山西省结核病流行病学调查分析
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摘要
目的：了解山西省人群中结核病的感染率，患病率及结核菌的耐药情况，评价山西省1990～2000年结核病控制的效果，为制定2001～2010年结核病控制规划提供科学依据。
方法：采用分层整群随机抽样的方法，对山西省11个市(地)21个调查点的30831人进行结核病流行病学调查，0～14岁儿童进行结核菌素试验，≥15岁人群和结核菌素试验反应≥10mm的儿童进行胸透，对胸透异常和咳嗽、咳痰症状≥3周者进行摄片、痰涂片和痰培养检查，培养阳性者进行抗结核药物敏感性试验，活动性肺结核患者进行社会经济状况调查，对2个全人口感染率调查点进行调查，对1999年死亡情况进行回顾性调查。用SAS软件包对调查资料进行整理分析和统计处理。
结果：本次调查11个地市，21个调查点，共调查30831人，确诊活动性肺结核病人146例，涂阳肺结核病人46例，菌阳肺结核病人56例，山西省活动性肺结核患病率为474／10万，涂阳肺结核患病率为149／10万，菌阳肺结核患病率为182／10万，且随年龄的增加而上升，估算现有活动性肺结核病人147572人，涂阳肺结核病人46389人。与1990年流调结果(444／10万、132／10万)相比，肺结核患病率与涂阳患病率均有所上升，活动性肺结核男、女性的患病率有差异(P＜0.05)，男、女性涂阳患病率间无差别(P＞0.05)，青壮年是结核病高发人群，老年结核病人是主要的传染源。农村的肺结核患病率和涂阳患病率(501／10万、164／10万)明显高于城市(351／10万、0／10万)，浸润型肺结核仍是主要的发病类型(占79.5％)，绝大多数病人处于无管理状态(活动性肺结核：
功西医祥大学2002卒硬士学世讼丈
52.20%、涂阳肺结核:71.43q0)，耐药性结核病，尤其是继发性耐药结核
病仍占一定比重(50%)。
结论:山西省结核病疫情仍然非常严重，应引起各级政府的高度重
视。病人的发现、治疗和管理是影响疫情的主要因素。提示:加大各级
政府对结核病防治工作的经费投入，加大执法力度，早期发现，早期诊
断以及良好的管理，对降低疫情至关重要。
Objective: To investigate the influence rate, the prevalence
of tuberculosis and drug resistance tuberculosis in Shanxi province. To evaluate the efficacy of control measures from 1990 to 2000 and to provide scientific basis for making Shanxi Tuberculosis Control Programmer from 2001 to 2010.
Methods: 30831 persons in 21 places of 11 cities in Shanxi
have been investigated . Tuberculin testing was carried out among 0-44 years old children; fluroscopy was carried out for >15 years old population and children with >10mm reaction of tuberculin testing; chest X-ray film, sputum smear and culture were done for the patients of fluroscopy abnormal and suspects of tuberculosis symptom(persistent cough for 3 weeks or more);drug sensitivity test was done for the patients with culture positive; a retrospective study of tuberculosis mortality in 1999 was conducted at all investigation points; social economic study was done for the active pulmonary tuberculosis cases; the survey of tuberculosis infection rate for all population was carried out in 2 investigation points. The analysis was done with SAS Software package.
Results: Among 30831 persons at 21 places of 11 cities, 146
active pulmonary tuberculosis, 46 smear positive pulmonary tuberculosis, 56 culture positive pulmonary tuberculosis have been diagnosed, the prevalence of active pulmonary tuberculosis was 474 per 100 000,the prevalence of smear positive pulmonary tuberculosis was 149 per 100 000 and the prevalence of bacteriological positive pulmonary tuberculosis was 182 per 100 000,it would increase when ages increase .It calculates accordingly that there are 147572 active pulmonary tuberculosis in our province at present, with 46398 case transmission . Compared with the epidemiological results of the year 1990(444 per 100 000 , 132 per 100 000), prevalence of pulmonary tuberculosis and that of smear positive have some increase. There is some differences (P<0. 05) between male' s and female ' s at the prevalence of active pulmonary tuberculosis, and there is no difference (P>0. 05) between male' s and female' s smear positive pulmonary tuberculosis . The young got it easily, the old are the main source of influence. The prevalence of tuberculosis and smear positive pulmonary tuberculosis are higher in countries (501 per 100 000, 164 per 100 000) than those in cities (351 per 100 000, 0 per 100 000) obviously, exudative tuberculosis is still a main kind, most of the patients are out of management, drug resistance tuberculosis especially the proportion of acquired drug resistance tuberculosis was still high.
