江西省经济欠发达地区发挥地市级结核病定点医院作用提升肺结核发现水平的研究

Study on the role of the prefectural tuberculosis designated hospital to improve the case finding of pulmonary tuberculosis in economic undeveloped areas of Jiangxi Province

目的:探讨通过发挥地市级结核病定点医院的作用,以提高肺结核和利福平耐药肺结核患者的发现水平。方法:分别从“中国疾病预防控制信息系统”子系统“结核病管理信息系统”和地市级结核病定点医院--赣州市第五人民医院(以下简称“赣州五院”)收集“探索提高贫困地区肺结核发现”项目实施前(2017-2018年)和实施后(2019-2020年)江西省赣州市登记的活动性肺结核患者(不含单纯结核性胸膜炎患者)和就诊的本市疑似肺结核患者(不含单纯结核性胸膜炎患者)的结核病诊断和耐药检测信息,分析并比较地市级定点医院在项目实施前后肺结核患者和利福平耐药肺结核患者发现的差异。结果:赣州五院2017-2020年共发现9279例疑似肺结核患者,最终确诊活动性肺结核患者7619例,其中利福平耐药肺结核患者385例;疑似肺结核患者GeneXpert MTB/RIF检测率和病原学阳性率分别从项目实施前的7.71%(361/4682)和36.39%(1383/3801)提高到实施后的66.70%(3066/4597)和52.46%(2003/3818),差异均有统计学意义(χ^(2)=3464.784,P<0.001;χ^(2)=199.388,P<0.001)。项目实施后,赣州五院发现的病原学阳性患者和利福平耐药患者占全市的比例分别达到33.97%(2003/5897)和81.31%(248/305),此两类患者中34.55%(692/2003)和28.63%(71/248)为涂阴患者经GeneXpert MTB/RIF检测后被发现。结论:地市级定点医院如能采用适宜的结核病诊断技术和患者发现策略,对所有就诊的疑似肺结核患者不分区域进行免费筛查,并实现患者诊断信息与县区级定点医院的互联互通,可以提高肺结核和利福平耐药肺结核发现水平。

Objective:To explore the role of prefectural tuberculosis designated hospital to improve the case finding of pulmonary tuberculosis(PTB)and rifampicin-resistant pulmonary tuberculosis(RR-PTB).Methods:The information on tuberculosis diagnosis and drug resistance testing of active PTB patients(excluding patients with simple tuberculous pleurisy)in Ganzhou were derived from the Tuberculosis Management Information System,a subsystem of China Disease Control and Prevention Information System before(2017-2018)and after(2019-2020)the implementation of the project“Study on improving the case finding of pulmonary tuberculosis in poor areas”.While,the diagnosis and drug resistance test information of suspected PTB cases in the Fifth People’s Hospital of Ganzhou(Ganzhou Fifth Hospital)were derived from the Hospital Information System.The differences of detection in PTB and RR-PTB cases were analyzed and compared before and after the implementation of the project.Results:From 2017 to 2020,a total of 9279 suspected PTB cases were treated in Ganzhou Fifth Hospitals,and 7619 cases of PTB patients were diagnosed,including 385 RR-PTB cases.The proportion of GeneXpert MTB/RIF testing and the rate of bacteriologically confirmed PTB in patients with suspected PTB increased from 7.71%(361/4682)and 36.39%(1383/3801)before the project to 66.70%(3066/4597)and 52.46%(2003/3818)after implementation,respectively,with statistically significant differences(χ^(2)=3464.784,P<0.001;χ^(2)=199.388,P<0.001).After the implementation of the project,the proportion of bacteriologically confirmed PTB and RR-PTB cases detected in Ganzhou Fifth Hospitals reached 33.97%(2003/5897)and 81.31%(248/305)of the whole prefecture,respectively.Among them,34.55%(692/2003)of bacteriologically confirmed PTB and 28.63%(71/248)of RR-PTB were smear-negative cases detected by GeneXpert MTB/RIF test.Conclusion:The case finding of PTB and RR-PTB in the whole city can be improved if the prefectural designated hospitals could adopt appropriate tuberculosis diagnosis techniques and the strategy of case finding,provide free screening for all suspected tuberculosis cases regardless of region,and interconnect tuberculosis diagnostic information with the medical and health institution in county.