摘要
目的分析山西省临汾市2019—2020年“探索提高贫困地区肺结核发现”项目实施期间结核病分子生物学核酸检测技术应用情况,为优化临汾市结核病防控策略提供依据。方法利用《中国疾病预防控制信息系统》及其子系统《结核病管理信息系统》和“探索提高贫困地区肺结核发现”项目月报表相关数据,以2018年数据为基线,对2019—2020年临汾市及所属项目县(大宁县及永和县)肺结核患者和病原学阳性肺结核患者发现、药物敏感性筛查等情况进行分析。结果临汾市2018—2020年病原学阳性率分别为29.6%(442/1495)、36.4%(476/1307)和50.5%(652/1292),呈逐年上升趋势,差异有统计学意义(χ^(2)_(趋势)=152.410,P=0.000)。到2020年,17个县区中,除大宁县及永和县外[69.4%(25/36)、81.8%(18/22)和59.3%(16/27)、66.7%(8/12)],浮山、洪洞、安泽、翼城县的肺结核患者[分别为76.2%(32/42)、64.7%(174/269)、60.0%(9/15)、55.9%(38/68)]和病原学阳性肺结核患者[76.5%(13/17)、70.4%(81/115)、7/7、66.7%(24/36)]超过50%为市级(临汾市第三人民医院)诊断。2018—2020年临汾市药物敏感性筛查率分别为75.1%[229/(442-137)]、88.5%[339/(476-93)]和90.7%[489/(652-113)],呈逐年上升趋势,差异有统计学意义(χ^(2)_(趋势)=25.505,P=0.000)。2018—2020年大宁县及永和县病原学阳性率分别为31.2%(15/48)、25.0%(14/56)和54.0%(34/63),差异有统计学意义(χ^(2)=170.407,P=0.000)。2018—2020年,大宁县及永和县初诊患者在市级诊断的比例分别为38.4%(106/276)、43.4%(75/173)和56.3%(98/174),呈逐年上升趋势(χ^(2)_(趋势)=36.564,P=0.000)。结论临汾市第三人民医院为临汾市提供了全方位的结核病分子生物学检测服务。应继续优化或完善诊疗流程,达到普通肺结核患者诊疗不出县的分级诊疗要求,同时发挥市级诊断作为区域性结核病分子生物学诊断实验室的作用。
Objective To analyze the application of nucleic acid detection technology for tuberculosis(TB)molecular biology in the project of“Explore and improve the level of tuberculosis detection in poor areas”implemented in Linfen,Shanxi from 2019 to 2020,to provide evidence for optimizing the strategy of TB prevention and control in Linfen.Methods Data of China’s Disease Prevention and Control Information System and its subsystem TB Management Information System,and the monthly report of the“Explore and improve the level of tuberculosis detection in poor areas”project were collected.Data of 2018 were selected as baseline,active pulmonary TB patients,detection of TB patients and drug sensitivity screening in Linfen from 2019 to 2020 were analyzed.Results The positive rates of etiology in Linfen increased year by year and were 29.6%(442/1495),36.4%(476/1307)and 50.5%(652/1292),respectively,from 2018 to 2020,the difference was statistically significant(χ^(2)_(trend)=152.410,P=0.000).By 2020,in 17 counties and districts,50%of the active pulmonary TB patients and pulmonary TB patients with positive etiology in Fushan,Hongdong,Anze and Yicheng counties(76.2%(32/42),64.7%(174/269),60.0%(9/15),55.9%(38/68),respectively;and 76.5%(13/17),70.4%(81/115),7/7,66.7%(24/36),respectively)were diagnosed by municipal hospital(Linfen Third People’s Hospital),while the rates in Daning and Yonghe were not(69.4%(25/36),81.8%(18/22)and 59.3%(16/27),66.7%(8/12)).From 2018 to 2020,the drug sensitivity screening rates in Linfen were yearly increased(75.1%(229/(442-137),88.5%(339/(476-93)and 90.7%(489/(652-113),respectively),the difference was statistically significant(χ^(2)_(trend)=25.505,P=0.000).From 2018 to 2020,the positive rates of etiology in Daning and Yonghe were 31.2%(15/48),25.0%(14/56)and 54.0%(34/63),respectively,with significant difference(χ^(2)=170.407,P=0.000);the proportion of newly diagnosed patients in Daning and Yonghe by municipal hospital increased from 38.4%(106/276)to 43.4%(75/173)and 56.3%(98/174)(χ^(2)_(trend)=36.564,P=0.000).Conclusion Linfen Third People’s Hospital provides Linfen a full range of TB molecular biological test.The diagnosis and treatment process should continue optimized to achieve the goal of graded diagnosis and treatment of common TB patients in the county,and the municipal diagnosis could work as a regional molecular biological diagnostic laboratory for TB.
作者
范月玲
王春蒲
高建伟
邓俊平
宋宏
冯苗
商亚丽
李清桃
张重辉
张彦萍
李仁忠
FAN Yue-ling;WANG Chun-pu;GAO Jian-wei;DENG Jun-ping;SONG Hong;FENG Miao;SHANG Ya-li;LI Qing-tao;ZHANG Chong-hui;ZHANG Yan-ping;LI Ren-zhong(Shanxi Center for Disease Control and Prevention,Taiyuan 030012,China)
出处
《中国防痨杂志》
CAS
CSCD
2021年第12期1280-1286,共7页
Chinese Journal of Antituberculosis
基金
探索提高贫困地区肺结核发现(0525)。
关键词
结核
分子生物学
核酸探针
小地区分析
Tuberculosis
Molecular biology
Nucleic acid probes
Small-area analysis