江西省南昌市结核病流行病学和病原学调查

发布时间：2018-06-14 09:49

本文选题：结核病 + 结核分枝杆菌　；参考：《中国疾病预防控制中心》2010年硕士论文

【摘要】： 结核病仍然是严重危害着人类健康的传染病之一,随着HIV/AIDS、耐药结核的流行等,使结核病再次成为严重的全球性公共卫生问题。我国结核病疫情严重,结核病患病人数位居世界第二,仅次于印度,被世界卫生组织列为全球22个结核病高负担国家之一。2000年全国结核病流行病学抽样调查结果显示44.5%(5.5亿)的人口感染了结核菌,明显高出全球1／3人口感染的水平。近几年,我国传染病疫情报,每年结核病新发病例100多万例。因此,控制结核病的发生与流行是目前我国卫生工作的重要任务之一。但由于种种原因,我国结核病的基础性研究工作明显滞后。本研究采用抽样调查方法,选择江西省南昌市4个区、县作为调查点,对该4个区、县医院2009年1-6月住院肺结核患者和拟诊肺结核病例进行调查。现场调查采用描述性流行病学方法,采用统一的调查表对所有拟诊病例进行个案调查。同时收集患者的三份深咳痰(清晨痰,夜间痰和即时痰)。涂片镜检和痰培养分枝杆菌,同一病例的三份痰标本,任何一份镜检阳性,即判定为涂片阳性。同一病例的三份痰标本,任何一份培养阳性,即判定为培养阳性,确诊结核病例。对培养出的分枝杆菌采用鉴别培养基进行菌种鉴定,以了解结核分枝杆菌、牛分枝杆菌和非结核分枝杆菌的感染状况。采用比例法对临床分离菌株进行了异烟肼、利福平、链霉素、乙胺丁醇等四种药物的敏感性检测。并通过EXCEL2003、spss 15.0统计软件和卡方检验对结果数据进行统计学处理和分析,以P0.05为差异有统计学意义。 442例拟诊病例中,男性315例,占71.3%,女性127例,占28.7%,男女比例为2.48：1。就诊患者年龄最小的12岁,最大80岁。以60岁以上病例数最高(占35.30%),老年成为患病高峰。其次分别为41-60岁年龄组,占31.67%,以及21-40岁年龄组,占26.70%,20岁以下病例数构成比最低(占6.33%)。农村结核病疫情突出,本次调查农村患病人数为322例,占72.85%,城镇患病人数为120例,占27.15%。农民病例数为272例,占61.54%,外来务工人员等流动人口病例数为66例,占14.93%,明显高于其他职业人群。本次调查复治病人有55例,占12.44%。9.72%的病例曾有几天到几年不等的不规律抗结核治疗史。13.35%(59例)的病例周围有结核病人,4.98%的病例具有密切的接触史,65.38%的病例没有接受过任何形式的防痨宣传教育,不到半数(45.93%)的病例了解结核病的传播途径,虽具备一定的结核病知识,但是不能有意识地对自己进行防护。仅37.00%的病例因症就诊的首诊医院为结防所。本研究对4个调查点432例拟诊病例收集到的1296份痰标本进行了传统的结核病细菌学检测。抗酸染色检测,阳性标本362份,阳性率27.93%；阴性934份,阴性率72.07%。被检测的432例拟诊病例中,涂片镜检阳性162例,阳性率为37.50%,阴性病例270例,阴性率为62.50%。1296份痰标本分枝杆菌培养阳性共382份,占29.48%,阴性914份,占70.52%。432例拟诊病例中分枝杆菌培养阳性159例,占36.81%,全阴病例273例,占63.19%。涂片染色和细菌培养方法联合应用,阳性率达40.97%,明显高于单独使用涂片染色或细菌培养的阳性率。本研究对已分离到的120株分枝杆菌菌株进行了菌种鉴定。该120株菌来自120个病例。108株分离株被鉴定为结核分枝杆菌(MTB),占90.00%；1株为牛结核分枝杆菌(M. bovis),占0.83%；11株为非结核分枝杆菌(NTM),占9.17%。对108株结核分枝杆菌进行了药物敏感性试验,对四种抗结核一线药物(SM,RFP, INH, EMB)全部敏感的菌株为97株,占89.81%；耐药菌株11株,占10.19%,其中,单耐药菌株7株,占6.48%；多耐药菌株4株,占3.70%。现场流行病学调查结果显示,442例拟诊病例中,男性高于女性,农村高于城镇,中老年、农民和流动人口为高发人群。存在结核病不规范治疗,占9.72%。65.38%的病例没有接受过任何形式的防痨宣传教育,结核病防治知识的宣教和普及工作急需加强。细菌学检测发现当地结核病病原较为复杂,包括结核分枝杆菌、牛分枝杆菌和非结核分枝杆菌,尤其是非结核分枝杆菌达9.17%,应该引起重视。结核分枝杆菌的耐药率达10.19%,其中,单耐药菌株占6.48%；多耐药菌株占3.70%。对同一病人同时采用涂片染色检查和细菌培养方法进行检查,可明显提高检测阳性率。本研究在一定程度上直接反映出江西省南昌地区结核病流行现状,具有重要的流行病学意义,同时,也为结核病的预防控制工作提供了一份可靠的基础科学数据。
[Abstract]:Tuberculosis is still one of the infectious diseases seriously endangering human health. With the HIV/AIDS, the epidemic of drug-resistant tuberculosis and so on, tuberculosis has become a serious global public health problem. In China, the epidemic of tuberculosis is serious, the number of patients with tuberculosis is second in the world, second only to India, the world's WHO is listed as the 22 highest tuberculosis in the world. The national tuberculosis epidemiology sample survey in one of the country's.2000 shows that 44.5% (550 million) of the population infected with tuberculosis bacteria, obviously higher than the global 1 / 3 population infection level. In recent years, China's infectious diseases and epidemic information and about 1000000 new cases of tuberculosis in China annually. Therefore, control of the occurrence and epidemic of tuberculosis is the current health of our country. One of the important tasks of the work. However, due to various reasons, the basic research work of tuberculosis in China is obviously lagging behind.
In this study, 4 districts of Nanchang, Jiangxi Province, were selected to investigate the cases of tuberculosis and tuberculosis in the 4 districts, and the county hospitals were hospitalized in 1-6 months of 2009. A descriptive epidemiological method was used and a unified questionnaire was used to investigate all the cases. Three deep expectoration (early phlegm, nocturnal phlegm and instant phlegm). Smear microscopy and sputum culture of Mycobacterium phlegm, three sputum specimens of the same case, any positive smear positive, three sputum specimens of the same case, any positive, or positive, confirmed tuberculosis cases. The infection status of Mycobacterium tuberculosis, Mycobacterium bovis and Mycobacterium tuberculosis was detected by the identification medium, and the sensitivity of four drugs, isoniazid, rifampicin, streptomycin and ethambutol was detected by proportion method, and the statistical software and card of EXCEL2003, SPSS 15 were used. The results of the statistical analysis and analysis of the results were statistically significant by P0.05.
