健康体检者结核病筛查及结核菌素试验强阳性者10年内自然发病情况研究  

Screening for tuberculosis in health examination participants and clinical study on the spontaneous occurrence of tuberculosis in the populations with strong positive reaction to tuberculin skin test in ten years

作　　者：林存智[1] 许俊华[2] 李金凤[1] 王芳芳[1] 张华[1] 王海荣 朱新红[4] 

机构地区：[1]青岛大学附属医院呼吸科,266003 [2]青岛大学附属医院检验科,266003 [3]青岛市胸科医院结核内科 [4]青岛市市立医院内科

出　　处：《中华健康管理学杂志》2015年第1期69-72,共4页Chinese Journal of Health Management

摘　　要：目的：分析健康体检者结核病筛查结果，研究结核菌素试验（TST）强阳性者10年内发病情况，为TST强阳性人群的化学预防提供理论依据。方法选取无结核病的健康体检者12598名，其中在校大学生8896名，农民工2496名，有活动性肺结核密切接触者1206名，进行TST，筛查强阳性人群和结核病患者。对强阳性人群行胸部X线检查和痰抗酸杆菌检测，诊断为结核病者给予规范抗结核治疗，对肺部正常未采取异烟肼预防的强阳性人群429名随访10年，观察3年内和第4-10年结核病发病情况及规范抗结核治疗者复发情况。分析不同人群发病率差异，组间比较使用χ2检验。结果 TST筛查出肺结核病患者37例，检出率为0.29%（37/12598）。其中大学生、农民工和密切接触者分别为11例（0.12%，11/8896）、12例（0.48%，12/2496）和14例（1.16%，14/1206），检出率差异有统计学意义（χ2=31.40，P=0.000）；强阳性人数897名，强阳性率7.12%（897/12598），其中大学生、农民工和密切接触者强阳性分别为316名（3.55%，316/8896）、388名（15.54%，388/2496）和193名（16.00%，193/1206），强阳性率差异有统计学意义（χ^2=583.04，P=0.000），且大学生低于农民工和密切接触者（χ^2=483.51和344.11，P〈0.01）。10年内随访429名TST强阳性者，有54名发病，肺结核累积发病率12.58%（54/429），其中大学生、农民工和密切接触者结核病累积发病率分别为9.21%（14/152）、9.58%（18/188）和24.72%（22/89），后者高于前两者（χ^2=10.63和11.21，P〈0.001）。失访75人，失访率17.48%（75/429），其中大学生、农民工和密切接触者失访率分别为7.89%（12/152）、28.19%（53/188）和11.23%（10/89），失访率差异有统计学意义（χ^2=17.59，P=0.000）。其中3年内，429名被随访者中有31名发病，累积发病率7.23%（31/429），大学生、农民工和密切接触者累积发病�Objective To analyze the results of screening for tuberculosis （TB） in health examination participants and study the spontaneous occurrence of TB in the subjects with strong positive reaction to tuberculin skin test （TST） in ten years. Method Totally 12 598 health examination participants without past TB history were selected, of whom 8 896 were college students, 2 496 migrant workers and 1 206 had close contacts with active TB patients. They were screened by TST with strong positive reaction. All of subjects with TST strong positive results received chest X-ray examination and sputum acid-fast bacteria＆amp;nbsp;detection. The subjects diagnosed to have TB were given regularly anti-tuberculosis drugs treatment and followed up for ten years. The 429 subjects without TB and no isoniazid preventive treatment were chosen to be followed up for ten years and spontaneous occurrence of TB in first three years and the fourth to tenth years respectively, as well as the recurrence of TB for the patients who received anti-tuberculosis regimen were recorded. Result Thirty-seven cases were diagnosed as TB by TST screening, and the total detection rate was 0.29% （37/12 598）. Among them 11 were college students （0.12%, 11/8 896）, 12 were migrant workers （0.48%, 12/2 496） and 14 were close contacts （1.16%, 14/1 206） respectively. The detection rates were different among the three groups （χ^2=31.40, P=0.000）. Among 897 strong positive subjects, the strong positive rate was 7.12%（897/12 598）, 316 were college students （3.55%, 316/8 896）, 388 migrants workers （15.54%, 388/2 496）, and 193 close contacts （16.00%, 193/1 206） respectively. There was significant difference in strong positive rate among the three groups （χ^2=583.04, P=0.000）, and the strong positive rate of college students was lower compared with that of the migrant workers and the close contacts （χ^2=483.51 and 344.11, P〈0.01）. In ten years, 54 subjects were diagnosed as TB in 429 subjects with strong positive r

关 键 词：结核菌素试验 结核 肺 累积发病率 健康管理 

分 类 号：R52[医药卫生—内科学]