2013-2019年河南省某县结核病4次抽样调查结果

The results of four tuberculosis sampling surveys in a county of Henan province from 2013-2019

目的 了解河南省尉氏县居民结核病疫情特征及变化趋势,探讨降低结核病患病率和发病率,提高结核病患者发现率,及有效控制结核病疫情的措施。方法 选择河南省尉氏县有地区代表性的社区作为调查现场,在2013-2015年及2019年每年开展1次抽样调查,每次抽样人口不少于3.5万人,对其中结核病发病重点人群(可疑症状者、结核患者密切接触者、既往结核患者、糖尿病患者、HIV感染者及65岁以上老年人)进行体检,发现结核病患者,分析结核病疫情特征和变化趋势。结果 4次调查共做问卷和访谈120 419人次,4次应检人口接受调查和健康教育的比例均>90%。2013年、2014年、2015年和2019年活动性肺结核患病率分别为216.8/10万、142.6/10万、89.4/10万和51.3/10万,发病率分别为166.8/10万、109.4/10万、61.9/10万和28.9/10万;涂阳患病率分别为23.4/10万、16.6/10万、13.7/10万和6.4/10万,菌阳患病率分别为40.0/10万、29.8/10万、24.1/10万和19.2/.10万。肺结核患者中,无症状者占44.7%,无症状者中老年患者比例82.1%;按患者来源分类:可疑症状者中检出率为7.8%,65岁以上老年人中检出率为1.3%,其他人群检出率为0.7%,不同人群患者检出率差异有统计学意义(P<0.05)。结论 通过对社区人口的健康教育和对结核病发病重点人群的主动干预,肺结核患病率及发病率呈明显下降趋势;65岁以上老年人是结核病发病的高危人群;建立对结核病重点人群的主动干预模式是提高结核病患者发现率、降低结核病疫情的重要措施。

Objective To analyze the prevalence and change trend of tuberculosis in Weishi county,explore measures to reduce the prevalence and incidence rate of tuberculosis,improve the detection rate of tuberculosis patients,and effectively control the tuberculosis epidemic situation.Methods A representative community was selected as the survey site,with a sample size of no less than 35 000 people every year.Physical examination on the tuberculosis was carried out in the key populations(people with suspected symptoms,close contacts of tuberculosis patients,previous tuberculosis patients,diabetes patients,people infected with HIV and the elderly over 65 years old) to detect tuberculosis patients.The epidemic characteristics and changes of tuberculosis were analyzed.Results More than 90% of the sampling residents received survey and health education every year.A total of120 419 questionnaires and interviews were conducted during the four years.In 2013/2014/2015/2019,the prevalence rates of active pulmonary tuberculosis were 216.8/105,142.6/105,89.4/105and 51.3/105,respectively,and the incidence rate were 166.8/105,109.4/105,61.9/105and 28.9/105,respectively.In 2013/2014/2015/2019,the prevalence rates of smear positive were 23.4/105,16.6/105,13.7/105and 6.4/105,respectively,and the prevalence rates of bacterial positive were 40.0/105,29.8/105,24.1/105and19.2/105,respectively.Among the patients with pulmonary tuberculosis,44.7% were asymptomatic,and the elderly patients accounted for 82.1% of the total asymptomatic patients.According to the source of patients,the detection rate of tuberculosis patients was 7.8% in people with suspected symptoms,1.3% in the elderly,and 0.7% in other populations.There were significant differences in the detection rates among different populations.Conclusion The prevalence and incidence rate of tuberculosis significantly decrease through health education for the community population and active intervention in the key population of tuberculosis;the elderly over 65 years old are high-risk groups of tuberculosis.Establishing an active intervention model for the key tuberculosis groups is an important measure to improve the detection rate of tuberculosis patients and reduce the tuberculosis epidemic.