中国结核病患者的发现与现代结核病控制策略扩展关系的预测分析

目的 分析影响发现结核病患者的因素,预测2005年中国结核病患者发现的进展情况。方法 描述1996～2003年新涂阳患者登记率和发现率的变化情况;分析新涂阳患者登记率与现代结核病控制策略(DOTS策略)覆盖率之间的相关关系,并建立回归方程,预测2004年和2005年的登记率。结果 1996～1998年全国新涂阳患者的登记率和发现率均呈上升趋势,随后4年处于平稳期,2003年则出现了较大幅度的上升,超过以往各年的最高登记率和发现率;1996～2003年期间新涂阳患者登记率与DOTS覆盖率的变化趋势呈正的直线相关关系(r=0.849,P=0.008),具有较高程度的关联。回归方程为:y=b_0 b_1X=1.754 0.217X,总体回归系数的95％CJ为0.082～0.352,F=15.43,P=0.008;其决定系数R~2=0.72。当2005年DOTS策略覆盖率达到100％时,全国新涂阳患者的登记率为23.5/10万,其95％CI为10.0～37.0;由此推算,全国新涂阳患者的发现率为51.8％,其95％CI为22.0～81.5(2005年患者发病率估算为45.4/10万)。结论 DOTS策略的扩展能够促进结核病患者的发现,但更为重要的是DOTS策略的实施质量对于结核病患者的发现起着至关重要的作用。

Analysis on the relationship between tuberculosis case detection and short-course coverage of directly observed treatment in China

OBJECTIVE: To analyze factors influencing tuberculosis (TB) case detection so as to predict the trend of case detection in the year of 2005. METHODS: Data was collected and analyzed regarding the correlation between the registration rate of newly identified smear-positive TB case and the directly observed treatment short-course (DOTS) coverage from 1996 to 2003. Based on the correlation analysis, regression equation was built to predict the case registration rate in 2005. RESULTS: Both case registration rate and case detection rate showed an increasing trend from 1996 to 1998 and kept a platform between 1999 and 2002, followed by a zooming change in 2003 to reach a 45% case detection rate while the smear-positive TB case registration rate and DOTS coverage showed highly correlative (r = 0.849, P = 0.008). The regression equation was: y = b(0) + b(1) X = 1.754 + 0.217X (95% CI of beta: 0.082 - 0.352), F = 15.43, P = 0.008; R(2) = 0.72. If the DOTS coverage rate reaches 100% in 2005, the national new smear-positive registration rate will have become 23.5/100 000 (95% CI: 10.0 - 37.0) and the national new smear-positive case detection rate will have reached 51.8% (95% CI: 22.0 - 81.5). CONCLUSION: Our research finding revealed that not only the expansion of DOTS could promote the rate of TB case detection but the quality of DOTS also played an important role in the TB control program. In order to reach the target of 70% case detection rate in 2005, programs as accelerating the DOTS expansion to increase the DOTS coverage and improving the quality of DOTS as well as other control measures need to be strengthened.