2015-2017年天津市肺外结核流行病学分析
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摘要
目的了解天津市肺外结核的流行病学特征,分析存在的问题,为制定肺外结核防治对策提供理论依据。方法对结核病信息管理系统中登记的天津市2015-2017年肺外结核疫情信息资料进行收集整理,采用描述性流行病学研究方法分析天津市肺外结核病人分布状况。结果 2015-2017年天津市累计登记报告肺外结核病人1 190例,占全部结核的10.39%,年均发病率为2.57/10万,报告单位以市级结核病定点医疗机构为主。肺外结核以结核性淋巴腺炎最多,占全部肺外结核的25.55%,其次是骨关节结核病(22.52%)和泌尿生殖系统结核病(11.26%);脑、淋巴结核以及肠、腹膜、肠系膜腺体结核病多发生在青少年(15～25岁年龄组)和壮年组(45～55岁年龄组),而骨关节结核、泌尿生殖系统结核在肺外结核患者中的比例随着年龄的增长而增加,泌尿生殖系统结核好发于青壮年组(25～55岁年龄组),皮肤结核在肺外结核患者中的比例随着年龄的增加而降低,肺外结核患者的HIV筛查率逐年下降。结论天津市肺外结核登记报告发病率逐年上升,报告单位以市级结核病定点医疗机构为主。下一步要继续加强肺外结核的登记报告制度,加强各区肺外结核HIV筛查工作,重视各医疗机构医务人员肺外结核的诊疗能力,减少肺外结核的误诊和漏诊。
Objective To have a comprehensive understanding of the epidemiological characteristics of extrapulmonary tuberculosis in Tianjin, and provide theoretical evidence for the prevention and control of extrapulmonary tuberculosis. Methods The data of registered extrapulmonary tuberculosis patients in TB management information system from 2015 to 2017 were collected and analyzed by descriptive epidemiological methods. Results A total of 1 190 extrapulmonary tuberculosis patients were registered in Tianjin from 2015 to 2017, accounting for 10.39% of all tuberculosis patients;the average annual incidence was 2.57/105. The main reporting institutions were municipal designated tuberculosis medical institutions. Tuberculous lymphatitis was the most common reported extrapulmonary tuberculosis, accounting for 25.55% of all extrapulmonary tuberculosis cases, followed by osteoarthrosis tuberculosis ( 22.52%) and urogenital tuberculosis (11.26%). Brain, scrofula and intestines, peritoneum, mesenteric gland tuberculosis mostly occurred in teenagers (15 to 25 years old) and the prime group (45 to 55 years old);the incidence of joint tuberculosis and urogenital system tuberculosis increased with age in extrapulmonary TB patients;urogenital system TB frequently occurred in young adults (25 to 55 years old); the proportion of patients with cutaneous tuberculosis among patients with extrapulmonary tuberculosis decreased with age; the HIV screening rate in extrapulmonary tuberculosis decreased year by year. Conclusion The reported incidence of extrapulmonary tuberculosis has shown a yearly increasing trend in Tianjin. Municipal designated tuberculosis medical institutions were the main reporting institutions. Relevant departments should strengthen the extrapulmonary tuberculosis registration and HIV screening in patients with extrapulmonary TB,attach importance to the extrapulmonary tuberculosis diagnosis and treatment ability of medical staff in hospitals so as to reduce misdiagnosis of extrapulmonary tuberculosis.
