江苏农村社区一般人群胸部X线摄片主动筛查肺结核的效果评估

Assessment of X-ray screening for active case finding in the general rural population of Jiangsu province

目的为准确获取江苏省农村一般社区人群结核病流行强度，探索有针对性的患者发现及干预措施提供科学依据。方法采取分层整群随机抽样方法，从张家港市、丹阳市、泰兴市共887个村中抽取50个行政村（社区），对抽样点所有人群进行问卷调查和体检，满15周岁以上人口进行胸部x线摄片检查；调查人数157168名，其中116796名参加胸部X线摄片，结果异常者及具有肺结核可疑症状者进行痰涂片检查。使用EpiData3．1和Excel2007软件建立数据库，用SPSS17．0软件包进行统计学处理和分析，组间比较采用χ2检验，P〈0．05为差异有统计学意义。结果张家港市、丹阳市、泰兴市参加调查人群中1557例有结核病可疑症状，其中咳嗽、咯痰≥2周者所占比例最高，为62．4％（972／1557）；胸片异常1622例；确诊活动性肺结核患者165例，检出率（粗患病率）为141．3／10万（165／116796），其中初治134例（含涂阳78例），占81．2％，复治3l例（涂阳31例），占18．8％；男124例，女41例，男：女=3．02：1；65岁以上年龄组患病率（335．1／10万，61／18205）相对于其他年龄组患病率（15～岁组：43．6／10万，16／36685；40～岁组：143．0／10万，88／61532）更高（χ2=73．05，PdO．001）；153例（92．7％）患者有胸片异常；79例（47．9％）患者在筛查1周内就得到及时确诊并开始规范化治疗管理；治疗成功率达到93．9％（155／165）；经济学分析发现，本次胸部X线摄片全人群筛查平均发现1例活动性肺结核患者直接成本约为31000元。结论胸部X线摄片主动筛查对于结核病患者早期发现和规范治疗具有重要意义，是被动发现方式的有益补充和重要干预手段。

Objective To assess the TB prevalence in rural Jiangsu province, in order to provide scientific evidence for appropriate active screening strategies and intervention measures. Methods With stratified cluster random sampling method,50 out of 887 villages（communities） in Zhangjiagang, Danyang and Taixing cities were sampled. Questionnaire survey and physical examination were conducted for all investigated population, chest X-ray was applied to population ≥15 years old except pregnant women. Totally 157 168 population were investigated and 116 796 were conducted X-ray screening. EpiData 3.1 and Excel 2007 software was used to set up database and SPSS 17.0 for statistic analysis. Results In the investigated population, 1557 people suffered with TB suspicious symptoms, among them 62.4%（972/1557）had cough for more than 2 weeks, and 1622 had chest Xray abnormali- ty. A total of 165 active TB cases was detected with the crude prevalence rate（detection rate） of active PTB of 141.3/100 000（165/116 796）. Among them, 134 were initial treatment cases （including 78 cases of smear positive） accounting for 81.2%, 31 were retreatment cases（including 31 cases of smear positive） accounting for 18.8%, and 124 were male and 41 were female with the ratio of 3.02 to 1; the prevalence rate of age group ≥65 years （335.1/100 000,61/18 205）was significantly higher than other age groups（15-- ： 43.6/100 000,16/36 685; 40--： 143.0/100 000,88/61 532）（χ2 =73.05,P〈0. 001）; 153 cases（92.7%） had chest X-ray abnormality; 79（47.9%）cases got access to timely diagnosis and medical care without delay（within 1 week）; 155 （93.9%） cases got treatment success; the economic analysis found that the direct cost for detecting one active TB cases by chest X-ray screening is about 31 000 RMB on average. Conclusion Chest X-ray screening plays an important role in active tuberculosis early detection and treatment, is an important intervention and a useful complement to the passive discovery.