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目的:评价诊断时的病情严重性及传染期在近期移民中筛查结核病的作用。 设计:利用荷兰结核病登记中心的资料,比较通过筛查发现和被动发现的移民肺结核病例。 研究对象:在1993—1998年之间到达荷兰的高流行国家的移民中,凡在30个月之内诊断的培养阳性的肺结核病人。 结果的测量:病情的严重性:痰涂片阳性、住院、死亡。传染期:存在症状的期间。 结果:882例细菌学确诊的肺结核病人均来自高流行国家,并且到达荷兰不满30个月。其中454例是通过筛查发现的,368例则为因症被动发现。与被动发现的病人相比较:筛查发现的病例中涂阳者较少(OR 0.5,95％CI 0.3—0.8);住院治疗者较少(OR 0.2,95％CI 0.1—0.2)。筛查发现的病人有症状的期间较短。估算筛查发现可使病人传染期减少约33％。 结论:筛查程序可较早发现病人、减少住院治疗、缩短症状期,因此可能减少结核病的传播。
OBJECTIVE: To evaluate the severity of the disease at diagnosis and the role of screening for tuberculosis among recent immigrants during the infection phase. Design: Use of information from the Dutch TB registry to compare immigrant cases of tuberculosis found through screening and passively detected. PARTICIPANTS: Among immigrants from high-prevalence countries that reached the Netherlands between 1993 and 1998, all positive TB patients were diagnosed within 30 months of diagnosis. Measurement of results: severity of illness: positive sputum smear, hospitalization, death. Infectious period: the period of symptoms. Results: All 882 bacteriologically diagnosed cases of tuberculosis were from high endemic countries and arrived in the Netherlands for less than 30 months. Of these, 454 were found by screening and 368 by passive screening. Compared with those found by passive screening, there were fewer smear-positive cases (OR 0.5, 95% CI 0.3-0.8) and fewer hospitalizations (OR 0.2, 95% CI 0.1-0.2). The patients found during the screening showed shorter duration of symptoms. Estimated screening can reduce the patient’s infection period by about 33%. CONCLUSIONS: Screening procedures can detect patients earlier, reduce hospitalization, and shorten symptoms, thereby reducing the spread of tuberculosis.