不明原因肺炎监测系统评价

发布时间：2018-08-01 17:41

【摘要】：研究目的:评价不明原因肺炎(PneumoniaofUnkonwn Etiology, PUE)监测系统目前运行现状;分析该监测系统在运行过程中存在的主要问题;依据上述研究发现与分析,提出针对该监测系统运行的建议。研究方法:采用描述性流行病学方法对2004至2016年全国PUE监测系统病例上报情况、监测目标疾病人感染禽流感等病例报告途径进行分析;选取4省份医疗机构,采用现况研究方法对临床医生PUE监测系统的理解和使用情况进行调查;采用现况研究方法对2家医疗机构PUE监测系统运行现状进行调查。从监测系统发现目标疾病的阳性预测值、灵敏度、可接受性、及时性等指标对PUE监测系统进行评价。研究结果:1. PUE监测系统病例上报情况(1) 2004至2016年,全国共上报1666例PUE病例,其中8%(125/1666)为人禽流感病例,包括41例人感染H5N1禽流感病例,81例人感染H7N9禽流感病例,2例人感染H5N6禽流感病例,1例人感染H9N2禽流感病例。监测系统发现目标疾病的阳性预测值为8%。(2) 2004至2016年全国报告PUE病例发病到诊断的平均间隔为6.0天,诊断到报告的平均间隔为0.5天,报告到审核的平均间隔为0.1天。疫情期间发病到诊断平均间隔长于非报告高峰时段,而疫情期间诊断到报告、报告到审核的平均时间间隔较短。2.人感染禽流感等新发呼吸道传染病病例报告途径(1) 2004至2016年全国内地共报告人感染禽流感、欧亚类禽猪流感病例共988例,其中13% (125/988)经PUE监测发现,49% (483/988)经法定报告途径发现,19% (183/988)经住院肺炎病例监测发现。PUE监测发现目标疾病的灵敏度为13%。(2) 2013年人感染H7N9禽流感疫情出现之前,人感染H5N1禽流感疫情时期的病例均经PUE监测系统上报。2013年人感染H7N9和其他各亚型禽流感疫情出现之后,53% (453/861)人感染禽流感病例经法定报告途径上报,18%(159/861)经住院肺炎病例监测途径上报,仅9% (78/861)经PUE监测上报。3.临床医生对PUE监测系统的理解和实践调查(1)调查的487名临床医生中,83% (403/487)知晓该监测系统,知晓该监测系统的临床医生中83% (326/395)接受过PUE监测相关培训。知晓该监测系统的医生中能完全掌握PUE病例定义者仅占9% (35/395)。(2) 51% (250/487)临床医生自述曾发现过符合PUE病例定义的患者,其中55% (139/250)在过去一年发现PUE病例数在1-5例之间,76% (166/220)曾报告过符合PUE定义的患者。临床医生报告病例后,84%以上认为报告程序简单易行、报告后有利于诊疗、报告后得到标本的检测结果、报告后得到相关部门的及时反应。(3)对临床医生报告病例的原因进行分析,48% (79/166)因病例诊断不明、治疗效果不好而报告;对临床医生未报告病例的原因进行分析,36%(30/84)因不知晓PUE监测工作,未将符合PUE病例定义的患者上报。59% (288/487)临床医生认为需要关注病情重的肺炎病例,49% (238/487)临床医生认为有传染性/聚集性的病例需上报至CDC。4.医疗机构PUE监测系统运行现况(1)调查期间,两家医院共筛查2619例可能与PUE诊断相关的急性呼吸道感染病例,其中13% (335/2619)符合PUE病例定义。仅有0.3% (1/335)上报至当地市疾控中心。(2)有病原学检测结果的311例PUE病例中,6% (18/311)检测结果呈阳性,且全部为季节性流感。其中61%(11/18)为甲型流感病毒阳性,39%例(7/18)为乙型流感病毒(Victoria型)阳性。(3)管床医生未将符合病例定义的病例上报原因主要为:76%不知道有不明原因肺炎监测这项工作,53%不理解病例定义。随着工作年限增加,管床医生对这项工作的知晓率也增加。结论:1. PUE监测系统阳性预测值为8%。该监测系统往往在人感染禽流感疫情早期的病例发现及报告中发挥主要作用。但随着人感染禽流感被纳入法定传染病进行报告管理,以及医务人员对疾病认识的加深,法定传染病报告、住院肺炎病例监测等成为病例发现和报告的主要途径,而通过PUE监测系统发现和报告已知人感染禽流感亚型病例的作用逐渐弱化。2.目前医院内有大量符合PUE定义的病例,但上报率低,且符合PUE定义的病例中目标病原体阳性者比例较低,病例定义假阳性率高,特异度差。3.临床医生对该监测系统的接受性尚可,也有意愿利用此监测系统报告病例,但对该监测系统的理解掌握程度不理想,培训工作有待进一步加强。建议:1.在新版方案下发之前,加强对现有PUE监测方案的培训,使其发挥应有作用。2.对PUE监测系统的监测目标重新定位,依据监测目的修改监测病例定义,提高其发现目标疾病病例的特异度,从而提高医务人员按照监测方案报告的依从性。
[Abstract]:Objective: To evaluate the current operation status of PneumoniaofUnkonwn Etiology (PUE) monitoring system and to analyze the main problems in the operation of the monitoring system. According to the above research findings and analysis, the suggestions for the operation of the monitoring system are proposed. The method of descriptive epidemiology is used for 2004 to 201. The cases reported in the 6 year national PUE monitoring system were reported, and the reports on the cases of avian influenza in the target disease were analyzed. The 4 province medical institutions were selected and the current status research method was used to investigate the understanding and use of the PUE monitoring system for clinicians, and the current status research method was used to run the PUE monitoring system of 2 medical institutions. A survey was conducted. The PUE monitoring system was evaluated from the positive predictive value of the target disease, sensitivity, acceptability and timeliness. The results of the 1. PUE monitoring system reported cases (1) from 2004 to 2016, 1666 cases of PUE were reported nationwide, of which 8% (125/1666) were human cases of avian influenza, including 41 cases of human feeling. There were 81 cases of H5N1 avian influenza, 81 cases of H7N9 avian influenza, 2 cases of H5N6 avian influenza and 1 cases of human H9N2 avian influenza. The monitoring system found that the positive predictive value of the target disease was 8%. (2) from 2004 to 2016. The average septum of PUE cases to the diagnosis was 6 days, and the average interval of the report was 0.5 days. The average interval between the audits was 0.1 days. The average interval between the epidemic period and the diagnosis was longer than the non reported peak period, and the report was diagnosed during the epidemic period. The average time interval of the review was reported, and the average time interval was shorter than the.2. human infection of avian influenza. (1) from 2004 to 2016 the mainland co reported the infectious bird flow. A total of 988 cases of avian and swine influenza, of which 13% (125/988) were detected by PUE, 49% (483/988) was found by legal reporting, 19% (183/988) was detected by hospitalized pneumonia cases, and.PUE monitoring found that the sensitivity of the target disease was 13%. (2) before the outbreak of H7N9 avian influenza epidemic in 2013 and the period of human infection of H5N1 avian influenza. After the PUE monitoring system reported the.2013 infection of H7N9 and other subtypes of avian influenza, 53% (453/861) cases of avian influenza were reported by the legal report. 