山西省长治市农村实施结核病控制策略效果评估

Evaluation of the effect of strategy for controlling tuberculosis in rural areas of Changzhi, Shanxi Province.

目的 为了尽快降低农村结核病疫情，我们在长治市５个县实施了“加强与促进结核病控制”策略。方法突出政府干预行为；健全以县为中心、乡（村）为基础的结核病管理网络；应用现代结核病控制技术对病人实行Ｄｉｒｅｃｔｌｙ ｏｂｓｅｒｕｅｄ ｔｒｅａｔｍｅｎｔ，ｓｈｏｒｔ－ｃｏｕｒｓｅ（ＤＯＴＳ）为主的管理模式。结果 从１９９４年９月～１９９９年８月，新发现涂阳肺结核病人７２６例，涂阳发现率为 ６８．４７／１０万（初治５４２人，占７４、７％；复治１８４人，占 ２５．３％。经过２个月强化治疗，痰菌总阴转率９７．６％。其中，初治病人９９．８％，复治病人９２．２％，５年队列分析表明，总治愈率９８．５％，结核病死亡率０．１８／１０，迁出１例，其他６例，各占０．３％和 ０．９％。结论 实施现代结核病控制策略，不仅有技地提高了排菌病人的发现率和治愈率，从根本上阻止了结核菌的传播，而且病死率也明显降低（降低９３．２％），挽救了一大批结核病患者的生命，极大地减轻了在民精神和经济负担，对加快我国农村结核病控制工作的进程将产生巨大作用。

Objective To reduce the incidence of tuberculosis in rural areas as quickly as possible, the strategy of intensifying and promoting the control of tuberculosis was carried out in 5 cities of Changzhi City. Methods The tuberculosis management network based on the townships and villages and centred with counties was soundly set up, while stressing the activities of governmental intervention. The practice of directly observed treatment, short - course (dots) combined with modem techniques were taekn as the main managerial model for treatment of buberculosis patients. Results During 1994 1999,726 newly smear positve tuberculosis patients were detected with a smear positive detection rate of 68. 471100 000 (542 patients were initially treated accounting for 74.7 and 184 patients were re - treated accounting for 25.3%) . The total sputum mycobacteriumnegative conversion rate was 97.6% two months after intensified treatment (99.8% in the initially treated group and 92.2% in the re - treated group) . The results of five - year cohort investigation showed that the total cure rate was 98. 5% and case fatality was 0. 18/100 000. Conclusion the imlementation of scientific strategy for tuberculosis control could not only increase the detection and cure rates of sputum positive cases but also could fundamentally interrupt the transmission of tuberculosis and significantly reduce the case fatality by 98. 2% in addition to that the peasants' mental and economic conditions were much and great impact on the process in the control of tujberculosis in rural areas would be envisaged.