汶川地震后10年间绵阳极重与重灾区结核病患者发现情况分析

Analysis of tuberculosis patients detection situation in extremely severe or severe disaster areas of Mianyang city duringten years after Wenchuan earthquake

目的分析四川省绵阳市地震灾害发生后10年间极重与重灾区结核病患者发现情况的变化趋势。方法回顾性分析2008--2017年绵阳市9个县（市、区）结核病防治机构（简称“结防机构”）登记的肺结核患者的资料，以涪城区、游仙区、三台县、梓潼县、盐亭县5个重灾区为对照，分析平武县、北川县、安县、江油市4个极重灾区肺结核报告发病率与活动性患者来源构成情况及长期变化趋势。结果2008年绵阳市极重灾区登记报告肺结核发病率为83．10／10万（1380／166．07万），重灾区为86．47／10万（3122／361．05万），差异无统计学意义（X^2=1．52，P=0．223），2009-2016年极重灾区登记报告肺结核发病率分别为91．24／10万（1516／166．15万）、86．33／10万（1439／166．69万）、95．30／10万（1466／153．83万）、89．36／10万（1341／150．07万）、86．20／10万（1295／150．23万）、84．22／10万（1271／150．91万）、85．01／10万（1288／151．51万）、77．57／lO万（1202／154．95万），均高于重灾县的83．79／10万（3050／363．99万）、76．30／10万（2780／364．34万）、84．48／lO万（2724／322．45万）、74．99／10万（2494／322．58万）、80．50／10万（2514／312．29万）、76．14／lO万（2419／317．70万）、75．20／10万（2369／315．Ol万）、72．00／10万（2320／322．24万），差异均有统计学意义（X^2值分别为7．36、14．15、13．87、26．88、4．00、8．49、12．56、4．41，P值均〈0．05）；到2017年，极重灾区结核病报告发病率为77．45／10万（1210／156．22万），与重灾县（72．68／10万，2361／324．87万）趋于接近（X^2=3．25，P=0．073）。结论绵阳市结核病发病率较高，地震对结核病发现工作的影响长期存在；应该尽快恢复和发挥三级结核病防治网络作用，开展积极有效的筛查与结核病防治工作。

Objective To analyze the case-detection trend of tuberculosis （TB） patients in the extremely severe or severe disaster areas in Mianyang City, Sichuan Province in the past 10 years since the 2008 Sichuan Earthquake. Methods The related data and information of the TB patients, who were registered in the TB facili- ties in 9 counties or districts of Mianyang city （including 5 severe disaster areas： Fucheng, Youxian, Santai, Zitong and Yanting; and 4 extremely severe disaster areas： Pingwu, Beichuan, An County and Jiangyou） from 2008 to 2017, were collected and analyzed retrospectively. The following indicators were analyzed and compared by extremely severe disaster areas and severe disaster areas： the reported incidence of pulmonary TB, the source of active TB patients, and the long-term changing trend. Results In 2008, the reported incidence of pulmonary TB was 83.10/10 000 （1380/1 660 700） and 86.47/10 000 （3122/3 610 500） respectively in the extremely severe disaster areas and severe disaster areas. The difference of the incidence between the two areas was not statistically significant （X^2= 1.52, P=0. 223）. After earthquake, in the extremely severe disaster areas, the reported incidence of pulmo- nary TB was 91.24/10000 （1516/1 661 500）, 86.33/10 000 （1439/1 666 900）, 95.30/10 000 （1466/1 538 300）, 89.36/10 000 （1341/1 500 700）, 86.20/10 000 （1295/1 502 300）, 84. 22/10 000 （1271/1 509 100）, 85.01/10 000 （1288/1 515 100） and 77.57/10 000 （1202/1 549 500） respectively from 2009 to 2016; which were all significantly higher than those in the severe disaster areas： 83.79/10 000 （3050/3 639 900）, 76.30/10 000 （2780/3 643 400）,84.48/10 000 （2724/3 224 500）, 74.99/10 000 （2494/3 225 800）, 80.50/10 000 （2514/3 122 900）, 76.14/10 000 （2419/3 177 000）, 75.20/10 000 （2369/3 150100） and 72.00/10 000 （2320/3 222 400）; Z2 was 7.36, 14.15, 13.87, 26.88, 4.00, 8.49, 12.56 and 4.41 respectively, and P values were all〈0.05. In 2017, the reported inci- dence of pulmonary TB in the extremely severe disaster areas was 77.45/10 000 （1210/1 562 200）, which was close to that in the severe disaster areas （72.68/10 000, 2361/3 248 700）, and X^2=3.25, P=0. 073. Conclusion The incidence of TB in Mianyang city is high, and earthquake has a long-term impact on case-detection of TB. The role of the three-level network （county, township and village levels） on TB prevention and control should be restored and strengthened as soon as possible; the active and effective TB screening and prevention work should he carried out.