北京市西城区2004-2011年大学新生结核菌素监测与结核病预防性治疗价值评价

目的探讨北京市大学新生实施PPD监测及对其中PPD反应硬结≥15mm者实施免费拍摄X线胸片检查和采取预防性治疗的必要性、可行性。方法对北京西城区三所大学自2004-2011年8年间入学新生做PPD试验,PPD反应≥15mm者摄胸部X线片并动员结核病预防性治疗,方案:3H2L2。结果 8年间共有新生14 833人,PPD试验人数14 504人,复验人数14 010人(占PPD试验人数的96.59%)。PPD反应≥15mm者1 689人(12.06%),全部摄胸部X线片,检出活动性肺结核病人4人(其中3人入学体验时已发现肺部病变),实际仅检出1人,活动性肺结核检出率(0.06%)。105人(6.22%)同意接受预防性治疗,但仅51人(48.57%)完成治疗。全部学生在校期间未发现肺及肺外结核病。为检出这名病人实际花费291 095.49元。结论北京市大学入学新生实施PPD监测及预防性治疗措施耗资巨大而无实效,不太符合费用/效益原则决策者应进一步调查研究以审核该项措施的可行性。

Evaluation on tuberculin monitoring and preventive treatment of TB among freshmen in Xicheng district of Beijing from 2004 to 2011

Objective To assess the necessity and feasibility in conducting tuberculin（PPD）monitoring and use of preventive treatment for TB among university freshmen in Xicheng district of Beijing.Methods A total of 14 504 freshmen from three universities were given PPD test in 2004-2011,students with PPD scleroma size of 15mm and larger had chest X ray and were suggested to have TB prophylactic therapy of 3H2L2.Results Out of 14 504 freshmen who did the PPD test,96.59% repeated the test.1689 students were found to have a firm bump sized 15mm and bigger,They all had chest X ray and 4 students were diagnosed of having active pulmonary TB.But because 3 of them were already found to have pulmonary lesions during enrollment check-up,actually only one new TB case was picked-up with the detection rate of 0.06%.Of 105 students who agreed to accept preventive treatment,51（48.57）had completed the treatment.However,the total cost was as high as 291095.49 Yuan for picking up this new case.Conclusions PPD monitoring and preventive treatment among university freshmen in Beijing does little good other than costly,suggesting that the necessity needs to be reevaluated.