2013-2017年静安区肺结核患者密切接触者筛查情况分析

Screening situation analysis on close contacts of pulmonary tuberculosis patients from 2013 to 2017,in Jing'an District,Shanghai

【目的】分析2013-2017年静安区肺结核患者密切接触者的筛查情况,为今后开展密切接触者筛查工作提供经验及理论依据。【方法】采用回顾性分析方法,将登记日期在2013年1月1日-2017年12月30日的患者及密切接触者筛查情况从“静安区结核病信息管理平台”中导出,分析研究对象的筛查基本情况、与指示患者不同关系的密切接触者筛查情况、有/无疑似结核症状密切接触者的检出情况、不同类型指示患者的密切接触者检出情况及指示患者传染时间与密切接触者确诊情况等。【结果】2013-2017年该区密切接触者总体筛查率为89.07%(1051/1180),检出活动性肺结核15例,检出率为1.427%(15/1051);2013-2017年密切接触者疑似结核症状筛查率分别为87.08%(155/178)、73.66%(165/224)、82.97%(190/229)、89.14%(156/175)及93.85%(351/374),其胸片检查率及痰涂片检查率分别从28.65%(51/178)下降到16.84%(63/374),从12.36%(22/178)下降到3.209%(12/374);“兄弟姐妹”关系的密切接触者检出率最高,为4.651%;有症状者、无症状者及未进行症状筛查者检出率分别为15.38%(8/52)、0.622%(6/965)及2.941%(1/34);未查痰指示患者的密接检出率最高,为3.448%(2/58);根据指示患者传播时间小于15 d、15~30 d及大于30 d划分,其密接检出率分别为1.911%、1.351%、1.090%,但差别无统计学意义(χ^(2)=0.834,P=0.659)。【结论】应对有疑似结核症状、“兄弟姐妹”关系的密切接触者等重点筛查人群进行除症状筛查外的进一步检查,以便提高检出率。社区随访管理医生要做好宣传教育工作,提高密切接触者的筛查意识,保证筛查效果。

[Objective]To make analysis on screening situation of close contacts of pulmonary tuberculosis(PTB)patients from 2013 to 2017,so as to provide experience and evidence for improving the work on close contacts of PTB patients.[Methods]The data from TB case detection results through investigating close contacts of PTB patients from Jan 2013 to Jan 2017 were retrospectively exported from Jing’an District TB information and management platform,and retrospective analysis was performed through analyzing the data to understand the basic characteristics of the subjects,screening results of the subjects for different relationships between patients and contacts,the differences of the screening results between the contacts with or without suspected tuberculosis symptoms and between close contacts of different types of PTB patients,the relationship between patients’ transmission time and screening results of the subjects.[Results]The total screening rate of the contacts were 89.07%(1 051/1 180);fifteen patients were detected to be with active tuberculosis,the positive rate being 1.427%(15/1051). From 2013 to 2017 in Jing’an District,the screening rates for suspected TB symptoms of close contacts were 87.08%(155/178),73.66%(165/224),82.97%(190/229),89.14%(156/175)and 93.85%(351/374),respectively. The chest radiography examination rates and sputum smear examination rates were down from 28.65%(51/178)to 16.84%(63/374),and from 12.36%(22/178)to 3.209%(12/374),respectively. The positive rate of siblings relationship contacts was the highest(4.651%);The positive rates of symptomatic,asymptomatic and no symptom screening contacts were 15.38%(8/52),0.622%(6/965)and 2.941%(1/34);The subjects that contacted but with no sputum test had the highest positive rate(3.448%,2/58);The screening results of the subjects were 1.911%,1.351% and 1.090% according to the patients’ transmission time(less than 15 days,15 to 30 days and more than 30 days),but the differences were not statistically significant(χ^(2)=0.834,P=0.659).[Conclusion]Close contacts with suspected TB symptoms,or relationship of siblings should have chest radiographs or sputum smears tests,so as to improve the detection rate. Community management doctors should do a good job in publicizing education to improve the screening awareness of close contacts,and ensure the screening effect.