2018年上海市松江区本市户籍≥65岁老年人口肺结核主动筛查及其效果分析

目的 分析上海市松江区本市户籍≥65岁老年人口肺结核主动筛查及其效果,为肺结核低流行地区老年结核病患者主动发现策略提供科学依据。方法 从上海市松江区2018年4月1日至8月31日15个社区卫生服务中心开展的针对≥65岁老年人健康管理服务项目的体格检查资料中,收集本市户籍≥65岁老年人主动筛查肺结核的情况。从《中国疾病预防控制信息系统》的子系统《结核病管理信息系统》(简称“《专报系统》”)中导出松江区2018年1月1日至2019年8月31日新登记的所有≥65岁本区户籍老年活动性肺结核患者的病案信息,与本年度主动筛查的数据进行比对,获取本年度及筛查后一年时间内的肺结核发病情况,通过筛查率和筛查检出率指标评价松江区老年肺结核主动筛查的效果。结果 2018年松江区≥65岁本市户籍人口共计129008名,参加老年人肺结核主动筛查的总筛查率为57.48%(74150/129008),其中70~74岁年龄组筛查率最高(65.51%,21446/32736),≥85岁年龄组筛查率最低(22.61%,3074/13596)。胸部X线摄影(简称“胸片”)检查率为98.31%(72899/74150),胸片异常者5050例(6.93%,5050/72899);其中确诊为新发肺结核患者3例(新检出率为4.12/10万,3/72899),在治既往肺结核患者3例,陈旧性肺结核患者524例(0.72%,524/72899),其他异常者4520例(6.20%,4520/72899;其他异常者包括肺部结节状病灶、肺部感染、胸膜增厚、斑片状阴影等)。2018年上海市松江区共登记本市户籍≥65岁老年肺结核患者57例,登记率为44.18/10万(57/129008),其中≥85岁年龄组登记率[73.55/10万(10/13596)]最高;被动发现率[41.86/10万(54/129008)]明显高于主动发现率(4.12/10万)(χ ²=24.00,P<0.001);接受过主动筛查者的发病率[21.58/10万(16/74150)]明显低于未接受过主动筛查者的发病率[74.74/10万(41/54858)](χ ²=20.16,P<0.001)。筛查后1年内32例主动筛查的老年人确诊为活动性肺结核(其中2018年登记13例,2019年登记19例)。结论 在低流行地区开展主动筛查老年人肺结核的检出率低,但对胸部异常筛查有临床意义,且可增加老年人结核病诊治意识,提前进行诊断和治疗,可结合老年人慢性病管理项目开展结核病重点筛查。

Analysis on the effect of active screening of tuberculosis among local people aged 65 or older in Songjiang District of Shanghai in 2018

Objective To analyze the effect of active screening of tuberculosis (TB) among local people aged 65 or older in Songjiang District of Shanghai, and provide scientific basis for active detection strategies for the elderly TB patients in a low epidemic area. Methods The current status of active screening of TB in local elderly aged 65 or older were collected from physical examination data of local elderly aged 65 or older via the health management platform between April 1st and August 31st 2018 performed in 15 community health service centers. The medical record information of all local elderly aged 65 or older with active TB who registered from January 1st 2018 to August 31st 2019 were collected from Tuberculosis Information Management System and Infectious Diseases Reporting Information Management System, and then compared with the data of active screening this year to acquire the morbidity of TB within one year after screening. Moreover, the effect of active screening for TB among elderly population was evaluated by screening rate and detection rate. Results A total of 129008 local elderly aged 65 or older were registered in 2018 in Songjiang District. The total screening rate for active screening of TB in the elderly was 57.48% (74150/129008), with the highest screening rate in the 70-74 age group (65.51% (21446/32736)), and the lowest screening rate in the ≥85 age group (22.61% (3074/13596)). The rate of conducting X-ray screening was 98.31% (72899/74150), of which 5050 had chest X-ray abnormalities (6.93%, 5050/72899), including 3 cases diagnosed as new TB with the new detection rate of 4.12/100000 (3/72899), 3 registered TB patients under treatment, 524 cases (0.72%, 524/72899) with old TB, and 4520 cases (6.20%, 4520/72899) diagnosed as other abnormalities, such as pulmonary nodule, pulmonary infection, pleural thickening, patchy shadow and so on. A total of 57 local TB elderly aged 65 or older were registered in Songjiang in 2018, with the registration rate of 44.18/100000 (57/129008), among which, the patients over 85 years old had the highest registration rate (73.55/100000 (10/13596)); the passive discovery rate was significantly higher than active detection rate (41.86/100000 (54/129008) vs. 4.12/100000, χ²=24.00, P<0.001); the morbidity of patients who received active screening (21.58/100000 (16/74150)) was significantly lower than that of unscreened patients (74.74/100000 (41/54858)) (χ²=20.16, P<0.001). And 32 elderly cases who received active screening were diagnosed with active TB within a year after screening (13 of them registered in 2018 and 19 registered in 2019). Conclusion The detection rate of active screening for TB in the elderly is low in low epidemic area, but it has clinical significance for screening chest abnormalities. In addition, it can improve the awareness of diagnosis and treatment of TB in elderly people, and they will more timely receive diagnosis and treatment. TB screening can be carried out in combination with the project of elderly chronic disease management.