Conclusions: The epidemic situation of tuberculosis is very
serious in our province, it's the main element influence of epidemic situation to find and manage the patients. Point out: The governments at different levels must pay more attention to tuberculosis control programme ,increase the budget , strengthen law management, finding early, diagnose early and have good management are very important for decreasing the epidemic situation.
方法：采用分层整群随机抽样的方法，对山西省11个市(地)21个调查点的30831人进行结核病流行病学调查，0～14岁儿童进行结核菌素试验，≥15岁人群和结核菌素试验反应≥10mm的儿童进行胸透，对胸透异常和咳嗽、咳痰症状≥3周者进行摄片、痰涂片和痰培养检查，培养阳性者进行抗结核药物敏感性试验，活动性肺结核患者进行社会经济状况调查，对2个全人口感染率调查点进行调查，对1999年死亡情况进行回顾性调查。用SAS软件包对调查资料进行整理分析和统计处理。
结果：本次调查11个地市，21个调查点，共调查30831人，确诊活动性肺结核病人146例，涂阳肺结核病人46例，菌阳肺结核病人56例，山西省活动性肺结核患病率为474／10万，涂阳肺结核患病率为149／10万，菌阳肺结核患病率为182／10万，且随年龄的增加而上升，估算现有活动性肺结核病人147572人，涂阳肺结核病人46389人。与1990年流调结果(444／10万、132／10万)相比，肺结核患病率与涂阳患病率均有所上升，活动性肺结核男、女性的患病率有差异(P＜0.05)，男、女性涂阳患病率间无差别(P＞0.05)，青壮年是结核病高发人群，老年结核病人是主要的传染源。农村的肺结核患病率和涂阳患病率(501／10万、164／10万)明显高于城市(351／10万、0／10万)，浸润型肺结核仍是主要的发病类型(占79.5％)，绝大多数病人处于无管理状态(活动性肺结核：
功西医祥大学2002卒硬士学世讼丈
52.20%、涂阳肺结核:71.43q0)，耐药性结核病，尤其是继发性耐药结核
病仍占一定比重(50%)。
结论:山西省结核病疫情仍然非常严重，应引起各级政府的高度重
视。病人的发现、治疗和管理是影响疫情的主要因素。提示:加大各级
政府对结核病防治工作的经费投入，加大执法力度，早期发现，早期诊
断以及良好的管理，对降低疫情至关重要。
Objective: To investigate the influence rate, the prevalence
of tuberculosis and drug resistance tuberculosis in Shanxi province. To evaluate the efficacy of control measures from 1990 to 2000 and to provide scientific basis for making Shanxi Tuberculosis Control Programmer from 2001 to 2010.
Methods: 30831 persons in 21 places of 11 cities in Shanxi
have been investigated . Tuberculin testing was carried out among 0-44 years old children; fluroscopy was carried out for >15 years old population and children with >10mm reaction of tuberculin testing; chest X-ray film, sputum smear and culture were done for the patients of fluroscopy abnormal and suspects of tuberculosis symptom(persistent cough for 3 weeks or more);drug sensitivity test was done for the patients with culture positive; a retrospective study of tuberculosis mortality in 1999 was conducted at all investigation points; social economic study was done for the active pulmonary tuberculosis cases; the survey of tuberculosis infection rate for all population was carried out in 2 investigation points. The analysis was done with SAS Software package.
Results: Among 30831 persons at 21 places of 11 cities, 146
active pulmonary tuberculosis, 46 smear positive pulmonary tuberculosis, 56 culture positive pulmonary tuberculosis have been diagnosed, the prevalence of active pulmonary tuberculosis was 474 per 100 000,the prevalence of smear positive pulmonary tuberculosis was 149 per 100 000 and the prevalence of bacteriological positive pulmonary tuberculosis was 182 per 100 000,it would increase when ages increase .It calculates accordingly that there are 147572 active pulmonary tuberculosis in our province at present, with 46398 case transmission . Compared with the epidemiological results of the year 1990(444 per 100 000 , 132 per 100 000), prevalence of pulmonary tuberculosis and that of smear positive have some increase. There is some differences (P<0. 05) between male' s and female ' s at the prevalence of active pulmonary tuberculosis, and there is no difference (P>0. 05) between male' s and female' s smear positive pulmonary tuberculosis . The young got it easily, the old are the main source of influence. The prevalence of tuberculosis and smear positive pulmonary tuberculosis are higher in countries (501 per 100 000, 164 per 100 000) than those in cities (351 per 100 000, 0 per 100 000) obviously, exudative tuberculosis is still a main kind, most of the patients are out of management, drug resistance tuberculosis especially the proportion of acquired drug resistance tuberculosis was still high.
