结核病监测预警指标体系和流行现状研究

发布时间：2018-02-04 11:49

本文关键词： 结核病监测预警指标体系发病率患病率发病特征病因分值　出处：《华中科技大学》2012年博士论文　论文类型：学位论文

【摘要】：研究目的： 1.构建与我国结核病流行特征相适应的监测预警指标体系,为结核病疫情的预警和控制筛选出敏感性高、时效性好、可操作性强的重要指标,进而为结核病的防控工作提供有力的科学依据。 2.探讨我国不同地区结核病患病率和发病率,了解农村、城市和流动人口几类人群的发病特征,为今后不同特征人群的结核病防控工作提供参考。 3.揭示研究地区总人群的发病影响因素,以及不同暴露因素对结核病发病的贡献程度,根据研究结果来提出合理可行的防治措施。研究方法： 1.采用定性和定量相结合的研究方法进行结核病监测预警指标体系构建,主要包括文献研究、德尔菲法与专家会议法。 2.采用横断面调查和随访研究的方法,获得调查现场人群基本资料和患病率,以及人群年发病率和发病特征资料。 3.采用卡方检验来对影响总人群发病的因素进行单变量分析,采用Cox回归模型对影响总人群发病的因素进行多元分析。将四个现场人群的特征属性按照能否被干预措施改变分为不可调节的背景变量和可调节的危险因素。运用SAS程序计算各危险因素的全人群归因危险度百分比(PARF)和偏人群归因危险度百分比(PARP),以确定各因素以及因素间的不同组合对结核病发病的贡献。研究结果： 1.本次研究,共咨询专家18位,进行了两轮专家咨询,构建了一套包括4个一级指标、9个二级指标,48个三级指标在内的结核病预警指标体系。第一轮咨询专家的熟悉程度范围为0.508-0.967,均数为0.801；权威系数范围为0.704-0.933,均数为0.850。第二轮专家的熟悉程度范围为0.840-0.967,均数为0.922；权威系数范围为0.893-0.957,均数为0.917。经归一法计算权重以后,权重排名前5位的指标为：新涂阳病例登记率、治愈率、完成治疗率、总体到位率、结核病的地区分布。 2.分别选取代表流动人口(广东)、中部农村人口(湖南)、城市人口(上海)和东部农村人口(江苏)的样本做现场研究。基线调查总人群活动性肺结核患病率为63.55/10万。广东、湖南、上海、江苏的活动性患病率分别为：103.23/10万、122.89/10万、16.52/10万、46.21/10万。总人口活动性肺结核标化发病密度为41.75/10万、涂阳肺结核标化发病密度为18.59/10万；各省活动性肺结核标化发病密度不完全一样。 3.对总人群发病影响因素分析,多因素分析结果显示,男性(RR=2.67,95%CI: 1.80-3.97)、年龄每增加5岁(RR=1.18,95%CI:1.03-1.36)、有结核病史(RR=3.83, 95%CI:2.00-7.31)、已婚(RR=2.1,95% CI:1.09-8.30)可能会增加发病的危险性；而职业为学生和儿童(RR=0.12,95%CI:0.02-0.57)、文化程度在初中及以上(RR=0.81,95%CI:0.67-0.99)的人群发病风险较小。 4.对四个现场的人群进行单独分析,结核病史是四个地区共同的危险因素,其他因素在不同地区对发病贡献不完全一致。吸烟对发病的贡献在广东和江苏最大(广东：PARF=8.02%, PARP=6.26%,上海：PARF=23.99%, PARp =20.61%),结核病史对发病的贡献在湖南和江苏最大(湖南：PARF=9.24%, PARP=7.85%,江苏：PARF=21.90%, PARP=17.32%)。如果能同时降低结核病史、结核病接触史、吸烟史和糖尿病史在人群中的暴露水平,则广东、湖南、上海和江苏至少能减少11.50%、13.83%、33.37%和47.73%的发病。研究结论： 1.所建立的监测预警指标体系与我国结核病流行特征相适应,可为结核病的防控工作提供有力的科学依据。 2.我国目前结核病高发区集中在经济不发达地区和中部农村,其次是在流动人口中。提示防控工作依旧要以农村地区和经济欠发达地区为重点,在老年人和男性中要做好结核病人的发现和治疗工作。 3.通过病因分值研究,提示在开展结核病防控工作的过程中,重点控制传染源,提高结核病人发现率和治愈率。提倡禁烟和控制血糖可有效降低结核病发病。创新点： 1.本研究首次构建了我国结核病监测预警指标体系,为结核病疫情早期预警提供有用工具。同时,还能为今后呼吸道传染病单病种监测预警指标体系构建提供方法学基础。 2本研究首次在国内建立大规模结核病人群观察研究现场,并获得发病率资料。 3本研究首次利用全人群归因危险度百分比和偏人群归因危险度百分比的概念来区分人群中背景变量和环境暴露因素引起的发病。
[Abstract]:The purpose of the study is:
1., we should set up a monitoring and early warning index system suitable for the epidemic characteristics of tuberculosis in China, and screen out important indicators with high sensitivity, good timeliness and operability for the early warning and control of tuberculosis epidemic, so as to provide a strong scientific basis for the prevention and control of tuberculosis.
2., we will discuss the incidence and incidence of tuberculosis in different areas of China, and understand the incidence characteristics of several groups of people in rural areas, urban areas and floating population.
3., we revealed the risk factors of the total population in the study area, and the contribution degree of different exposure factors to the incidence of tuberculosis. Based on the results, we put forward reasonable and feasible control measures.
Research methods:
1. the combination of qualitative and quantitative methods is used to construct the index system of tuberculosis monitoring and warning, including literature research, Delphy Fa and expert meeting.
2. the methods of cross-sectional investigation and follow-up study were used to obtain the basic data and prevalence of the crowd, as well as the data of the annual incidence and characteristics of the population.
3. using the chi square test on Influence Factors of total incidence of univariate analysis, Cox regression model was used for multivariate analysis of the factors affecting the total incidence. The attributes of four groups according to the site can be divided into intervention measures to change the risk can not be adjusted for background variables and adjustable population factors. Using SAS program to calculate the risk factors the attributable risk percentage (PARF) and partial population attributable risk percentage (PARP), to determine the contribution of various factors and factors on tuberculosis.
The results of the study:
