某区2004年中、小学生结核病普查

ANALYSIS ON GENERAL INVESTIGATION OUTCOMES OF TUBERCULOSIS OF STUDENTS AND PUPILS IN LONGGANG DISTRICT,SHENZHEN,IN YEAR 2004.

目的：评估本地区中小学生结核病流行病学状况。方法：用传统流行病学和分子流行病学方法。对125893名中、小学生进行PPD实验和X线检查；结核病人进行痰结核菌涂片和培养；对结核分枝杆菌分离株进行分子流行病学研究，用标准RFLP技术使用IS6110插入序列对结核分枝杆菌进行分型和成簇分析。结果：125893名中、小学生中（95．9％）接种过BCG。小学生1～4年级PPD阳性20963例，阳性率47．9％，其中强阳性17例；确定诊断结核感染3例、颈淋巴结结核4例，原发综合征和肺门淋巴结结核10例。小学5、6年级和中学生共X线异常阴影并确诊为肺结核48例。58例肺结核病人痰抗酸染色阳性15例（25．9％）、培养阳性42例（72．4％）；患病率46．1／10万；涂阳患病率13．5／10万。42株结核分枝杆菌中，IS6110 RFLP分析23株（55％）成簇，拷贝相似性高；其余19株IS6110拷贝呈现多态性。最大簇包含3例病人。结论：本地区中、小学生结核病患病率较低；新近传播病例未形成较大成簇，近期可能无集团感染和暴发发生。

Objective： To evaluate the epidemiological state of tuberculosis of students and pupils in Longgang district using conventional and molecular epidemiological methods. Methods： In a general investigation of tuberculosis of 125 893 students and pupils in Longgang district from April to May in 2004, the tuberculin skin test （PPD） and chest radiology （X- ray） was made. Smear and culture of M tuberculosis for presumed tuberculosis patients. The standard restriction fragment length polymorphism （RFLP） technique together with the IS6110 insertion sequence was used to subtype Mtuberculosis. Results： It is 120 857 （95.9%） BCG-vaccinated people in 125 893 receiver. 20 963 people （47.9 % ） who were tuberculin skin test （PPD） positive in 43 682 pupils range of 1-4 grade, but only 17 pupils were strong reactive positive （〉15 mm）. Latent tuberculosis was diagnosed infection in 3 children, cervical lymph nodes tuberculosis was diagnosed in 4 children, primary pulmonary TB and mediastinal lymph nodes TB was diagnosed in 10 children. 48 who were chest radiology positive in 82 211 pupils range of 5, 6 grade and students. All 58 tuberculosis patients were only 15 with （25.9%） positive staining and 42 （72.4%） had been cultured for acid-fast bacilli. The standardized incidence of active and bacteriological positive pulmonary tuberculosis were 46.1/100,000 and 13.5/100,000 respectively. Of the 42 patients who had isolates of M tuberculosis available, 23 （55 % ） showed molecular clustering with 13 （31% ） defined as being recently transmitted. Conclusion： The incidence of TB of students and pupils in Longgang district is lower. Recent transmitted TB accounts for a moderate proportion of tuberculosis cases.