广州市越秀区2014-2018年大中学生菌阳肺结核接触者筛查情况分析  

Screening data of contacts with pathogen positive cases of pulmonary tuberculosis in college and middle school students at Yuexiu District,Guangzhou from 2014 to 2018

作　　者：樊晖[1] 刘志辉[1] 陈其琛[1] 刘国标[1] 陈剑锋[1] 龚芳[1] 林晓珊[1] 张言斌[1] 胡锦兴[1] 刘健雄[1] Fan Hui;Liu Zhihui;Chen Qichen;Liu Guobiao;Chen Jianfeng;Gong Fang;Lin Xiaoshan;Zhang Yanbin;Hu Jinxing;Liu Jianxiong(Guangzhou Chest Hospital,Guangzhou 510095,China)

机构地区：[1]广州市胸科医院,510095

出　　处：《国际医药卫生导报》2021年第11期1592-1596,共5页International Medicine and Health Guidance News

基　　金：“艾滋病和病毒性肝炎等重大传染病防治”国家科技重大专项(2017ZX10201302、2018ZX10715004);广州市卫生健康科技重大项目(2020A031003)。

摘　　要：目的探讨病原学检测阳性肺结核大、中学生治疗延误、有无空洞、病灶范围、细菌载荷量等因素对其校内接触者结核病传播的影响。方法回顾性分析2014年1月1日至2018年12月31日年广州市越秀区大学、中学79例病原学检测阳性结核病患者(下称“线索病例”;男45例,女24例,年龄12~25岁)的临床诊疗情况,并对其4934例校内接触者(男1867例、女3067例,年龄12~65岁)结核菌素皮肤试验(tuberculin skin test,TST)结果进行比较分析。结果线索病例来自33所大学和中学,其中在8所学校12例线索病例的密切接触者中发现13例结核病患者(下称“接触者病例”),其中有7例线索病例和2例接触者病例分别发生7~81 d与16~76 d的就诊延误。接触者未发病和接触者发病线索病例的就诊延误、诊断延误、有无空洞、病灶范围和病原学检测(包括涂片与培养)比较,差异均无统计学意义;线索病例的密切接触者与非密切接触者的TST阳性率、强阳性率分别为68.36%(1934/2829)、21.81%(617/2829)和47.84%(1007/2105)、3.42%(72/2105)(P<0.001)。结论加强密切接触者筛查有助于早期发现结核病例,在学校结核病控制中应该加强这一工作。Objective To explore the transmission of tuberculosis caused by treatment delay,cavitation,lesion range,bacterial load,and other factors in school contacts with pathogen positive cases of pulmonary tuberculosis.Methods The clinical diagnosis and treatment data of 79 patients with pathogen-positive pulmonary tuberculosis from the universities and middle schools at Yuexiu District,Guangzhou,including 45 males and 24 females who were 12-25 years old and hereinafter referred to as"clue cases",were retrospectively analyzed.And the results of tuberculin skin test(TST)of their 4934 contacts at their campuses or schoolyard,including 1867 males and 3067 females who were 12-65 years old,were analyzed.Results The clue cases came from 33 universities and middle schools.Thirteen patients with tuberculosis were found in the close contacts of 12 clue cases at 8 universities and middle schools,hereinafter referred to as"contact cases";7 clue cases and 2 contact cases presented treatment delay of 7-81 days and 16-76 days,respectively.There were no statistical differences in delay of seeking medical attention,diagnosis delay,cavitation,lesion range,and pathogenic testing(including smears and cultures)between the healthy and sick cases of the contacts.The positive rate and strong positive rate of TST were 68.36%(1934/2829)and 21.81%(617/2829)in the clue cases'close contacts,and were 47.84%(1007/2105)and 3.42%(72/2105)in the clue cases'non-close contacts(P<0.001).Conclusion It is essential that screening of close contacts should be strengthened in school tuberculosis control for the early detection of tuberculosis cases.

关 键 词：肺结核 学校 接触者 就诊延误 结核菌素皮肤试验 

分 类 号：R521[医药卫生—内科学]