贵州省肺结核严重流行地区病例诊断与管理调查

摘要:目的　对贵州省肺结核流行最严重地区的肺结核病例进行复核诊断，了解其诊断的准确性，调查分析肺结核报告发病率较高的原因，为采取针对性的有效防控措施提供依据。方法　由综合调查专家组核实县级3家医疗卫生机构肺结核报告情况，对阴性痰涂片，肺结核患者的X线胸片进行复查，结合病案资料判断诊断的准确性，随机入村现场调查肺结核防治管理。结果　医院报告肺结核病例784例，漏报9例，漏报率为1.13%。结防机构排除重复报告170例、网络专报系统无重复报告病例。复核肺结核病例诊断370例，符合率为83.24％，结防机构诊断符合率高于医院，差异有统计学意义（χ2＝9.096，P＜0.05）。复核阴性痰涂片80张，符合率100％。中断治疗的肺结核病例追踪率为76.57%，追踪到位率79.82%。规则服药完成率68.33%。结论　当地肺结核报告病例存在过诊情况，实际发病率为287/10万，比贵州省平均报告发病率133.47/10万高出1倍以上。由于特殊的地理环境条件，当地许多防治措施难以到位，需进一步采取强有力的综合防治措施遏制肺结核流行。

Investigation on the diagnosis and management of cases in the most serious pulmonary tuberculosis epidemic areas of Guizhou province

Abstract: Objective The aim of this study was to retrospectively analyze the pulmonary tuberculosis cases in the most serious pulmonary tuberculosis epidemic areas of Guizhou province, in order to explore the diagnostic accuracy, investigate and analyze the reasons of higher reported incidence of pulmonary tuberculosis, as well as to provide the basis for adopting targeted and effective control measures. Methods Comprehensive survey experts rechecked the reports of pulmonary tuberculosis in three medical and health organizations. The negative sputum smears, X-ray chest films, and medical records were combined and reviewed to determine the diagnostic accuracy. The experts randomly entered the villages and conducted the field investigation of prevention and cure administration. Results Hospitals reported 784 cases of pulmonary tuberculosis, while nine cases were not reported, with a missing report rate of 1.13%. Anti-tuberculosis organizations found 170 cases of duplicate records while network reporting systems found none. Three hundred and seventy pulmonary tuberculosis cases had been rechecked. The coincidence rate was 83.24%. The diagnostic coincidence rate of anti-tuberculosis organizations was higher than that of hospitals. The difference was statistically significant (P<0.05). Eighty negative sputum smears were reviewed. The coincidence rate was 100%. The follow-up rate of pulmonary tuberculosis patients who discontinued treatment was 76.57%, and arrival rate of the traced cases was 79.82%. 68.33% of the patients were in compliance with regular treatment. Conclusion There were over-diagnosis situation in local pulmonary tuberculosis reported cases. The actual incidence rate was 287/100 thousands, which was more than twice the reported average incidence rate (133.47/100 thousands) of Guizhou province. Due to the special natural and geographical environment conditions, many of local prevention and control measures were difficult to implement. Strong and comprehensive control measures must be adopted to restrain the prevalence of tuberculosis.