2016-2020年河南省许昌市学校肺结核患者和密切接触者筛查分析

Analysis of tuberculosis cases and screening results of close contacts in schools in Xuchang of Henan,2016-2020

目的 分析2016-2020年许昌市学校肺结核患者和密切接触者筛查情况,为制定学校结核病防控策略提供科学依据。方法 以2016-2020年确诊的学校肺结核患者和密切接触者为研究对象,筛查方式包括:可疑症状、结核菌素(PPD)试验和(或)胸部X线检查(胸片),采用描述性分析方法,对筛查结果进行回顾性分析。结果 2016-2020年许昌市共发现学校肺结核患者427例,男女比为1.74∶1,其中,15~18岁组患者数最多,244例(57.14%);病原学阴性及无病原学结果肺结核患者332例(77.75%);发现方式以因症就诊发现为主,305例(71.43%);第二季度报告学校肺结核患者数最多,147例(34.39%)。共筛查密切接触者41 986人,PPD试验41 635人,PPD强阳性者2 567人(6.17%);胸片筛查9 484人,胸片异常59人(0.62%),通过进一步检查确诊新患者18例;2017年密切接触者PPD强阳性率(7.29%)和胸片异常率(0.99%)最高;病原学阳性患者密切接触者PPD强阳性率(6.85%)高于病原学阴性(包括无病原学结果)患者密切接触者PPD强阳性率(5.72%),差异有统计学意义(P<0.05)。结论 许昌市学校肺结核疫情较为严峻,发病群体以高中阶段和大学阶段学生群体为主。及时有效地开展密切接触者结核病筛查,早期发现潜伏感染者,避免学校结核病聚集性疫情的发生。

Objective To analyze tuberculosis cases and screening results of close contacts in schools in Xuchang from 2016 to 2020,and provide scientific basis for tuberculosis prevention and control in schools.Methods The tuberculosis cases definitely diagnosed in schools and close contacts of them from 2016 to 2020 were selected as the study subjects.The screening means included suspicious symptoms,tuberculin(PPD)tests and/or chest X-rays.Descriptive analysis was used to retrospectively analyze the screening results.Results From 2016 to 2020,a total of 427 tuberculosis cases were detected in schools in Xuchang.The ratio of male to female was 1.74:1.Of the total cases,244(57.14%)were 15-18 years old.The tuberculosis cases with negative or no etiological results accounted for the majority of 332 cases(77.75%).The main method of detection was based on seeking medical advice due to symptoms(305 cases,71.43%).The second quarter had the highest proportion of cases reported(34.39%,147/427).A total of 41986 close contacts were screened,and 41635 of them were screened by PPD test,among whom 2567(6.17%)were strongly positive for PPD.Of the close contacts,9484 were screened by chest X-ray,and 59(0.62%)were abnormal in chest X-ray.Through further test,18 new cases were diagnosed.In 2017,the strong positive rate of PPD(7.29%)and abnormal rate of chest radiograph(0.99%)were the highest in close contacts.The strong positive rate of PPD in close contacts of cases with positive etiology(6.85%)was higher than that in close contacts of patients with negative etiology(including no etiology results)(5.72%),there was significant difference in the incidence(P<0.05).Conclusions The epidemic of tuberculosis in schools of Xuchang is serious,and the main groups of the cases are high school and college students.The TB screening should be carried out in close contacts in a timely and effective manner to detect latent infection in early stage,so as to avoid the occurrence of TB cluster in schools.