control 2012[R].Geneva:World Health Organization,2012.
[5]World Health Organization.Global tuberculosis control 2013[R].Geneva:World Health Organization,2013.
[6]马艳,李亮,刘二勇,等.涂阴肺结核流行传播特点与随访预后的文献结果分析[J].中国防痨杂志,2015,37(5):520-525.
[7]中华人民共和国卫生部疾病控制司.初治涂阴活动性肺结核病人免费治疗管理指南(试行)[J].中华结核和呼吸杂志,2005,28(10):667-669.
[8]中华人民共和国卫生部疾病预防控制局,中华人民共和国卫生部医政司,中国疾病预防控制中心.中国结核病防治规划实施工作指南(2008年版)[M].北京:中国协和医科大学出版社,2009.
[9]辛云巧,于洁.654例涂阴肺结核患者诊疗情况分析[J].中国防痨杂志,2013,35(3):210-212.
[10]中华人民共和国国务院办公厅.全国结核病防治规划(2011-2015年)的通知(国办发[2011153号)[EB/OL].[2011-12-06],http://www.gov.cn/zwgk/2011-12/06/content-2012869.htm.
[11]中华人民共和国卫生部.结核病防治管理办法[Z].2013.
[12]腾燕,刘飞鹰.我国定点医院结核病防治模式实施现状综述[J].中国防痨杂志,2014,36(4):290-293.
[13]赵津,李仁忠.结核病定点医院肺结核诊断治疗管理现况分析[J].中国健康教育,2011,27(1):13-17.
[14]陈伟,陈秋兰,成诗明,等.2008-2012年全国学生结核病疫情特征分析[J].中国防痨杂志,2013,35(12):949-954.
[15]中华人民共和国卫生部办公厅,中华人民共和国教育部办公厅.关于印发《学校结核病防控工作规范(试行)》的通知[Z].卫办疾控发[2010]10号.
[16]张忠顺,肖和平.上海市肺科医院首次复治肺结核临床调查分析[J].中国防痨杂志,2010,32(1):1-5.
[17]Choi H,Lee M,Chen RY,et al.Predictors of pulmonary tuberculosis treatment outcomes in South Korea:a prospective cohort study,2005-2012[J].BMC Infectious Diseases,2014,14:360.
[18]Ananthakrishnan R,Kumar K,Ganesh M,et al.The profile and treatment outcomes of the older(aged 60 years and above)tuberculosis patients in Tamilnadu.South India[J].PLo S One,2013,8(7):e67288.
[19]Noubom M,Nembot FD,Donfack H,et al.Characteristics of TB patients in west Cameroon:20002009[J].Pan Afr Med J,2013,16:39.
[20]Yamaguchi Y,Kawabe Y,Nagayama N,et al.A study on the clinical features of pulmonary tubercu Iosis in elderly patients[J].Kekkaku,2001.76:447-454.
[21]成诗明,刘二勇,杜昕.老年结核病患者对中国结核病控制的影响[J].中国防痨杂志,2004,25(8):655-657.
[22]Hong Kong Chest Service/Tuberculosis Research Centre,Madras/British Medical Research Council.A study of the characteristics and course of sputum smear-negative pulmonary tuberculosis[J].Tubercle,1981,62(3):155-167.