2020年四川省定点医疗机构病原学阴性肺结核诊断质量评估分析  

Analysis of quality assessment of pulmonary tuberculosis with negative etiology in designated medical institutions in Sichuan Province,2020

作　　者：钟引 何金戈[1] 李京 杨妮[1] 宋杨[1] ZHONG Yin;HE Jinge;LI Jing;YANG Ni;SONG Yang(Sichuan Center for Disease Control and Prevention,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川省疾病预防控制中心,成都610041

出　　处：《职业卫生与病伤》2025年第1期46-50,共5页Occupational Health and Damage

摘　　要：目的了解四川省结核病定点医疗机构病原学阴性肺结核诊断现状,对其诊断质量进行评估,为进一步规范病原学阴性肺结核诊断流程,提高诊断质量提供科学依据。方法采用整群抽样的方法,2020年11月抽取四川省21个市(州)共26个结核病定点医疗机构作为调查点,现场查阅2019年登记病原学阴性肺结核患者的病案资料、胸部影像学资料和实验室检查资料,由各市(州)组成的专家组采用交叉评估的方式进行现场调查。结果1834名病原学阴性肺结核患者中,有94.27%(1729/1834)符合《肺结核诊断》(WS 288-2017)标准临床诊断病例;痰涂片检查率为90.95%(1668/1834),痰培养检查率为28.46%(522/1834),分子生物学检查率40.40%(741/1834),有6.76%(124/1834)的患者未开展任何病原学检查项目;免疫学、病理学、胸水等各项实验室检查率均低于50.00%,分别为PPD试验41.98%(770/1834)、抗结核抗体36.21%(664/1834)、IGRA试验24.26%(445/1834)、胸水实验室检查13.79%(253/1834)、支气管镜检查8.23%(151/1834)、肺外结核病病理检查1.91%(35/1834);60.47%(1109/1834)的患者未进行诊断性抗感染治疗,47.33%(868/1834)患者未进行病案讨论。结论肺结核定点医疗机构存在痰检流程不规范,痰涂片标本质量不高,病原学、免疫学、病理学、胸水等各项实验室检查率有待提高,未充分发挥诊断小组作用的问题,需规范诊断流程,提高诊断质量。Objective To understand the status of diagnosis of pulmonary tuberculosis with negative etiology in TB medical institutions in Sichuan Province and to evaluate its diagnosis quality,so as to provide scientific basis for further standardizing the diagnosis process of pathogenic negative tuberculosis and improving the diagnosis quality.Methods A total of 26 designated TB medical institutions in 21 cities(prefectures)of Sichuan Province were selected as investigation points by cluster sampling method in November 2020.The medical record data,chest imaging data and laboratory examination data of registered etiological negative tuberculosis patients in 2019 were reviewed on-site,and the expert group composed of various cities conducted on-site investigation by means of cross-evaluation.Results Among the 1834 patients,94.27%(1729/1834)met the clinical diagnosis criteria stipulated in the Diagnosis For Pulmonary Tuberculosis(WS 288-2017);The sputum smear examination rate was 90.95%(1668/1834),the sputum culture examination rate was 28.46%(522/1834),the molecular biology examination rate was 40.40%(741/1834),and 6.76%(124/1834)of the patients did not undertake any pathogen examination project;The laboratory examination rate of immunology,pathology and pleural effusion was lower than 50.00%,41.98%(770/1834)for PPD test,36.21%(664/1834)for anti-tuberculosis antibody,24.26%(445/1834)for IGRA test,13.79%(253/1834)for laboratory examination of pleural effusion,8.23%(151/1834)for bronchoscopy,and 1.91%(35/1834)for pathological examination of extra-pulmonary tuberculosis;60.47%(1109/1834)of the patients did not receive the diagnostic anti-infection treatment,and 47.33%(868/1834)did not have medical record discussion,respectively.Conclusions There are problems with the sputum examination process not being standardized,poor quality of sputum smear specimens,low rates of laboratory tests such as pathogen detection,immunology,pathology,pleural effusion,and underutilization of the diagnostic team in TB medical institutions.Therefore,

关 键 词：结核 病原学阴性肺结核 诊断质量 

分 类 号：R521[医药卫生—内科学] R181.3[医药卫生—临床医学]