Conclusions: The epidemic situation of tuberculosis is very
serious in our province, it's the main element influence of epidemic situation to find and manage the patients. Point out: The governments at different levels must pay more attention to tuberculosis control programme ,increase the budget , strengthen law management, finding early, diagnose early and have good management are very important for decreasing the epidemic situation.
引文
1. WHO Tuberculosis Programme, Tuberculosis. HIV on collision course in Asia, WHO Press Release, WHO/HQ/63,1994
2. WHO Tuberculosis Programme, Framework for Effective Tuberculosis Control, WHO Publication, WHO/HQ/60,1994
3. WHO/HQ, Tuberculosis Unit, Global Tuberculosis situation and Tuberculosis Control programme, WHO Publication, WHO/TB/91.159,1991
4．殷大奎．在“世界结核病防治日”座谈会上的讲话，中国防痨杂志，2000．(2)．57
5. World Heaalth Organization. Anti-tuberculosis drug resistance in the world Report No. 2. Prevalence and trends. Geneva:WHO, 2000.
6. World Heaalth Organization. Global tuberculosis control. WHO report 2000. Geneva: WHO, 2000.
7．中华人民共和国卫生部．1979全国结核病流行病学抽样调查资料汇编．1991．
8．中华人民共和国卫生部．1984／85全国结核病流行病学抽样调查资料汇编．1988．
9．中华人民共和国卫生部．1990全国结核病流行病学抽样调查资料汇编．1992．
10．山西省结核病防治研究所．山西省结核病流行病学调查资料汇编．1980．
11．山西省结核病防治研究所．山西省结核病流行病学调查资料汇编．1991．
12．施鸿生 结核病流行病学调查抽样方法．卫生部结核病控中心．
13．王忠仁，张本．中国结核病学发展史．第一版 当代中国出版社，北京．1997．
14. WHO Tuberculosis Progranmme, Who Attacks Global Neglect of Tuberculosis Crisis, WHO Press Release. WHO/89,1993
15．张慎鹏．641例肺结核病人发病年龄与临床X线分析．现代预防医学，1996．23(3)：176
16．陈建欢，周婷．港口区1993-1996年7种传染病疫情分析．旅行医学科学，1998．4(2)：12
17．宋文虎，肖成志，宋礼章．结核病学进展．第1版．光明日报出版社，北京．1995．7
18．沈海，林松柏，孙亚玲．上海市外来人员肺结核病分布与临床特征．上海预防医学，1998．10(10)：443
19．刘军卫，吴晓红．珠海特区结核病的流行病学特点浅析．现代预防医学，1997．24(3)：361
20. Murray C JL, Styblo K, Rouillon A. tuberculosis in developing countries: burden, intervention and cost. Bull Int Union Tuberc Lung Dis, 1990, 65: 6
21．王成科，蒲松常．585例痰涂片阳性肺结核病例空间聚集性分布探讨．现代预防医学，1994．21(2)：110
22．谭京录，王仕昌，韩建平，等．世行贷款结核病控制项目实施的不均衡性和影响因素评析．中国防痨杂志，2001．23(2)：95
23．王黎霞，刘胜安，王雪静．用趋势分析法研究我国涂阳肺结核患病率的地理分布．中华流行病学杂志，1995．16(5)：274
24．李沼鸿．香港防痨工作的过去和展望．中国防痨杂志，1996．18(2)：49
25．张炳涛，施建华．结核病死亡率分析研究．江苏预防医学，1996：7(1)：25
26．宋文虎，肖成志，宋礼章．结核病学进展．第1版．光明日报出版社，北京．1995．181
27. Friden TR, et al. The emergence of drug-resistant Tuberculosis in New York City. N Engl J Med, 1993, 328: 521
28. F. Papion, et al. Resistance de Mycobacterium Tuberculose aux principaux antibiotiques. Rev fr Resp, 1983, 11:239
29. A. R. Moss; D. Alland; E. Telzak; et al.一株多种耐药结核菌在纽约全市的暴发流行 结核与肺部疾病杂志·中文版 1997．10．15：1(2)：46
30．戴元生，王克文，杜昕，等．世行贷款项目省结核病控制实施水平不均衡性及其影响因素评析．结核病与胸部肿廇，1997．2(3)：144
31．刘津兰，王小靖，汤光华，等．影响新发传染源发现率有关因素的探讨．中国防痨杂志，1995．17(1)：13
32．邱伟，方娟，郭倩，等．广州市越秀区小学健康教育调查．赣南医学院学报，1997．17(3)：273
33. Wandwalo ER, Morkve O. Knowledge of disease and treatment among tuberculosis patients in Mwanza, Tanzania Int J Tuberc Lung Dis, 2000, 4: 1041
34．苏汝俞，董小玲．初治菌阳肺结核不固定化疗期的短化研究近期疗效观察．中华医学会结核病诊断治疗新进展学术研讨会论文汇编，1994，174
2. WHO Tuberculosis Programme, Framework for Effective Tuberculosis Control, WHO Publication, WHO/HQ/60,1994
3. WHO/HQ, Tuberculosis Unit, Global Tuberculosis situation and Tuberculosis Control programme, WHO Publication, WHO/TB/91.159,1991
4．殷大奎．在“世界结核病防治日”座谈会上的讲话，中国防痨杂志，2000．(2)．57
5. World Heaalth Organization. Anti-tuberculosis drug resistance in the world Report No. 2. Prevalence and trends. Geneva:WHO, 2000.
