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目的探讨分级接触者筛查方法在大学生肺结核聚集性发病调查中的应用效果,为有效控制聚焦性疾病蔓延提供依据。方法对天津市某大学首发肺结核病例的接触者分级筛查,开展流行病学调查、症状筛查、PPD试验、TBSA检测和胸部DR检查。结果本次调查逐步筛查了3级接触者,共934名师生。在1~3级接触者中,肺结核可疑症状发生率分别为7.1%,0.4%和0.2%,PPD强阳性率分别为62.5%,30.7%和26.7%,TB-SA阳性率分别为45.5%,22.3%和17.4%,DR胸片可疑阴影发生率分别为16.7%,4.4%和0.6%,各项检查的阳性率均呈递减(χ2值分别为36.32,23.02,7.03,52.22,P值均<0.05)。最终在接触者中确诊17例学生肺结核病例,从1~3级接触者的肺结核检出率分别为14.3%,3.1%和0.6%,差异有统计学意义(χ2=43.97,P<0.01)。在宿舍楼层分布上,女生43号楼3层的肺结核罹患率为11.6%,高于男生4层的2.0%及其他楼层的0.8%,差异有统计学意义(χ2=45.97,P<0.05);专业分布上,10级动画专业、10级环艺专业和其他专业罹患率分别为18.9%,6.8%和0.6%,差异有统计学意义(χ2=72.30,P<0.05)。结论分级接触者筛查方法适用于学校内结核病疫情调查,可以明确疫情波及人群。调查发现病例间有流行病学关联,疫情主要在宿舍楼层及专业内传播。
Objective To investigate the application of screening contact classification method in the investigation of the incidence of pulmonary tuberculosis in college students and provide evidence for the effective control of the spread of focal disease. Methods Totally classified contacts of pulmonary tuberculosis cases in a university in Tianjin were investigated by epidemiological investigation, symptom screening, PPD test, TBSA test and chest DR examination. Results The survey gradually screened 3 contacts, a total of 934 teachers and students. Among 1 to 3 contacts, the incidence of suspicious symptoms of tuberculosis were 7.1%, 0.4% and 0.2% respectively. The positive rates of PPD were 62.5%, 30.7% and 26.7%, respectively. The positive rates of TB-SA were 45.5% 22.3% and 17.4% respectively. The incidences of suspicious shadow on DR chest radiographs were 16.7%, 4.4% and 0.6%, respectively. The positive rates of various examinations decreased (χ2 = 36.32,23.02,7.03,52.22, P < 0.05). In the end, 17 cases of tuberculosis were diagnosed among the contacts, and the detection rates of tuberculosis from 1 to 3 contacts were 14.3%, 3.1% and 0.6%, respectively. The difference was statistically significant (χ2 = 43.97, P <0.01). In the distribution of dormitory floors, the attack rate of tuberculosis in the third floor of 43 girls was 11.6%, higher than 2.0% of the fourth floor of boys and 0.8% of the other floors, the difference was statistically significant (χ2 = 45.97, P <0.05). In the professional distribution, the attack rates of Grade 10 animation specialty, Grade 10 HuanYi specialty and other specialties were 18.9%, 6.8% and 0.6%, respectively, with significant differences (χ2 = 72.30, P <0.05). Conclusion The method of classified contacts screening is suitable for the survey of tuberculosis epidemics in schools, which can make it clear that the epidemic affects the population. An epidemiological correlation was found between the cases. The outbreak was mainly spread on the dormitory floors and majors.