慈利县肺结核病治愈后复发情况的流行病学分析

Epidemiological Analysis on Relapse Pulmonary Tuberculosis in Cili County

目的探讨在结核病控制项目中肺结核病复发的流行病学特征及影响因素,为预防和控制结核病复发提供依据和对策。方法采取回顾性调查方法,追踪曾诊断为涂阳肺结核病并完成疗程,且治愈后复发的患者,资料用χ2检验进行分析。结果慈利县4 360例涂阳治愈的肺结核病例中有225例复发,总复发率为5.16%,其中男性复发率为5.22%,女性复发率为5.05%,两者差异无统计学意义(χ2=5.21,P>0.05)。复发率最高的是70岁以上年龄组,为25.12%,最低为<10岁年龄组为0复发,年龄组间差异有显著统计学意义(χ2=402.82,P<0.01)。判愈后最早出现复发病例是第3个月,占0.89%,判愈后复发最多是在<1年之内,占47.11%,复发时间差异有显著统计学意义(χ2=978.08,P<0.01)。已判愈的初治涂阳与已判愈的复治涂阳病例,差异有统计学意义(χ2=41.35,P<0.01)。复发病例以农民最多,占69.81%,复治后2个月末,痰菌阴转、胸部阴影吸收,占59.11%;复治期间死亡8例,占3.56%。结论控制结核病治愈后复发关键是对前3年治愈病例进行重点监测,对既往为复治涂阳肺结核病患者及既往治疗时痰菌阴转慢的患者应高度关注。结核病控制的重点人群是农民。

Objective To study the influencing factors and epidemic situation about relapse pulmonary tuberculosis from Tuberculosis Control Project loaned by the World Bank in Cili County and mountainous area, and to provide a scientific evidence for TB prevention and control. Methods The registration reports of relapse pulmonary tuberculosis cases were retrospectively analyzed, and Chisquare test was conducted to analyze the epidemiological data. Results There were 225 relapse cases among 4,350 smear - positive pulmonary tuberculosis cure cases in Cili County, the total relapse rate was 5.16 % ; the relapse rate was .5.22 % in males and 5.05 % in females, there was no statistically significant difference between them （X2 = 5.21, P 〉 0.05）. The highest relapse rate was in the age group of over 70 years （25.12 % ）, and the lowest re- lapse rate was in the age group of less than 10 years （0.00 % ）, there were statistically significant differences among different age group （X2 = 402.82, P〈 0.01）. After curing, the relapse time was from the third month （0.89 % ） to the twelfth month （47.11% ）, there was a statistically significant difference in the relapse time （X2 = 978.08, P〈 0.01）. Statistically signifi- cant difference was found between new smear - positive cases and retreatment smear - positive cases （X2 = 41.35, P 〈 0.01）. Most of the relapse cases were farmers （69.81% ）. At the end of the second month of retreatment time, 59.11% cas- es showed sputum negative conversion and pathologic absorption. There were 8 death cases during retreatment time, ac- counted for 3.56 %. Conclusions Monitoring cured TB cases during the first three years and paying special attention to pulmonary tuberculosis patients with the history of retreated smear- positive and pulmonary tuberculosis patients with the his- tory of slow sputum negative conversion are the key measures for control of relapse TB cases. Farmers are the key population for control of TB.