18% (159/861) was reported through the monitoring of hospitalized pneumonia cases. Only 9% (78/861) was reported to.3. clinicians for the understanding of the PUE monitoring system through PUE monitoring. Of the 487 clinicians surveyed by the practice survey (1), 83% (403/487) knew the monitoring system, and 83% (326/395) of the clinicians in the monitoring system received PUE monitoring training. It was known that only 9% (35/395) of the PUE case definitions were fully mastered among the doctors in the monitoring system. (2) 51% (250/487) clinicians had discovered the character of the monitoring system. In the case of PUE case, 55% (139/250) found the number of PUE cases in 1-5 cases in the past year, 76% (166/220) reported the patient with the PUE definition. After the clinician reported the case, more than 84% thought the report procedure was simple and easy, the report was beneficial to the diagnosis and treatment, the report was obtained after the report, and the report was related. The timely response of the Department. (3) analysis of the causes of the cases reported by clinicians, 48% (79/166) reports of unidentified cases and poor treatment results; analysis of the causes of unreported cases by clinicians, 36% (30/84) because of the unknowing PUE monitoring work, and not reporting to patients defined in PUE cases to.59% (288/487) clinicians. In order to pay attention to severe pneumonia cases, 49% (238/487) clinicians considered infectious / aggregated cases to be reported to the CDC.4. medical institution PUE monitoring system running status (1), the two hospitals were screened for 2619 cases of acute respiratory tract infection associated with PUE diagnosis, of which 13% (335/2619) met the definition of PUE case. Only 0.3% (1/335) was reported to the local CDC. (2) of the 311 cases of PUE with pathogeny test results, 6% (18/311) test results were positive, and all were seasonal influenza. 61% (11/18) was influenza A virus positive, 39% (7/18) was type B virus (Victoria) positive. (3) the doctor of tube bed did not conform to the case definition. The main reasons for the case report were as follows: 76% I did not know the work of unidentified pneumonia monitoring, and 53% did not understand the case definition. As the years of work increased, the awareness rate of the work was also increased. Conclusion: the positive predictive value of the 1. PUE monitoring system is 8%., which is often found in the early cases of human infection with avian influenza and The report plays a major role in the report, but with the report management of the human infection of avian influenza and the deepening of medical personnel's awareness of the disease, the report of the legal infectious disease, the monitoring of the cases of pneumonia in the hospital and so on as the main way of the case discovery and report, the PUE monitoring system found and reported the known people infected with avian influenza. The role of the type case has gradually weakened.2.. There are a large number of cases with PUE defined in the hospital, but the rate of reporting is low, the ratio of the target pathogen positive in the case with the PUE definition is low, the false positive rate of the case definition is high, the specificity poor.3. clinician is acceptable to the monitoring system, and the monitoring system will also have the intention to report the disease by using this monitoring system. For example, the understanding of the monitoring system is not ideal, and the training work needs to be further strengthened. 1. to strengthen the training of the existing PUE monitoring scheme before the new version of the scheme, so that it can play its due role in the repositioning of the monitoring target of the PUE monitoring system, and to modify the definition of the monitoring case according to the monitoring purpose and improve its discovery. The specificity of target disease cases can improve the compliance of medical staff according to the monitoring plan.
【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】：2017
【分类号】：R563.1;R181.3

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