上海口岸2014—2015年入境人员肺结核筛查情况

Screening of pulmonary tuberculosis in entry applicants in Shanghai port during 2014-2015

为了解上海口岸入境人员肺结核的筛查情况及后续处理,防止结核病通过口岸跨境传播,本研究于2014年1月—2015年12月对所有在上海口岸办理入境体检的14岁以上人员进行结核病筛查,通过病史、体格检查和胸部X线摄影筛查疑似肺结核患者;对疑似肺结核患者进行痰细菌学检测、T-SPOT.TB和Xpert MTB/RIF检测。结果显示,2014—2015年上海口岸入境人员共检出疑似肺结核患者215例,总检出率为229.76/10万;确诊肺结核患者33例,总检出率为35.27/10万,确诊率为15.3%。对210例疑似肺结核患者进行痰细菌学检测,结果显示结核分枝杆菌培阳率为14.3%,非结核分枝杆菌培阳率为17.1%。有95例和78例疑似肺结核患者分别接受T-SPOT.TB和Xpert MTB/RIF检测,以痰细菌学检测为"金标准",TSPOT.TB的灵敏度为100%,特异度为49.4%;Xpert MTB/RIF的灵敏度为87.5%,特异度为96.8%。33例确诊肺结核患者中,25例(75.8%)离境,15例(45.5%)在离境前接受抗结核治疗,8例(24.2%)失访。本研究显示,上海口岸入境人员中肺结核确诊率仍有待提高。筛查与诊断中,T-SPOT.TB具备较高灵敏度,Xpert MTB/RIF具备较高特异度,两种方法均有较高应用价值,两者联用可提高检出率,缩短检出时间。对确诊病例或未确诊的可疑病例应加强后续监管。

In order to prevent the cross-border transmission of tuberculosis（TB）,tuberculosis screening was performed on each entry applicant older than 14 years in Shanghai port during 2014-2015.Suspected tuberculosis patients were selected by history enquiry,physical examination and chest X-ray scanning.Thereafter,sputum smear and culture,T-SPOT.TB assay and Xpert MTB/RIF test were applied in the suspected tuberculosis patients.In total,215 persons were suspected of tuberculosis in Shanghai port during2014-2015,with the detection rate of 229.76/100 000.Among them,33 were confirmed as pulmonary tuberculosis,with confirmation rate of 15.3%.In all suspected patients,95（44.2%）and 78（36.3%）cases were subjected to T-SPOT.TB assay and Xpert MTB/RIF test respectively.The sensitivity and specificity of T-SPOT.TB assay were 100% and 49.4%compared with sputum culture results as the standard of diagnosis.The sensitivity and specificity of Xpert MTB/RIF test were 87.5% and 96.8% comparatively.Among 33 confirmed tuberculosis patients,25（75.8%）left Shanghai,15（45.5%）accepted anti-tuberculosis treatment for 2 weeks before leaving,and 8（24.2%）cases were lost.The results suggest that the confirmation rate of tuberculosis in Shanghai port is relatively low in suspected cases.T-SPOT.TB assay with higher sensitivity and Xpert MTB/RIF test with higher specificity can be complementary and performed simultaneously in suspected cases to improve the detection rate of tuberculosis.All the confirmed and suspected tuberculosis cases should be managed and followed up in the future during the applicant＇s stay in China.