1. in this study, a total of 18 experts, conducted two rounds of expert consultation, constructs a set including 4 primary indexes, 9 level two indexes, 48 level three indexes and early warning index system of tuberculosis. The first round of the expert's familiarity with the range of 0.508-0.967, increased to 0.801; the coefficient of authority the range of 0.704-0.933, are the number of 0.850. second round of expert's familiarity with the range of 0.840-0.967, increased to 0.922; the authority coefficient is in the range of 0.893-0.957, mean 0.917. was calculated by normalization method of weight, the weight of the top 5 indicators: the new smear positive case registration rate, cure rate, treatment rate, overall in place, area distribution of tuberculosis.
2. were chosen to represent the floating population (Guangdong), central rural population (Hunan), city population (Shanghai) and Eastern rural population (Jiangsu) do field research sample. Baseline survey of the general population prevalence of active pulmonary tuberculosis was 63.55/10 million. Guangdong, Hunan, Shanghai, the prevalence rate of activity of Jiangsu respectively. 103.23/10 million, 122.89/10 million, 16.52/10 million, 46.21/10 million. The total population of active tuberculosis incidence density of 41.75/10 million, smear positive tuberculosis incidence density for 18.59/10 million; the active tuberculosis incidence density is not exactly the same.
Analysis of risk factors of 3. of the total population, the results of multivariate analysis showed that male (RR=2.67,95%CI: 1.80-3.97), each additional 5 years of age (RR=1.18,95%CI:1.03-1.36), a history of tuberculosis (RR=3.83, 95%CI:2.00-7.31), married (RR=2.1,95% CI:1.09-8.30) may increase the risk of occupation; and for students and children (RR=0.12,95%CI:0.02-0.57), the degree of culture in junior high school and above (RR=0.81,95%CI:0.67-0.99) incidence and less risk.
4. to carry out the analysis of four field populations, history of tuberculosis is common risk factors in four areas, other factors in different regions on the incidence of contribution is not entirely consistent. The incidence of smoking on contribution in Guangdong and Jiangsu (Guangdong: PARF=8.02%, PARP=6.26%, Shanghai: PARF=23.99%, PARp, =20.61%) on the incidence of tuberculosis history contribution in Hunan and Jiangsu (Hunan: PARF=9.24%, PARP=7.85%, Jiangsu: PARF=21.90%, PARP=17.32%). If it can reduce the history of tuberculosis, TB contact history, exposure level, smoking and diabetes in the population in Guangdong, Hunan, Shanghai and Jiangsu at least 11.50% to reduce the incidence of 33.37%, 13.83%, and 47.73%.
The conclusions are as follows:
The 1. established monitoring and warning index system adapted to the epidemic characteristics of tuberculosis in China can provide a powerful scientific basis for the prevention and control of tuberculosis.
2. of China's current high incidence of TB in rural areas concentrated in economically underdeveloped areas and central, followed in the floating population. It is suggested that prevention and control work still to rural areas and underdeveloped areas as the focus, in older people and men to do the case detection and treatment.
3., through the study of etiological score, it is suggested that in the process of TB control and prevention, we should focus on controlling the sources of infection, increasing the detection rate and cure rate of tuberculosis patients. Promoting smoking control and controlling blood sugar can effectively reduce the incidence of tuberculosis.
Innovation point:
1., this study is the first to set up a tuberculosis surveillance and early warning index system in China. It will provide a useful tool for early warning of tuberculosis epidemic. Meanwhile, it will also provide a methodological basis for the construction of a single disease surveillance and early warning index system for respiratory infectious diseases in the future.
2 this study was the first time to establish a large-scale field of observation and Study on a large-scale tuberculosis population in China, and to obtain information on the incidence of the disease.
3, this study first used the concept of the whole population attributable risk percentage and the percentage of population attributable risk percentage to distinguish the incidence of background variables and environmental exposure factors.

【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R521

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