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背景:在几内亚比绍共和国比绍实施的Bandim卫生项目。目的:对最初就诊时已被排除患有结核病的既往结核病可疑者进行结核病筛查。设计:这是一个队列随访研究,对初次就诊时痰涂片检查为阴性的“结核病阴性可疑者”在其初次就诊后1个月内进行结核病症状筛查,并将有症状者转诊接受临床复查和HIV检测。结果:2007年的10个月期间共登记结核病可疑者428例,其中80%(343例)为痰涂片阴性,而21例涂片阴性者被诊断为涂阴肺结核患者。在余下的322例结核病阴性可疑者中,对212例进行了随访,并在初诊后1个月内对有症状者进行了复查。在接受随访的患者中,89例(42%)仍然有症状;经复查痰涂片和胸部X线,5例被确诊为患有结核病。44例有症状且接受HIV检测的患者中,39%(17例)为HIV感染者。322例结核病阴性可疑者中,13例(4%)在随访前已经死亡。结论:很大一部分结核病阴性患者在初诊后一个月仍有症状。几例结核病患者初诊时未被诊断,结核病患者的HIV感染率较高。结核病阴性可疑者死亡率较高,这就需要结核病和艾滋病防治规划均应提高对此问题的重视程度。
Background: Bandim Health Project in Bissau, Republic of Guinea-Bissau. Objective: To screen for tuberculosis in suspected TB patients who had previously been excluded from tuberculosis at the initial visit. Design: This is a cohort study of negative sputum smear tests on first visit, “Tuberculosis-negative suspects” Screening of tuberculosis symptoms within 1 month after initial visit and referral of symptomatic Accept clinical review and HIV test. Results: 428 suspicious TB cases were registered during the 10-month period in 2007, of which 80% (343 cases) were sputum smear negative and 21 cases were negative smears were smear-negative pulmonary tuberculosis. Of the remaining 322 TB suspects, 212 were followed up and the symptomatic were reviewed within one month after first visit. Of the patients who were followed up, 89 (42%) still had symptoms; 5 were diagnosed with tuberculosis after review of sputum smear and chest X-rays. Of 44 patients with symptomatic HIV testing, 39% (17) were HIV-infected. Out of 322 tuberculosis-negative suspects, 13 (4%) died before follow-up. Conclusion: A significant proportion of patients with negative TB still have symptoms one month after first visit. A few cases of tuberculosis patients were not diagnosed at first visit, TB patients with higher rates of HIV infection. Tuberculosis-negative suspects, high mortality, which requires tuberculosis and AIDS prevention and control programs should raise the issue of attention.