中国四个项目地区耐多药肺结核患者筛查率、检出率与发现及时性的比较

目的分析医院和疾病预防控制系统（简称“医防”）合作模式下耐多药肺结核患者发现情况，为耐多药肺结核患者发现提供政策建议。方法收集整理中国疾病预防控制中心结核病预防控制中心与比尔及梅琳达·盖茨基金会合作项目在2011-2012年实施1年期间4个项目地区（开封市、连云港市、重庆市永川区、呼和浩特市）耐多药肺结核可疑者筛查的常规记录，使用筛查率、检出率和发现时间间隔等指标，评价耐多药肺结核患者的发现情况。4个项目地区登记涂阳肺结核患者共2816例，接受快速耐药筛查2365例，其中开封市774例、连云港市761例、重庆市永川区700例、呼和浩特市581例；有完整发现时间信息的来源于结核病防治（简称“结防”）机构的涂阳肺结核患者1608例。使用Kruskal-Wallis H 秩和检验对4个项目地区的发现情况进行组间比较，显著性水平设定为α=0.05。结果项目地区涂阳肺结核患者总体筛查率为83.98%(2365/2816)；使用快速诊断技术耐多药肺结核患者检出率为6.22%(147/2365)。4个项目地区结防机构来源患者发现时间间隔的中位数为7d，送痰、快速诊断和反馈时间间隔的中位数分别为2、5和0d。开封市、连云港市、重庆市永川区和呼和浩特市结防机构来源的耐多药肺结核患者发现时间间隔的中位数分别为6、7、9和14d（H=275.19，P<0.001）；送痰时间间隔的中位数分别为1、2、2和2d（H=104.92，P<0.001）；快速诊断时间间隔的中位数分别为5、4、5和6d（H=8.19，P=0.042）；反馈时间间隔的中位数分别为0、0、0和5d（H=580.32，P<0.001）。结论在医防合作模式下使用快速诊断技术对所有涂阳肺结核患者进行筛查，筛查率较高，检出率处于比较理想的水平，并且患者发现较为及时，这种发现方式是值得借鉴推广的。

Case finding of multidrug-resistant tuberculosis through PPM-DOTS in 4 sites in China

Objective To analyze the effect of PPM-DOTS（public TB control institution-public hospital mix for DOTS, PPM-DOTS） in case finding of multidrug-resistant tuberculosis （MDR-TB） cases and to explore the suitable strategy for MDR-TB case finding. Methods The routine records for screening suspected MDR-TB patients in 2011 to 2012 were collected. Screening rate, detection rate and diagnosis time were used to evaluate the effect of PPM-DOTS in MDR-TB case finding. There were 2365 suspected MDR-TB cases detected in four program cities： 774 in Kaifeng, 761 in Lianyungang, 700 in Yongchuan district, Chongqing and 581 in Hohhot; the number for smear positive MDR-TB patients who came from CDC with complete dignosis time was 1608. Kruskal-Wallis H was used to compare the case detection situation in different sites, 0.05 was set as the significance level. Results The overall screening rate in the four sites was 83.98%（2365/2816）. The detection rate with rapid test was 6.22%（147/2365）. Generally, the medians of diagnosis time, time for sputum transportation, rapid test and information feed-back were 7 d, 2 d, 5 d and 0 d, respectively in four sites. The medians of dignosis time in Kaifeng, Lianyungang, Yongchuan district and Hohhot were 6 d, 7 d, 9 d and 14 d（H=275.19, P〈0.001）. The medians of time for sputum transportation were 1 d, 2 d, 2 d and 2 d（H=104.92, P〈0.001）, the medians of time for rapid test were 5 d, 4 d, 5 d and 6 d（H=8.19,P=0.042）, and the medians of the time for information feed-back were 0 d, 0 d, 0 d and 5 d（H=580.32, P〈0.001）. Conclusion The screening rate and detection rate were in good levels, and the MDR-TB patients can be found in time. It is feasible and effective to identify MDR-TB cases by rapid diagnostic method to screen smear positive TB patients in PPM-DOTS settings, and this detection model is worthy learning and expanding.