2021年重庆市新生筛查结核病结果分析

Screening results of tuberculosis among new students in Chongqing Municipality, 2021

目的 分析重庆市不同医疗机构开展新生结核病筛查效果的异同,为学校结核病新生筛查工作提供参考。方法 通过《重庆市新生结核病筛查调查表》和《重庆市统计年鉴》收集2021年重庆市秋季入学的各教育阶段新生结核病筛查资料和学生人口数据,分析学生活动性肺结核患者检出率及结核菌素纯蛋白衍生物(purified protein derivative tuberculin, PPD)强阳性率,采用SPSS 25.0进行描述性分析和χ^(2)检验。结果 2021年重庆市新生结核病筛查798 135人,筛查率为42.36%,其中高中(61.48%)、初中(54.93%)筛查率较高。共发现151人活动性肺结核患者,高中(34.82/10万)、高等教育(28.59/10万)及寄宿制初中(11.83/10万)检出率较高。学前教育及小学新生197 469人,主要由其他医疗机构(41.44%)开展筛查工作。非寄宿制初中新生有14 587人开展了结核症状筛查,以其他医疗机构筛查为主。寄宿制初中新生有194 457人开展了PPD筛查,不同类型医疗机构患者检出率差异有统计学意义(P=0.002),不同类型医疗机构筛查PPD强阳性率差异有统计学意义(P<0.001),由定点医疗机构筛查的患者检出率(23.45/10万)和学生PPD强阳性率(2.76%)较高。高中新生有241 240人开展了PPD筛查,不同类型医疗机构患者检出率差异有统计学意义(P=0.001),不同类型医疗机构PPD强阳性率差异有统计学意义(P<0.001),由定点医疗机构筛查的患者检出率(48.78/10万)和学生PPD强阳性率(4.89%)较高。高等教育阶段新生有150 382人开展了胸部X光片检查,活动性肺结核患者检出率为28.59/10万,不同类型医疗机构患者检出率差异无统计学意义(P=0.785)。结论 进一步提高学前教育、小学和高等教育阶段新生结核病筛查比例,建立新生结核病筛查质量控制体系,加强和规范学校结核病体检筛查工作。

Objective To analyze the similarities and differences of tuberculosis(TB) screening results of new students among different medical institutions in Chongqing Municipality, and to provide references for TB screening among new students in schools. Methods Tuberculosis screening data of new students and population data of students at all educational stages enrolled in autumn 2021 in Chongqing Municipality were collected by means of Tuberculosis Screening Questionnaire for New Students in Chongqing and Chongqing Statistical Yearbook. The detection rate of active pulmonary tuberculosis and the strong positive rate of purified protein derivative tuberculin(PPD) test among the students were analyzed. SPSS 25.0 software was used for descriptive analysis and χ^(2) test. Results A total of 798,135 new students in Chongqing in 2021 were screened for TB, with the screening rate of 42.36%. High school(61.48%) and junior middle school(54.93%) had higher screening rates. 51 patients with active pulmonary tuberculosis were found, and the detection rates of high school(34.82/100,000), higher education(28.59/100,000) and boarding junior middle school(11.83/100,000) were high. 197,469 students in preschools and primary schools were screened for TB, mainly by other medical institutions(41.44%). 14,587 new students from non-boarding junior high schools underwent TB symptom screening, and mainly screening by other medical institutions. 194,457 new students from boarding junior high schools underwent PPD test, and there were statistically significant differences in the detection rate of patients in different types of medical institutions(P=0.002) as well as in the strong positive rate of PPD test detected by different types of medical institutions(P<0.001). The detection rate of patients(23.45/100,000) and the strong positive rate of PPD test(2.76%) in designated medical institutions were high. 241,240 new students from high schools underwent PPD test,and there were statistically significant differences in the detection rate of patients in different types of medical institutions( P = 0.001) as well as in the strong positive rate of PPD test detected by different types of medical institutions( P<0.001). The detection rate of patients( 48.78/100,000) and the strong positive rate of PPD test( 4.89%) in designated medical institutions were high. 150,382 freshmen at higher education stages underwent chest X-ray examination,and the detection rate of active pulmonary tuberculosis was 28.59/100,000. No statistically significant difference was found in the detection rate of patients in different types of medical institutions( P = 0. 785).Conclusion We should further improve the proportion of TB screening in preschool education,primary school education and higher education,establish the quality control system for TB screening,strengthening and standardizing TB screening in schools.