上海市肺结核疫情控制主要影响因素分析

The major influencing factors of pulmonary tuberculosis on its control in Shanghai

目的 评估上海市肺结核疫情的流行情况及主要影响因素 ,并对有关防治对策进行探讨。方法 对 1997～ 2 0 0 1年本市居民和外来流动人口的新登记肺结核病例及其耐药情况进行分析。结果 近 5年上海市居民肺结核发病疫情处于小幅波动态势 ,递降率趋缓 ,并出现回升的趋势。本市外来流动人口结核病疫情呈逐年上升 ,活动性肺结核及细菌培养阳性肺结核年递增达 9.4%及 8.2 %。本市居民 65岁以上肺结核新登记率及细菌培养阳性新登记率高居各年龄组之首 ;低年龄组新登记率呈上升趋势 ;初始耐药率及获得性耐药率有逐年上升趋势。结论 上述情况是影响本市结核病疫情的主要因素 ,必须予以足够重视 ,争取政府及有关部门保证充足的资源投入。通过社区 (乡、镇 )医务人员 ,做好老年人群肺结核因症推荐及因症就诊发现肺结核的工作 ,实施全程督导化疗。对儿童、青少年结核感染者中结核菌素强阳性的对象 ,实施预防性化学治疗以减少发病。同时必须加强归口管理 ,落实督导化疗 ,以控制本市耐药及耐多药肺结核的发展势头。

Objective To evaluate the epidemiologic situation and major influencing factors of pulmonary TB in Shanghai, and discuss the control countermeasures of TB. Methods Statistical analysis was performed on the TB re gistration and drug resistance rates of residents and immigrant from 1997 to 2001. Results During the past five years, the prevalence of pulmonary TB in Shanghai was fluctuating in small amplitude, with trend of flare up. The prevalence of pulmonary TB among immigrant was increasing year by year, the annual increasing rates of active pulmonary TB and positive bacteria culture reached 9.4% and 8.2%, respectively. At present, the registration of new patients and positive bacteria culture among victims >65 years ranked first for all ages. And the new registration rate of pulmonary TB among lower ages were also increasing. The initial and acquired drug resistance rates increased annually. Conclusion The resurgence of TB in recent years, calls for great attention to its control. We should strive for sufficient support of resources from the government and the corresponding agencies. The finding of pulmonary TB patients among the elderly can be achieved through the medical network when they seek for medical advice as they have care symptoms. We can start practice therapy among teenagers and youngsters with strong positive tuberculosis test of infectious TB. At the same time, we must enhance convergence case management, implementing DOTS, so as to control the developing trend of drug resistance and MDRTB situation.