浙江省衢州市农村老年人肺结核主动筛查效果分析

祝平; 徐冰俊; 方春福; 郝晓刚; 王炜; 张幸

doi:10.3784/jbjc.202207180327

浙江省衢州市农村老年人肺结核主动筛查效果分析

Effect of active screening of pulmonary tuberculosis in the elderly in rural area in Quzhou, Zhejiang

摘要

摘要:
目的分析浙江省衢州市开展农村老年人群肺结核主动筛查效果。
方法 2020年通过对浙江省衢州市6个县（市、区）89个乡镇持续居住6个月及以上且满65周岁本市常住人口开展居民健康体检时利用胸部数字影像（DR）检查，胸片诊断为疑似肺结核病例转诊定点医院进行确诊，并追踪落实诊断结果的主动筛查方法，收集其筛查的统计报表和病例个案调查表，获取老年人群肺结核筛查情况与检出率情况。
结果 2020年符合要求的体检对象共计311385人，接受居民健康体检187065人，完成居民健康体检和胸部DR检查者共186096人，筛查率为59.76%（186096/311385），女性筛查率（64.22%，98652/153606）高于男性（55.42%，87444/157779），差异有统计学意义（χ²=2507.786，P=0.001）；70～岁年龄组筛查率最高（82.82%），≥85岁年龄组最低（37.95%），随年龄增长呈下降趋势，差异有统计学意义（趋势χ²=6510.086，P=0.001）；不同地区筛查率常山县最高（80.75%，30199/37396），柯城区最低（35.47%，21596/60889），发现活动性肺结核患者174例，检出率93.50/10万（174/186096），检出率男性（160.10/10万，140/87444）明显高于女性（34.46/10万，34/98652），差异有统计学意义（χ²=78.331，P<0.001）；常山县检出率最高（175.50/10万，53/30199），龙游县最低（28.97/10万，8/27613），差异有统计学意义（χ²=39.904，P=0.001）；不同年龄组检出率比较，差异无统计学意义（χ²=1.775，P=0.777）。
结论浙江省衢州市高疫情地区居民健康体检时整合胸部DR检查开展农村老年人肺结核主动筛查可推广使用，但筛查率和检出率偏低，需要根据当地疫情人群高危因素优化筛查策略。

Abstract:
Objective To analyze the effect of active pulmonary tuberculosis screening in rural elderly population in Quzhou, Zhejiang province.
Methods In 2020, chest digital radiography (DR) was conducted in the health examination for the elderly who were aged ≥65 years and had local residence for consecutive 6 months in 89 townships of 6 counties (districts) of Quzhou. The suspected pulmonary TB cases by the examination were referred to designated hospitals for diagnosis. The information about active screening and case survey were collected to understand the coverage of the active screening and the detection rate of pulmonary TB in elderly population.
Results In 2020, a total of 311 385 persons met the requirements for health examination, in whom 187 065 received health examination, and 186 096 completed health examination and chest DR. The screening rate was 59.76% (186096/311385), and the screening rate was higher in women (64.22%, 98652/153606) than in men (55.42%, 87444/157779), the difference was significant (χ²=2507.786, P=0.001). The screening rate was highest in age group 70– years (82.82%) and lowest in age grtoup ≥85 years (37.95%), and showed a downward trend with age, the difference was significant (trend χ²=6510.086, P=0.001); The screening rate was highest in Changshan county (80.75%, 30199/37396) and lowest in Kecheng district (35.47%, 21596/60889), the difference was significant (χ²=46983.142, P=0.001). A total of 174 active pulmonary tuberculosis cases were detected with a detection rate of 93.50/100 000 (174/186096), and the detection rate was significantly higher in men (160.10/100 000, 140/87444) than in women (34.46/100 000, 34/98652), the difference was significant (χ²=78.331, P<0.001). The detection rate was highest in Changshan county (175.50/100 000, 53/30199) and lowest in Longyou county (28.97/100 000, 8/27613), the difference was significant (χ²=39.904, P=0.001). The differences in detection rate among different age groups had no significance (χ²=1.775, P=0.777).
Conclusion The active screening of pulmonary TB by chest DR in rural elderly in their health examination can be widely used in areas with high incidences of pulmonary TB, but the screening rate and detection rate need to be increased, and the screening strategy need to be improved according to the high-risk factors in local population.

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