Among the 442 cases of diagnosis, 315 were male, 71.3% and 127 women, accounting for 28.7%. The proportion of men and women was 12 years old, and the maximum was 80 years old. The highest number of cases was 60 years old (35.30%), and the elderly became the peak of the disease. The second was 41-60 years old, 31.67%, and 21-40 age group, accounting for 26.70% and under 442 years of age. The constituent ratio is the lowest (6.33%). The epidemic situation of rural tuberculosis is prominent, the number of rural diseases in this survey is 322 cases, accounting for 72.85%, and the number of urban diseases is 120 cases, accounting for 272 cases of 27.15%. farmers, accounting for 61.54%, the number of migrant workers and other migrant workers is 66 cases, accounting for 14.93%, obviously higher than other occupational groups. This survey has 55 patients with 55 retreated patients 55. For example, the cases of 12.44%.9.72% had a history of.13.35% (59 cases) with a history of irregular anti tuberculosis treatment for several days to several years, and 4.98% of the cases had a close contact history. 65.38% of the cases had not received any form of anti tuberculosis propaganda and education, and less than half (45.93%) of cases knew the transmission route of tuberculosis, although it had a way to understand the transmission of tuberculosis. A certain amount of tuberculosis knowledge is available, but not consciously. Only 37% of the cases are diagnosed as the first aid hospital.
In this study, 1296 sputum specimens collected from 432 cases of 4 survey cases were examined by traditional tuberculosis bacteriology test. Acid stain detection, positive specimens were 362, positive rate 27.93%, negative 934, negative rate 72.07%. were detected in 432 cases of diagnosis, smear positive 162 cases, positive rate 37.50%, negative case 270 cases, negative cases. The sex rate of Mycobacterium tuberculosis in 62.50%.1296 phlegm specimens was 382, accounting for 29.48% and negative 914, accounting for 159 cases of Mycobacterium tuberculosis in 70.52%.432 cases, 36.81% and 273 cases of full Yin, accounting for the combination of 63.19%. smear staining and bacterial culture, with the positive rate of 40.97%, which was obviously higher than that of smear stain alone or fine. The positive rate of bacteria culture.
In this study, 120 strains of Mycobacterium strains isolated were identified. The 120 strains from 120 cases were identified as Mycobacterium tuberculosis (MTB), accounting for 90%, 1 Mycobacterium tuberculosis (M. bovis), 0.83% and 11 non tuberculous Mycobacterium (NTM), accounting for 9.17%..
108 strains of Mycobacterium tuberculosis were tested for drug sensitivity. 97 strains of SM, RFP, INH, EMB were all sensitive to 97, 89.81%, 11, 10.19%, of which 7, 6.48%, and 4, 3.70%..
The results of the field epidemiological survey showed that in 442 cases, the male was higher than the female, the rural area was higher than the town, the middle age and the old, the peasants and the floating population were the high incidence. There was no standardized treatment for tuberculosis. The cases of 9.72%.65.38% did not accept any form of anti tuberculosis propaganda education. The education and popularization of tuberculosis prevention and control knowledge were in urgent need. Strengthen.
Bacteriological detection found that the local tuberculosis pathogens were more complex, including Mycobacterium tuberculosis, Mycobacterium bovis and non tuberculosis mycobacterium, especially 9.17% of non tuberculosis mycobacterium, which should be paid attention to.
The drug resistance rate of Mycobacterium tuberculosis was 10.19%, of which 6.48% were single resistant strains, and 3.70%. was multidrug-resistant strains.
Smear staining and bacterial culture were used to check the positive rate of the same patient.
This study, to a certain extent, directly reflects the epidemic situation of tuberculosis in Nanchang area of Jiangxi Province, and has important epidemiological significance. At the same time, it also provides a reliable basic scientific data for the prevention and control of tuberculosis.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R52;R181.3

【参考文献】