Objective To have a comprehensive understanding of the epidemiological characteristics of extrapulmonary tuberculosis in Tianjin, and provide theoretical evidence for the prevention and control of extrapulmonary tuberculosis. Methods The data of registered extrapulmonary tuberculosis patients in TB management information system from 2015 to 2017 were collected and analyzed by descriptive epidemiological methods. Results A total of 1 190 extrapulmonary tuberculosis patients were registered in Tianjin from 2015 to 2017, accounting for 10.39% of all tuberculosis patients;the average annual incidence was 2.57/105. The main reporting institutions were municipal designated tuberculosis medical institutions. Tuberculous lymphatitis was the most common reported extrapulmonary tuberculosis, accounting for 25.55% of all extrapulmonary tuberculosis cases, followed by osteoarthrosis tuberculosis ( 22.52%) and urogenital tuberculosis (11.26%). Brain, scrofula and intestines, peritoneum, mesenteric gland tuberculosis mostly occurred in teenagers (15 to 25 years old) and the prime group (45 to 55 years old);the incidence of joint tuberculosis and urogenital system tuberculosis increased with age in extrapulmonary TB patients;urogenital system TB frequently occurred in young adults (25 to 55 years old); the proportion of patients with cutaneous tuberculosis among patients with extrapulmonary tuberculosis decreased with age; the HIV screening rate in extrapulmonary tuberculosis decreased year by year. Conclusion The reported incidence of extrapulmonary tuberculosis has shown a yearly increasing trend in Tianjin. Municipal designated tuberculosis medical institutions were the main reporting institutions. Relevant departments should strengthen the extrapulmonary tuberculosis registration and HIV screening in patients with extrapulmonary TB,attach importance to the extrapulmonary tuberculosis diagnosis and treatment ability of medical staff in hospitals so as to reduce misdiagnosis of extrapulmonary tuberculosis.
引文
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[2]Peto HM, Pratt RH, Harrington TA, et al.Epidemiology of extrapulmonary tuberculosis in the United States.1993-2006[J].Clin Infect Dis,2009,49(9):1350-1357.
[3]Inoue T,Koyasu H,Hattori s.Epidemiological significance of patients with extra-pulmonary TB-a study of 10082 patients with tuberculosis[J].Kekkaku,2011,86(5):493-498.
[4]Christensen AS,Roed C,Andersen PH,et al.Long-term mortality in patients with pulmonary and extrapulrnonary tuberculosis:a Danish nationwide cohort study[J].Clin Epidemiol,2014)(6):405-421.
[5]Fortfin J,Martin-Ddvila P,G6mez-Mampaso E,et al.Extra-pulmonary tuberculosis:differential aspects and role of 16SrRNA in urine[J].Int J Tubere Lung Dis,2014,18(4):478-485.
[6]贾留群,龙虹羽,胡倩婧,等.Xpert MTB/RIF试验对肺外结核诊断价值的Meta分析[J].中华临床医师杂志,2013,7(6):2587-2591.
[7]柳伟坤,李向东,尹吉林,等.肺外结核18F-FDG PET/CT显像的诊断价值[J].南方医科大学学报,2013,33(7):1083-1086.
[8]王凤平,陈蕾,陈苏芳,等.结核感染T细胞检测在肺外结核诊断应用价值[J].实用预防医学,2014,21(10):1247-1249.
[9]Wang X, Yang Z, Fu Y, et al.Insight to the Epidemiology and Risk Factors of Extrapulmonary Tuberculosis in Tianjin,China during 2006-2011.PLoS One,2014,9(12):e112233.
[10]傅衍勇,李敬新,江丽娜,等.2011-2013年天津市医疗机构报告肺外结核的情况调查,2016,38(2):104-109.
[11]吴小梅,蔡颖,刘巍.某院军队住院结核病患者10年资料分析[J].西南国防医药,2015,25(6):587-589.
[12]Mor Z,Pinsker G,Cedar N,et al.Epidemiology of extra-pulmonary tuberculosis in Israel,1999-2010[J].Int J Tuberc Lung Dis,2013,17(2):229-233.
[13]Herath S, Lewis C.Pulmonary involvement in patients presenting with extra-pulmonary tuberculosis:thinking beyond a normal chest X-ray[J]. J Prim Health Care,2014,6(1):64-68.
[14]Fortfin J,Martin-Ddvila P,Gómez-Mampaso E,et al.Extra-pulmonary tuberculosis:differential aspects and role of 16SrRNA in urine[J]. Int J Tubere Lung Dis,2014,18(4):478-485.
[15]黄建生,沈梅,李永祥,等.上海市肺外结核病流行病学分析(摘要)[A].中华医学会第六届全国结核病学术大会论文汇编[C],2000.
