上海市社区人群肺结核患者发现效果评价研究

Evaluation of tuberculosis detection among general population in Shanghai

目的 评价上海市社区人群中肺结核患者发现情况,为上海市肺结核患者发现政策的制定提供科学依据.方法 通过“结核病信息管理系统”和“传染病报告信息管理系统”获取2015年上海市登记报告的6850例肺结核患者的信息;于2014-2015年通过多阶段整群随机抽样的方法在上海市徐汇、闵行、长宁和松江区抽取352 904名居民进行横断面调查,获取肺结核患病率;进而通过登记率和患病率计算患者诊断率,以此评价上海市肺结核患者发现情况.结果 2015年上海市共登记活动性肺结核患者6850例,活动性肺结核登记率为28.2/10万（6850/24 256 797）;本市户籍居民登记率为26.9/10万（3843/14 292 597）,流动人口登记率为30.2/10万（3007/9 964 200）;涂阳肺结核登记率为10.0/10万（2426/24 256 797）,菌阳肺结核登记率为13.4/10万（3260/24 256 797）.患病率抽样调查共调查居民317 218名,发现活动性肺结核患者107例,经标化后,活动性肺结核患病率为52.3/10万（95％CI：44.7/10万～60.9/10万）;本市户籍居民肺结核患病率为34.8/10万（95％CI：27.8/10万～43.0/10万）,明显低于流动人口肺结核患病率（84.4/10万;95％CI：64.2/10万～108.8/10万）,差异有统计学意义（Fisher精确概率法,P＜0.001）;涂阳肺结核患病率为15.5/10万（95％CI：11.4/10万～20.4/10万）,菌阳肺结核患病率为17.7/10万（95％CI：13.3/10万～22.9/10万）.通过结核病登记数据和患病数据计算患者诊断率,得出2015年上海市肺结核患者诊断率为0.60/人年（95％CI：0.51/人年～0.69/人年）;菌阳肺结核患者诊断率为0.83/人年（95％CI：0.65/人年～1.15/人年）,明显高于菌阴肺结核患者诊断率（0.46/人年,95％ CI：0.38/人年～0.55/人年）,差异有统计学意义（Fisher精确概率法,P=0.001）;上海市户籍人口活动性肺结核患者诊断率为0.83/人年（95％CI：0.67/人年～1.04/人年）,明显高于流动人口活动性肺结核患者诊断率（0.39/人年,95％CI：0.30/人年～0.52/人年）,差异有统计学意义（Fisher精确概率法,P＜0.001）.患病率调查发现的107例活动性肺结核患者中无可疑症状者比率较高,占89.7％（96/107）,其中新发现的22例患者中无可疑症状者比率为81.8％（18/22）.结论 上海市菌阳肺结核患者发现水平较高,但活动性肺结核患者总体发现水平仍相对较低,社区人群肺结核患者中无症状比率高及流动人口发现水平低是主要原因.

Objective To evaluate detection of tuberculosis among general population in Shanghai,providing basis for the strategy of pulmonary tuberculosis detection.Methods The information of 6850 pulmonary tuberculosis patients reported in 2015 was derived from Tuberculosis Information Management System and Infectious Diseases Reporting Information Management System by Shanghai Municipal Center for Disease Control and Prevention.The prevalence of pulmonary tuberculosis was derived from a cross-sectional study on 352 904 residents during 2014-2015,from Xuhui,Minhang,Changning and Songjiang District,in which multi-stage stratified cluster random sampling method was used.Patient diagnostic rate was calculated as indicator of tuberculosis detection,which can be measured as the number of newly reported case of tuberculosis per 100 000 populations per year （notification rate）divided by the prevalence of new cases of tuberculosis per 100 000 populations.Results A total of 6850 tuberculosis case were notified in 2015,Shanghai.The notification rate of active tuberculosis was 28.2/100 000 （6850/24 256 797）.The notification rate in local residents was 26.9/100 000 （3843/14 292 597）,lower than that in migrants （30.2/100 000,3007/9 964 200）.The notification rate of sputum smear positive case and bacterial positive case were 10.0100 000 （2426/24 256 797） and 13.4/100 000 （3260/24 256 797）,respectively.The prevalence of tuberculosis was 52.3/100 000 （95% CI：（44.7-60.9）/100 000）.The prevalence was 34.8/100 000 （95% CI：（27.843.0）/100 000） in local residents,which was significantly lower than in migrants （84.4/100 000;95%CI：（64.2-108.8）/100 000;P〈0.001）.The prevalence of smear positive tuberculosis case was 15.5/100 000 （95%CI：（11.4-20.4） /100 000）.The prevalence of bacterial positive tuberculosis case was 17.7/100 000 （95 %CI：（13.3-22.9）/100 000）.The patient diagnostic rate was calculated through the notification rate and the prevalence.The active pulmonary tuberculosis patient diagnostic rate （PDR） was 0.60/person year （95%CI：（0.51-0.69） person year）.The PDR was 0.83/person year （95%CI：（0.65-1.15）/person year） for sputum positive tuberculosis,which was significantly higher than 0.46/person year （95%CI：（0.38 0.55）/person year） for sputum negative tuberculosis,P=0.001.The PDR was 0.83/person year （95%CI：（0.67-1.04）/person year） in local resident,which was significantly higher than 0.39/person year （95 % CI：（0.30-0.52）/person year） in migrants （P〈0.001）;89.7% （96/107） of tuberculosis cases found in the prevalence survey had no tuberculosis symptoms;81.8% （18/22） of newly diagnosed tuberculosis cases had no tuberculosis symptoms.Conclusion The case detection level of infectious tuberculosis was high,while the case detection level of active tuberculosis was relatively lower mainly because of the high proportion of none-symptom case among community population and low PDR in migrants.