大学生群体肺结核患病的流行病学研究,以广西大学大学生为研究案例

Epidemiological Study of Pulmonary Tuberculosis among College Students,Case Study of Students in Guangxi University

大学是年轻人群体较为密集的场所,人员的流动性频繁(高),而结核病具有传染性强和病程长等特点,是高校传染病疫病的重要防控项目之一。为了深入了解高校校园的结核病流行特征,提供全面的、完整的疫情监控、预防和治疗策略和方案,我们以广西大学2013~2016年期间在校大学生为研究对象,通过对新生入学体检病例、毕业生毕业体检病例、校医院门诊诊疗病例、广西南宁市西乡塘疾控中心反馈追踪病例及结核病密切接触者的筛查病例进行了系统的分析。结果表明,2013~2016年在校大学生结核病发病率分别为32.27/10万、49.06/10万、61.15/10万、111.57/10万,4年累计的平均发病率63.51/10万,结核病发病率呈现逐年上升的趋势。使用SPSS Statistics 20.0软件进行统计学分析,计数数据差异分析采用卡方检验,年度间差异有统计学意义(x2=23.39,p<0.01);109例患者中男生多于女生,21~24岁患者占70.64%,平均年龄21.44岁,其中,通过体检筛查出的无症状病例占49.55%,因症就诊病例占50.45%,休学率为23.85%。在与55例患者的密切接触的1 717个大学生中,筛查出结核患者5例,筛出率292.21/10万。我们的研究初步发现高校大学生群体中具有较高的无症状结核病例发生,这部分患者是潜在的结核病传染源,推测这可能是引起广西大学校园大学生结核病发病率上升的主要原因。由此,我们认为主动筛查发现无症状结核病患者是控制高校结核病传染源和降低在校大学生结核发病率重要的方法和措施。

The universities are places where young age groups relatively concentrate, so they have a frequent （high） rate of human flow. The tuberculosis （TB） is characterized by the strong infectiousness and the long duration of the disease course, thus being one of the important projects of prevention and control of communicable diseases in colleges and universities. In order to have a thorough understanding of the campus TB epidemic characteristics and to provide comprehensive and complete strategies and plans monitoring, preventing and treating this disease, we took students in Guangxi University during 2013-2016 as the research object and systematically analyzed cases of freshmen entrance medical examination, graduating medical examination, university hospital outpatients, and feedback tracking cases from Xixiangtang Center for Disease Control in Nanning of Guangxi, and the screening cases who had close contact with TB patients. The results showed that the proportion of TB incidence was 32.27per 100 000 students in 2013, 49.06 per 100 000 students in 2014, 61.15 per 100 000 students in 2015, and 111.57 per 100 000 students in 2016. The average incidence rate of the four years was 63.51 per 100 000 students, therefore the rate of TB incidence showed a upward trend year by year. The statistical analysis in this study was conducted by using the SPSS Statistics 20.0 software, the differences of counting data were subjected to analysis by chi-square test, and the annual differences had statistical significance （x2=23.39, p〈0.01）; among 109 patients, boys were more than girls and 20-24 year-old patients accounted for 70.64% with the average age of 21.44. In addition, the asymptomatic cases, treatment cases and cases of the temporary absence from the university due to the TB accounted for 49.55%, 50.45%, and 23.85%, respectively. Five TB cases were screened out from 1 717 students closely contacted with 55 TB patients, which indicated the screening rate was 292.21 per 100 000 students. Our research preliminarily found that the higher rate of asymptomatic TB cases existed in universities and it was likely that those people were potential TB infection sources in campus who were also considered to be the major reason that led to the increase in the TB incidence of students in Guangxi University. Therefore, we believed that the active screening of asymptomatic TB patients was the important approach and measure to control TB infection sources and reduce TB incidence in colleges and universities.