对肺结核可疑者采用症状查痰法提高患者发现率

目的探讨更全面的发现肺结核病例的检查诊断程序。方法在采用通用的胸透筛查法发现肺结核患者的基础上，采用症状查痰法，对有症状且≥3周者，直接做痰结核分枝杆菌检查，并拍摄X线胸片，对按胸透筛查法和症状查痰法发现的患者进行比较；对肺结核诊断程序改进后的结核病患者的发现情况进行分析。结果采用症状查痰法发现活动性肺结核新病例900例，比胸透筛查法多发现活动性肺结核患者73例，患者发现率提高8．8％(73／827)；发现涂阳肺结核病例262例，比胸透筛查法多发现活动性肺结核患者30例，患者发现率提高12．9％(30／232)；培养阳性肺结核病例360例，比胸透筛查法多发现患者63例，患者发现率提高21．2％(63／297)。症状查痰法发现新病例的细菌学检查阳性者的比例高于胸透筛查法，胸透筛查法发现新病例中，涂片阳性者占28．1％(232／827)，痰菌培养阳性者占35．9％(297／827)；而症状查痰法发现新病例中，涂片阳性者占29．1％(262／900)，痰菌培养阳性者占40．0％(360／900)。症状查痰法多检出的活动性肺结核患者73例中，涂阳和菌阳患者的比例均很高，分别为41．1％(30／73)和86．3％(63／73)，较胸透筛查法的检出涂阳比例(28．1％)和菌阳比例(35．9％)高。结论采用症状查痰法比胸透筛查法发现的活动性肺结核患者增加，特别是菌阳肺结核患者的发现率增加21．2％，使这些患者得到及时诊断，有利于结核病传染源的控制。

Improved case finding by using sputum examination in pulmonary tuberculosis suspects with clinical symptoms

Objective To investigate more effective methods in case finding of tuberculosis (TB). Methods Sputum examination for TB suspects was applied on the basis of traditional chest X-ray screening. TB suspects with cough more than 3 weeks were subjected to a sputum examination firstly. The case finding rate of X-ray screening alone and in combination with sputum examination for TB suspects were compared. Results Nine hundred new cases of active pulmonary TB were detected by application of sputum examination to TB suspects, among which 73 more cases were found than X-ray screening alone, and the case detection rate increased 8.8% (73/827). Among the 900 new cases, 30 more cases were found than that of X-ray screening alone in 262 smear positive cases, and the case detection rate increased 12.9%. Three hundred sixty cases were culture positive, among which 63 more cases were found than X-ray screening alone, the case detection rate increased 21.2% (63/297). Among the cases detected by X-ray screening alone, the smear positive rate was 28.1% (232/827), and the culture positive rate was 35.9% (297/827). However, among the cases detected by sputum examination, 29.1% (262/900) was smear positive, and 40.0% (360/900) was culture positive. Among the 73 more cases of active pulmonary TB found by using sputum examination in TB suspects, both the smear positive and the culture positive rates were higher, 41.1%(30/70) and 86.3% (63/73) respectively, as compared to those of cases found by X-ray screening (28.1% and 35.9% respectively). Conclusion Sputum examination in individuals with symptoms suggestive of pulmonary TB could find out more cases with active disease(21.2%) than chest X-ray screening alone.