湖北省两所监狱结核病现况调查研究

目的 了解示范区监狱结核病疫情和防治工作现状。方法 对示范区2所监狱3516名在押人员进行肺结核普查和结核病知晓率问卷调查，对有肺结核可疑症状者和X线胸片异常者进行痰涂片、培养、菌型鉴定和药敏试验检查。利用结核分枝杆菌散在分布数目可变串联重复序列分析方法(MIRU-VNTR)对痰菌阳性患者进行传染源同源性分析。计算监区肺结核患病率，并与普通人群患病率进行比较。结果 共确诊肺结核患者40例，其中涂片阳性1例，涂片阳性培养阳性1例(涂片阳性1例与涂片阳性培养阳性1例为同一例患者)，涂片阴性培养阳性5例，涂片阴性培养阴性34例。6例培养阳性菌株药敏试验结果显示，共有3例患者耐药，其中1例耐链霉素，1例同时耐异烟肼、利福平和乙胺丁醇，1例同时耐异烟肼、利福平、乙胺丁醇和氧氟沙星。肺结核患病率、涂阳患病率、菌阳患病率分别为1156.4/10万（40/3459）、28.9/10万（1/3459）、173.5/10万（6/3459）。其中肺结核患病率高于当地普通人群患病率338.4/10万（χ²=17.858，P＜0.01）。在押人员对3条核心信息总知晓率为61.6%（6384/10 359），其中乙监狱67.4%（4737/7026），甲监狱49.4%（1647/3333），差异有统计学意义（χ²=309.1，P＜0.01）。同一监狱5例痰菌阳性患者其传染源来源不同。结论 监狱结核病疫情严重，应探索有效的监狱结核病防控模式。

Cross-sectional survey on pulmonary tuberculosis in two prisons of Hubei

Objective To understand the situation of TB epidemic in prison and the status of prevention work. Methods The pulmonary tuberculosis(PTB) census and questionnaire investigation were performed for all the prisoners,and sputum smear,sputum culture,bacterial identification and drug susceptibility test(DST) were done for prisoners with abnormal chest radiograph shadow or suspicious symptoms.Besides,the infectious source homology analysis was made for culture positive patients through Mycobacterial interspersed repetitive unit-variable number of tandem repeat(MIRU-VNTR) typing method.The prevalence of tuberculosis in prison was calculated and compared with the general population. Results A total of 40 cases were diagnosed as PTB,of which one was sputum smear positive,one was culture positive(same with the smear positive),five were smear negative and culture positive,and 34 were smear negative and culture negative.The DST results for six culture positive patients showed that,there are three drug-resistant cases,among which,one was streptomycin-resistant,one was resistant to isoniazid,rifampicin and ethambutol simultaneously,one resisted to isoniazid,rifampicin,ethambutol and ofloxacin.The prevalence of PTB,smear positive,culture positive were 1156.4/100 000(40/3459),28.9/100 000(1/3459),173.5/100 000(6/3459) respectively.The PTB prevalence in prisoners was higher than that in local residents(χ2=17.858,P<0.01).The total awareness rate for three pieces of core TB information was 61.6%(6384/10 359),while 67.4%(4737/7026) for the B prison,49.4%(1647/3333)for the A prison.The difference was statistically significant(χ2=309.1,P<0.01).In addition,the homology analysis showed that the infectious sources of the five culture-positive patients in the same prison were different. Conclusion The TB epidemic in prison is serious,so the effective prison TB control working model should be explored.