6. World Heaalth Organization. Global tuberculosis control. WHO report 2000. Geneva: WHO, 2000.
7．中华人民共和国卫生部．1979全国结核病流行病学抽样调查资料汇编．1991．
8．中华人民共和国卫生部．1984／85全国结核病流行病学抽样调查资料汇编．1988．
9．中华人民共和国卫生部．1990全国结核病流行病学抽样调查资料汇编．1992．
10．山西省结核病防治研究所．山西省结核病流行病学调查资料汇编．1980．
11．山西省结核病防治研究所．山西省结核病流行病学调查资料汇编．1991．
12．施鸿生 结核病流行病学调查抽样方法．卫生部结核病控中心．
13．王忠仁，张本．中国结核病学发展史．第一版 当代中国出版社，北京．1997．
14. WHO Tuberculosis Progranmme, Who Attacks Global Neglect of Tuberculosis Crisis, WHO Press Release. WHO/89,1993
15．张慎鹏．641例肺结核病人发病年龄与临床X线分析．现代预防医学，1996．23(3)：176
16．陈建欢，周婷．港口区1993-1996年7种传染病疫情分析．旅行医学科学，1998．4(2)：12
17．宋文虎，肖成志，宋礼章．结核病学进展．第1版．光明日报出版社，北京．1995．7
18．沈海，林松柏，孙亚玲．上海市外来人员肺结核病分布与临床特征．上海预防医学，1998．10(10)：443
19．刘军卫，吴晓红．珠海特区结核病的流行病学特点浅析．现代预防医学，1997．24(3)：361
20. Murray C JL, Styblo K, Rouillon A. tuberculosis in developing countries: burden, intervention and cost. Bull Int Union Tuberc Lung Dis, 1990, 65: 6
21．王成科，蒲松常．585例痰涂片阳性肺结核病例空间聚集性分布探讨．现代预防医学，1994．21(2)：110
22．谭京录，王仕昌，韩建平，等．世行贷款结核病控制项目实施的不均衡性和影响因素评析．中国防痨杂志，2001．23(2)：95
23．王黎霞，刘胜安，王雪静．用趋势分析法研究我国涂阳肺结核患病率的地理分布．中华流行病学杂志，1995．16(5)：274
24．李沼鸿．香港防痨工作的过去和展望．中国防痨杂志，1996．18(2)：49
25．张炳涛，施建华．结核病死亡率分析研究．江苏预防医学，1996：7(1)：25
26．宋文虎，肖成志，宋礼章．结核病学进展．第1版．光明日报出版社，北京．1995．181
27. Friden TR, et al. The emergence of drug-resistant Tuberculosis in New York City. N Engl J Med, 1993, 328: 521
28. F. Papion, et al. Resistance de Mycobacterium Tuberculose aux principaux antibiotiques. Rev fr Resp, 1983, 11:239
29. A. R. Moss; D. Alland; E. Telzak; et al.一株多种耐药结核菌在纽约全市的暴发流行 结核与肺部疾病杂志·中文版 1997．10．15：1(2)：46
30．戴元生，王克文，杜昕，等．世行贷款项目省结核病控制实施水平不均衡性及其影响因素评析．结核病与胸部肿廇，1997．2(3)：144
31．刘津兰，王小靖，汤光华，等．影响新发传染源发现率有关因素的探讨．中国防痨杂志，1995．17(1)：13
32．邱伟，方娟，郭倩，等．广州市越秀区小学健康教育调查．赣南医学院学报，1997．17(3)：273
33. Wandwalo ER, Morkve O. Knowledge of disease and treatment among tuberculosis patients in Mwanza, Tanzania Int J Tuberc Lung Dis, 2000, 4: 1041
34．苏汝俞，董小玲．初治菌阳肺结核不固定化疗期的短化研究近期疗效观察．中华医学会结核病诊断治疗新进展学术研讨会论文汇编，1994，174