2010-2012年度北京西北地区结核性创面流行病学调查

发布时间：2018-03-10 12:27

本文选题：肺外结核病　切入点：结核性创面　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：初步摸清2010-2012年度北京西北地区结核性创面流行病学数据、特点和规律，填补我国目前在此方面的空白，为后期的临床研究提供可靠数据。方法：本研究为回顾性调查研究，收集2010年1月至2012年12月总参谋部总医院肺外结核性创面住院患者，采集性别、年龄、民族、户籍、治疗费别、结核病类型、全身症状、创面情况、诊断方法、确诊时间、治疗方法及转归情况等资料，统计分析其规律及特点。结果：总参谋部总医院2010-2012年度肺外结核住院患者中，结核性创面235例,发生率为4.0%；男女之比为1.448∶1；平均年龄36.9±17.9岁，中位数35岁，16-30岁青壮年患者构成比最大（42.6%）P0.01。农村患者69.4%，城市患者30.6%（P0.05）；治疗费别医保覆盖率77%；结核性创面的原发病灶中，以周围淋巴结结核为主要原发病灶，占47.7%（P0.01）；其中又以颈部淋巴结为主（88.4%）；73.6%的患者全身症状不明显；影像学检查提示为肺外结核病占44.3%，其中，骨关节结核占87.5%；PPD试验阳性率为80.8％，创面分泌物结核分枝杆菌培养阳性率为43.8％，活检病理检查的阳性率为74.6％；确诊平均时间为4.4月（中位数：3月），确诊时间在6个月以上的患者中农村居民占85.4%；出现创面的平均时间为8.6月（中位数：4月）；卡介苗接种率13.6%；抗结核药物方面，规范化用药率仅有24.7%；耐药性方面，43.5%不同程度耐药；耐单药占26.8%，，耐多药占16.7%；耐药率最高的为异烟肼，其次为链霉素，耐药率分别为16.7%和13.4%。创面特性方面，单发占86.6%，窦道型占54.4%。在治疗方法中，传统换药治疗占54.0%，治愈率4.7%，单纯病灶清除术占20.9%，治愈率89.8%，病灶清除结合负压封闭式引流技术占25.1%，治愈率94.9%；换药治疗组治愈率明显低于手术组（P0.001），而单纯病灶清除术与病灶清除结合负压封闭式引流技术治疗组在治愈率上并无显著差异（P=0.265）。远期疗效方面，换药治疗组复发率13.4%，单纯病灶清除术治疗复发率3.3%，病灶清除结合负压封闭式引流技术治疗组无复发，换药治疗复发率远高于其他治疗方式（P0.01）。结论：结核性创面有一定的发生率，并非罕见；农村地区的男性青壮年患者发生率高，应加强该群体人群的疾病防控；国家医保政策尚未完全覆盖结核性创面的诊治；及时确诊仍很困难；原发病灶以周围淋巴结、骨关节结核为主；结核杆菌抗酸染色和培养阳性率不高，诊断时应综合PPD试验、影像学检查和创面特征，尽早行活体组织病理检查；卡介苗接种率较低；内科抗结核治疗仍存在药物使用不规范问题，规范化抗结核药物使用率很低；抗结核药物耐药率高达43.5%；创面以单发为主；在治疗方法上，传统换药保守治疗治愈率较低，且复发率高；外科手术干预能显著性提高治愈率，降低复发率。
[Abstract]:Objective: to investigate the epidemiological data, characteristics and rules of tuberculous wound in northwestern Beijing from 2010 to 2012, to fill in the blank in China, and to provide reliable data for later clinical research. Methods: from January 2010 to December 2012, the inpatients with tuberculous pulmonary wounds were collected from January 2010 to December 2012. Sex, age, nationality, household registration, treatment fee, type of tuberculosis, systemic symptoms were collected. The data of wound condition, diagnosis method, diagnosis time, treatment method and prognosis were analyzed statistically. Results: among the patients with extrapulmonary tuberculosis in the General staff General Hospital from 2010 to 2012, 235 cases had tuberculous wound, the incidence rate was 4.0%, the ratio of male to female was 1.448: 1, the average age was 36.9 卤17.9 years old. The median age was 35 years old and 16-30 years old. The largest proportion of young and middle-aged patients was 42.6% P0.01.The rural patients were 69.44.The urban patients were 30.6% P0.05; the coverage rate of medical insurance was 77%; the primary lesion of tuberculous wound was peripheral lymph node tuberculosis. The percentage of patients with P0.01 was 47.7%, and the percentage of patients with cervical lymph nodes was 88.4%, and 73.6% of the patients had no obvious systemic symptoms, and the imaging examination showed that extrapulmonary tuberculosis accounted for 44.3%, of which, The positive rate of bone and joint tuberculosis was 80.8%, the positive rate of mycobacterium tuberculosis in wound secretion was 43.8%, the positive rate of biopsy and pathology was 74.6%, the average time of diagnosis was 4.4 months (median: March, the time of diagnosis was more than 6 months). Rural residents accounted for 85.4% of the patients, and the average time for wound appearance was 8.6 months (median: April); BCG vaccination rate was 13.6%; anti-tuberculosis drugs, The standardized drug use rate was only 24.7%; the drug resistance was 43.5%; the single drug resistance was 26.8%, and the multidrug resistance was 16.7.The highest drug resistance rate was isoniazid, followed by streptomycin, and the drug resistance rates were 16.7% and 13.40.The wound characteristic, In the treatment, 86.6% were single and 54.4% were sinus type. The cure rate of traditional dressing change treatment was 54.0, the cure rate was 4.7, the cure rate was 89.8, the cure rate was 89.8, and the cure rate was 94.94.The cure rate in the treatment group was significantly lower than that in the operation group (P 0.001), and the cure rate was 94.9 in the control group, while the cure rate in the control group was significantly lower than that in the operation group (89.8%). There was no significant difference in the cure rate between the treatment group and the treatment group with debridement combined with negative pressure closed drainage. The recurrence rate of the treatment group was 13.4%, and the recurrence rate of the treatment group was 3.3.The recurrence rate of the treatment group was significantly higher than that of the other treatment methods (P 0.01a), and no recurrence was found in the treatment group combined with negative pressure closed drainage. Conclusion: the incidence of tuberculous wounds is not rare, the incidence of male young and middle-aged patients in rural areas is high, the disease prevention and control of this group should be strengthened, the diagnosis and treatment of tuberculous wounds have not been completely covered by the national medical insurance policy. It is still very difficult to diagnose in time; the primary focus is peripheral lymph nodes, bone and joint tuberculosis. The positive rate of acid fast staining and culture of Mycobacterium tuberculosis is not high. The diagnosis should be combined with PPD test, imaging examination and wound characteristics. Histopathological examination in vivo was carried out as early as possible; the rate of BCG vaccination was low; the problem of nonstandard drug use was still existed in the treatment of internal medicine and the use rate of standardized antituberculous drugs was very low; the drug resistance rate of antituberculous drugs was as high as 43.5%; In the treatment, the cure rate of the traditional conservative treatment is low, and the recurrence rate is high; the surgical intervention can significantly improve the cure rate and reduce the recurrence rate.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R52

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