2010-2016年广州市越秀区学生肺结核流行特征与治疗管理

Analysis of the Characteristics of Tuberculosis Epidemic and Treatment Management of TB Cases in schools in Yuexiu District of Guangzhou from 2010 to 2016

目的深入了解本地区学生结核病流行疫情与患者治疗管理情况,为提高学校结核病控制水平提供决策依据与科学指导。方法对"中国疾病预防控制信息系统"之"结核病信息管理系统(新)"中报告的2010-2016年广州市越秀区学生肺结核患者资料进行整理,分析广州市越秀区学生肺结核报告发病率、抗酸菌涂片检查情况、年龄构成、学生类别构成以及治疗分类、治疗管理方式、治疗结局等情况。结果 (1)6年间广州市越秀区至少有268所大、中、小学报告肺结核病例,无聚集性疫情暴发,病例总数为442例,其中:2010-2016年报告发病率(1/10万)分别为4.71、7.00、4.78、4.43、6.38、5.66和4.80,男、女性别报告发病率则分别为6.38和4.39;抗酸菌涂片检查阳性病例195例(占44.12%)、阴性病例246例(占55.88%),初治病例435例(占98.42%)、复治病例7例(占1.58%);5岁~、10岁~、15岁~、20岁~和25岁~各年龄组患者的百分构成分别为0.23%、4.75%、56.11%、34.39%和4.52%;小学、初中、高中与大学学生患者的百分构成分别为1.81%、6.11%、50.00%和44.34%。(2)442例学生肺结核患者的治疗中,报告的治疗管理方式有强化期督导、全程督导、全程管理和自服药4种方式,其病例数分别为22、182、237和1例,百分构成分别为49.77%、41.18%、53.62%和0.23%,其治疗结局为:193例治愈,248例完成疗程,1例结果不明。结论广州市越秀区学生肺结核发病率高于全国水平且下降趋势不明显,学校结核病控制工作力度务必加强、控制策略水平亟待提高。

Objective To learn more about tuberculosis epidemics among students in Yuexiu District and their treatment management and to provide decision-making basis and scientific guidance for improving the control of tuberculosis in schools. Methods By ＂Tuberculosis information management system（ new version） ＂of ＂China information system for disease control and prevention＂,the information of students with pulmonary tuberculosis in Yuexiu district of Guangzhou from2010 to 2016 was gathered and sorted. Then these data were analyzed,which included the reported incidence of pulmonary tuberculosis,acid-fast bacterial smear examination status,age percent composition,student category percent composition,treatment classification,treatment management methods,treatment outcomes,and so on. Results（1） The total number of cases were 442 who came from at least 268 schools（ including primary school,junior secondary school,senior secondary schools and universities or colleges） and there were no aggregated outbreaks from 2010 to 2016. Calculated by the total population of the district,the reported incidence of TB student was 6. 38/100 000 in male while it was 4. 39/100 000 in female. And they were 4. 71/100 000,7. 00/100 000,4. 78/100 000,4. 43/100 000,6. 38/100 000,5. 66/100 000 and 4. 80/100 000 respectively in seven years. One hundred ninety five cases（ 44. 12%） were positive and the other were negative in acid-fast bacterial smear examination. All of 442 cases comprised 435 initial cases（ 98. 42%） and 7 retreated cases（ 1. 58%）. According to 5 ~,10 ~,15 ~,20 ~ and 25 ~ age groups,their percent compositions were 0. 23%,4. 75%,56. 11%,34. 39%,and 4. 52% respectively. All cases were composed of primary school students,junior secondary school students,senior secondary school students and university or college students,which counted for 1. 81%,6. 11%,50. 00%,and44. 34% respectively.（2） All of 442 cases were managed with anti-tuberculosis therapy in the four treatment management models as following： intensive period supervision,full course supervision,full course management and self-administration.The numbers of cases with the four treatment management were 22,182,237 and 1 respectively,which accounted for 49. 77%,41. 18%,53. 62% and 0. 23% respectively. By anti-tuberculosis therapy,193 cases were cured and 248 cases completed therapy course,but the treatment outcome of one case was unknown. Conclusion The incidence of pulmonary tuberculosis among students in Yuexiu District of Guangzhou is higher than the national level and does not decrease obviously. Thus it is imperative to strengthen efforts and improve the level of policy and strategy in school tuberculosis prevention and control.