2019年广东省连江口镇≥5岁常住人口肺结核主动筛查策略实施效果分析  

Analysis of the implementation effect of active tuberculosis screening strategy in permanent residents aged 5 and older in Lianjiangkou Town,Guangdong in 2019

作　　者：吴惠忠 周芳静 廖庆华 陈亮 赖晓宇 余美玲 温文沛 周琳 WU Hui-zhong;ZHOU Fang-jing;LIAO Qing-hua;CHEN Liang;LAI Xiao-yu;YU Mei-ling;WEN Wen-pei;ZHOU Lin(Cnter for Tuberculosis Control of Guangdong Province,Guanngzhou 510630,China)

机构地区：[1]广东省结核病控制中心,广州510630

出　　处：《中国防痨杂志》2021年第10期1032-1038,共7页Chinese Journal of Antituberculosis

基　　金：“十三五”国家科技重大专项(2018ZX10715004-002);广东省医学科研基金项目(C2016019)。

摘　　要：目的评价不同主动筛查策略对肺结核患者的发现效果。方法 2019年12月,以居委会(村)为单位,采用整群随机抽样的方法从广东省清远市英德市连江口镇11个居委会(村)抽取2个单位作为研究现场,对研究现场≥5岁的2800名常住人口进行问卷调查,收集基本信息,并进行肺结核可疑症状筛查、结核感染筛查[γ-干扰素释放试验(IGRA)]和胸部数字影像(DR)摄片检查,对上述检查任一阳性者的痰液标本开展痰涂片、培养及分子生物学检查。以临床诊断为参照标准,通过敏感度、特异度和受试者工作特征曲线下面积(AUC)评价不同筛查策略的发现效果。结果2800名研究对象中,有肺结核可疑症状者272例(9.71%),胸部DR异常者301例(10.75%),结核感染筛查阳性者617例(22.04%);其中,胸部DR异常者中疑似肺结核者67例(22.26%)。共发现活动性肺结核患者8例,发现率为285.71/10万,除1例为已登记并接受治疗的患者外,其他7例均为≥15岁胸部DR异常的新发现患者。以临床诊断为参照标准,胸部DR摄片筛查的敏感度和特异度最优,分别为7/8和88.28%(2207/2500),AUC值最大(0.88)。结论不同的主动筛查策略中,胸部DR检查的诊断价值最高,可作为主动筛查策略的优先选择。Objective To evaluate the effect of different active screening strategies on the detection of pulmonary tuberculosis(PTB)patients. Methods Cluster random sampling method was used to select 2 units from 11 communities(villages)in Lianjiangkou Town,Yingde City,Qingyuan City,Guangdong Province as the study site in December 2019.Basic information was collected from 2800 permanent residents aged 5 and older at the study site.Screening for tuberculosis symptoms,screening for Mycobacterium tuberculosis infection(interferongamma release test(IGRA))and chest digital radiography(DR)were performed.Sputum samples from patients with positive results from any of the above screenings were examined by smear,culture and molecular biology tests.Using clinical diagnosis as a reference standard,performance of different screening strategies were evaluated by sensitivity,specificity and area under the receiver operating characteristic curve(AUC). Results Among the2800 people undergoing active screening,there were 272 cases(9.71%)with suspected symptoms of tuberculosis,301 cases(10.75%)with abnormal chest DR,and 617 cases(22.04%)with positive IGRA results.Among them,67 cases(22.26%)with abnormal chest DR were presumptive tuberculosis patients.A total of 8 active pulmonary tuberculosis patients were diagnosed and the discovery rate was 285.71/100 000.Except for 1 patient who had been registered and receiving treatment,the other 7 patients were all newly detected from aged 15 and older population with abnormal chest DR.With clinical diagnosis as the reference standard,chest DR screening had the best sensitivity and specificity(7/8 and 88.28%(2207/2500),respectively),and the highest AUC(0.88).Conclusion Among different active screening strategies,chest DR has the highest diagnostic value and can be used as the priority choice of active screening strategy.

关 键 词：结核 肺 传染病控制 多相筛查 人群监测 数据说明 统计 

分 类 号：R521[医药卫生—内科学]