健康检查与被动就诊在肺结核患者发现中的对比研究

目的对比健康检查主动发现和常规被动发现患者的情况，比较分析主动和被动发现患者在人口学、临床特征、实验室检查等方面的特征，分析主动发现对肺结核患者的意义，为我国肺结核患者发现策略的制定提供依据。方法收集“十二五”国家科技重大专项“结核病流行与干预模式研究”课题部分研究地区健康检查调查221383人（简称“主动发现方式”）和同期研究乡镇所在县（区）通过被动发现方式服务的7625650人中发现的活动性肺结核患者的资料。主动发现方式发现患者的数据来源于项目调查表格；被动发现方式发现患者的相关数据来源于结核病患者管理信息系统、门诊病历、初诊患者登记本。使用Excel软件建立数据库并采用双录入，利用SPSS17．0软件包进行统计和分析，用卡方检验比较两组患者各因素组间分布的差异，以P〈O．05为差异有统计学意义。结果主动发现方式共检出活动性肺结核患者444例，活动性肺结核检出率为200．56／10万。被动发现方式在县级结核病防治机构共登记活动性肺结核患者758例，登记率为9．94／10万。主动发现的444例活动性肺结核患者中，男：女=2．70：1；年龄分布≥60岁者358例，占80．63％。被动发现的758例肺结核患者中，男：女=1．86：1；年龄分布≥60岁者300例，占39．58％。性别和年龄分布上，主动发现组和被动发现组差异均有统计学意义（性别、年龄x2值分别为5．430和203．090，P值均〈0．05）。主动发现的患者中，痰涂片阳性率为7．43％（33／444），低于被动发现患者的痰涂片阳性率（39．31％，298／758）。主动发现的患者中，病变范围在1～2个肺野者251例，占56．53％；3～4个肺野者153例，占34．46％；5～6个肺野者40例，占9．01％。被动发现的患者中，病变范围在1～2个肺野者508例，占67．02％；3～4个肺野者171例，占22．56％；5～6个肺野者79例，占10．42％；两组相比肺部病灶范围差异有统计学意义（x2=19．517，P〈0．001）。主动发现的患者中，空洞率为6．53％（29／444），显著低于被动发现患者的空洞率（20．84％，158／758）（x2=43．661，P〈0．001）。结论主动发现的患者病情未必轻，但是患者症状不明显。主动发现对于结核病患者的早期诊断具有重要价值。

The comparative study of health check and passive identification in tuberculosis case detection

Objective This study is to compare the TB patients detected by active health check and passive identification, including their geographical and clinical features, laboratory testing and to analyze the significance of active discovery in TB case detection in order to provide a basis for policy formulation. Methods We collected the health check information of 221 383 people in part of ＂tuberculosis incidence and intervention pattern＂ study area （hereinafter referred to as ＂active discovery methods＂）and 7 625 650 people information among which TB cases were detected by passive identification （hereinafter referred to as ＂passive discovery methods＂）. The data of patients de- tected by active discovery were from the project survey; of passive discovery were from the TB patients management system, out-patient medical records, registration of newly diagnosed patients. Using Excel software for database setting up and double entry, packages SPSS 17.0 for statistical analysis. We compared two groups of patients using a Chi-square test, with P〈0. 05 as a statistically significant difference. Results A total of 444 cases of TB pa- tients were detected by active case discovery with the detection rate of 200.56 per 100 000. In contrast, 758 cases of TB patients were registered in TB institutions with the registration rates of 9.94 per 100 000. In 444 patients with active discovery, the male . female=2.70 ： 1; 358 cases elder than 60 years accounting for 80.63%. In 758 caseswith passive discovery, male., female=1. 86 ： 1; 300 cases elder than 60 years accounting for 39. 580/00. The gender and age distribution in active and passive discovery group are statistically different （x2= 5. 430 and 203. 090 for gen- der and age respectively, P both less than 0. 05）. For active discovery, 7.43 % （33/444） were sputum smear-positire, lower than passive discovery of 39.31% （298/758）. In active discovery patients, the lesions of 251 cases ranged in 1--2 lung fields, accounting for 56.53% ;153 cases of 3--4 lung fields accounting for 34.46% ;40 cases of 5--6 lung fields accounting for 9.01%. In passive discovery patients, the lesions of 508 cases ranged in one or two lung fields accounting for 67.02%;171 cases of 3--4 lung fields accounting for 22.56%;79 cases of 5--6 lung fields accounting for 10. 42% ; The difference is statistically significant in two groups （x2 = 19. 517, P〈0. 001）. 6.53% （29/444） of active discovered patients had lung cavities, significantly lower than 20.84% （158/758） of passive dis covered patients （x2=43. 661, P〈0. 001）. Conclusion The illness of the patients detected by active discovery may not be light, but symptoms not obvious. The active discovery has an important value for early diagnosis of pa- tients with tuberculosis.