2000—2009年天津市监狱系统在押犯人中结核病患者发现情况分析

Analysis of TB case-finding in prisoners in Tianjin prison system from 2000 to 2009

目的了解天津市监狱系统在押犯人中结核病患者发现情况和变动趋势。方法天津市结核病控制中心自2000年起对监狱系统在押犯人采取入监体检、普查和因症就诊相结合的方式,2000—2009年间确诊结核患者1811例。收集这10年间监狱结核患者登记资料,对结核患者发现方式、发病特征及其变动趋势进行分析。结果 1811例患者中,涂阳肺结核占9.7%（176/1811）,涂阴肺结核占82.9%（1502/1811）,结核性胸膜炎占7.3%（133/1811）;以男性和青壮年占多数,男性占98.3%（1780/1811）,25-54岁患者占84.0%（1522/1811）。复治患者比例由2000年的39.0%（144/369）,至2009年下降至3.3%（7/211）;患者发现方式看,普查所占比例由2001年时占70.2%（207/295）,至2009年下降至19.4%（41/211）;入监体检和因症就诊比例2001年分别占7.5%（22/295）和22.4%（66/295）,至2009年分别上升至38.4%（81/211）和42.2%（89/211）;具有肺结核主要症状（咳嗽、咯痰≥2周或咯血、血痰）的患者所占比例2000年56.9%,至2009年下降至28.4%;因症就诊患者平均就诊延误时间2000年为38.38 d,至2009年缩短至8.41 d。结论监狱患者的发现以入监体检、普查和因症就诊为主,10年间普查所占比例下降,入监体检和因症就诊所占比例升高;复治比例和具有肺结核主要症状者比例下降;因症就诊患者就诊延误时间缩短。证明监狱结核患者发现更为及时,患者发现取得良好效果,今后监狱系统结核病控制工作还应该坚持3种方式相结合的患者发现方法。

Objective To know the TB case-finding in prisoners and its trend in Tianjin prison system. Methods Tianjin center for TB control and prevention initiated TB case-finding in prison system since 2000 through physical examination of new prisoner,general screening,and passive case finding.During 2000 to 2009,1811 active TB cases were diagnosed.Data in last decade was collected and the methods of TB case-finding,characteristic and trend of TB in prisons were analyzed. Results In the 1811 TB cases,smear-positive pulmonary TB accounted for 9.7%（176/1811） and smear negative accounted for 82.9%（1502/1811）,and 7.3%（133/1811） were TB pleurisy;the majority of TB were male and young adults,male accounted 98.3%（1780/1811）;25—54 age category accounted 84.0%（1522/1811）.The proportion of retreatment cases decreased from 39.0%（144/369） in 2000 to 3.3%（7/211） in 2009;In terms of case detection methods,patients detected through massive screening decreased from 70.2%（207/295） in 2001 to 19.4%（41/211） in 2009,while the other two methods-new prisoners physical examination and passive case-finding contributed 7.5%（22/295） and 22.4%（66/295） in 2001 respectively,and increased to 38.4%（81/211） and 42.2%（89/211） in 2009;Patients with suspicious TB symptoms,namely cough and expectoration for more than 2 weeks,or having bloody sputum or hemoptysis,decreased from 56.9% in 2000 to 28.4% in 2009;for the cases detected by passive case-finding,the patients＇ delay in health seeking reduced from 38.38 days in 2000 to 8.41 days in 2009. Conclusion Physical examination of new prisoner,general screening,and passive case finding were three main methods for tuberculosis case-finding in prisoners.However,the proportion of patients detected by general screening decreased,while increased for other two methods;the proportion of retreatment and with TB suspicious symptoms decreased;the patients＇ delay in health seeking reduced.These findings indicate that tuberculosis cases in prisons became more timely,and case finding methods achieved good effect.In the future,we will continue to combine these three methods in case finding in prisoners.