[16]陈平,胡骅,赖旭辉,等.建德市肺外结核流行病学调查[A].中国防痨协会结核病控制专业委员会学术研讨会论文集[C].2010.
[17]成诗明,周林,刘二勇,等.结核分枝杆菌和艾滋病病毒双重感染防治合作模式与效果[J].中国防痨杂志,2011,33(7):416-421.
[18]崔哲哲,冯启明,林玫,等.2010-2013年广西TB/HIV双重感染监测数据分析与评价[J].广西医学,2015,37(3):364-367.
[2]Peto HM, Pratt RH, Harrington TA, et al.Epidemiology of extrapulmonary tuberculosis in the United States.1993-2006[J].Clin Infect Dis,2009,49(9):1350-1357.
[3]Inoue T,Koyasu H,Hattori s.Epidemiological significance of patients with extra-pulmonary TB-a study of 10082 patients with tuberculosis[J].Kekkaku,2011,86(5):493-498.
[4]Christensen AS,Roed C,Andersen PH,et al.Long-term mortality in patients with pulmonary and extrapulrnonary tuberculosis:a Danish nationwide cohort study[J].Clin Epidemiol,2014)(6):405-421.
[5]Fortfin J,Martin-Ddvila P,G6mez-Mampaso E,et al.Extra-pulmonary tuberculosis:differential aspects and role of 16SrRNA in urine[J].Int J Tubere Lung Dis,2014,18(4):478-485.
[6]贾留群,龙虹羽,胡倩婧,等.Xpert MTB/RIF试验对肺外结核诊断价值的Meta分析[J].中华临床医师杂志,2013,7(6):2587-2591.
[7]柳伟坤,李向东,尹吉林,等.肺外结核18F-FDG PET/CT显像的诊断价值[J].南方医科大学学报,2013,33(7):1083-1086.
[8]王凤平,陈蕾,陈苏芳,等.结核感染T细胞检测在肺外结核诊断应用价值[J].实用预防医学,2014,21(10):1247-1249.
[9]Wang X, Yang Z, Fu Y, et al.Insight to the Epidemiology and Risk Factors of Extrapulmonary Tuberculosis in Tianjin,China during 2006-2011.PLoS One,2014,9(12):e112233.
[10]傅衍勇,李敬新,江丽娜,等.2011-2013年天津市医疗机构报告肺外结核的情况调查,2016,38(2):104-109.
[11]吴小梅,蔡颖,刘巍.某院军队住院结核病患者10年资料分析[J].西南国防医药,2015,25(6):587-589.
[12]Mor Z,Pinsker G,Cedar N,et al.Epidemiology of extra-pulmonary tuberculosis in Israel,1999-2010[J].Int J Tuberc Lung Dis,2013,17(2):229-233.
[13]Herath S, Lewis C.Pulmonary involvement in patients presenting with extra-pulmonary tuberculosis:thinking beyond a normal chest X-ray[J]. J Prim Health Care,2014,6(1):64-68.
[14]Fortfin J,Martin-Ddvila P,Gómez-Mampaso E,et al.Extra-pulmonary tuberculosis:differential aspects and role of 16SrRNA in urine[J]. Int J Tubere Lung Dis,2014,18(4):478-485.
[15]黄建生,沈梅,李永祥,等.上海市肺外结核病流行病学分析(摘要)[A].中华医学会第六届全国结核病学术大会论文汇编[C],2000.
[16]陈平,胡骅,赖旭辉,等.建德市肺外结核流行病学调查[A].中国防痨协会结核病控制专业委员会学术研讨会论文集[C].2010.
[17]成诗明,周林,刘二勇,等.结核分枝杆菌和艾滋病病毒双重感染防治合作模式与效果[J].中国防痨杂志,2011,33(7):416-421.
[18]崔哲哲,冯启明,林玫,等.2010-2013年广西TB/HIV双重感染监测数据分析与评价[J].广西医学,2015,37(3):364-367.