Objective:To analyze the spatial distribution characteristics of tuberculosis (TB) and to grasp the key areas where TB aggregation occurs in Guangzhou from 2018 to 2021, and to provide evidences for the disease prevention and control measures.Methods:The information of TB patients whose current address was Guangzhou from 2018 to 2021 was collected through the Tuberculosis Management Information System, a subsystem of the Chinese Disease Prevention and Control Information System. Spatial scans were conducted and spatial distribution maps were drawn at the district level to analyze the spatial aggregation of TB.Results:A total of 34 306 cases of TB were reported in Guangzhou from 2018 to 2021. The average annual incidence was 46.46/100 000. There were 22 891 males and 11 415 females, with a male to female ratio of 2.01:1. The highest proportion of young adults, 25-<35 years old, was 23.06% (7 910/34 306). Among the occupations, the proportion of domestic work and non-working was the highest, at 45.77% (15 701/34 306). The ratio of local domicile to floating population was 1.03:1. TB aggregation areas were mainly in the central urban areas including Yuexiu, Haizhu, Liwan, and Tianhe, and the suburban areas including Baiyun and Huangpu. The aggregation areas had extended to the distant suburban areas of Guangzhou such as Zengcheng and Conghua.Conclusions:TB incidence in Guangzhou displays spatial aggregation at the district level, from 2018 to 2021, and mainly in the central urban areas and suburban areas, with a tendency to spread to the distant suburban areas. Surveillance in the key areas should be strengthened, and scientific, objective, and feasible TB prevention and control measures should be carried out.

Objective:To analyze the situation of tuberculosis screening among key groups in Haizhu District of Guangzhou City between 2016 and 2020 "The 13th Five-Year Plan for Tuberculosis Control", evaluate the effectiveness of tuberculosis prevention and control, and provide scientific basis for formulating tuberculosis prevention and control strategies.Methods:By means of retrospective study, sociological and economic evaluation, the screening of family members of patients with etiologically positive tuberculosis, patients above 65 years old, diabetic patients, and close contacts of tuberculosis in schools in Haizhu District of Guangzhou City from January 2016 to December 2020 were analyzed. The count data were compared by χ 2 test. Results:(1)A total of 2 911 cases of pulmonary tuberculosis were registered, 8 714 cases of close family contacts were screened, with a screening rate of 99.86%, and the positive rate was 0.24% (21/8 714). The positive rate of pulmonary tuberculosis in subjects with clinical symptoms was higher than that in subjects without clinical symptoms. (2)A total of 8 606 subjects above 65 years old were screened for suspicious symptoms of pulmonary tuberculosis, with a screening rate of 1.26% (8 606/682 011). A total of 10 472 diabetic patients were screened for suspicious pulmonary tuberculosis symptoms, 4 964 cases were screened by chest radiograph, 211 cases of pulmonary tuberculosis were screened out by symptom screening and chest radiograph, with a positive rate of 1.11% (211/19 078). (3)A total of 3 741 cases of pulmonary tuberculosis were screened for human immunodeficiency virus (HIV), 11 cases of them were positive for HIV, with a positive rate of 0.29% (11/3 741). A total of 6 697 HIV infected patients were screened for pulmonary tuberculosis, with a positive rate of 0.82% (55/6 697). (4)A total of 445 cases of pulmonary tuberculosis were enrolled in schools, 14 304 cases of close contact were screened, with a screening rate of 92.53%, 13 cases of pulmonary tuberculosis were screened out, all of them were students, with a positive rate of 0.09% (13/14 304). (5)Results of sociological evaluation: the reported incidence of pulmonary tuberculosis decreased from 78.04/100 000 in 2016 decrease to 53.76/100 000 in 2020. There were 5 697 cases of pulmonary tuberculosis managed by standardized method, with a standardized management rate of 95.76%; 6 015 cases of pulmonary tuberculosis were successfully treated, with a success rate of 95.31%. (6)Results of economic evaluation: a total of 768 lives were saved in disability adjusted life year (DALY) 63 392, and 60 150-90 225 healthy people were protected from tuberculosis infection. It reduced the number of new cases of infectious pulmonary tuberculosis by 3 008-4 512, avoided the loss of new cases by 31 702-47 551, and recovered the loss of gross domestic product (GDP) by 961 022.72 Yuan.Conclusions:The benefits of tuberculosis screening among key groups in Haizhu District of Guangzhou City have been achieved. The mode of active detection of key groups should be promoted, in order to reduce the spread of tuberculosis and accelerate the decline of tuberculosis epidemic.

目的 分析2014-2020年广州市流动人口肺结核流行特征,为制定流动人口结核病防控策略提供科学依据.方法 通过《中国疾病预防控制信息系统》子系统《结核病信息管理系统》收集广州市2014-2020年流动人口肺结核患者资料,包括年龄、性别、职业、患者发现方式、治疗分类、病原学结果等,分析该类人群的分布特征,应用季节指数对时间序列进行季节效应分析.结果 2014-2020年广州市共登记68 329例肺结核患者,其中流动人口肺结核患者30 692例,占全市患者总数的44.92％,并呈现逐年上升趋势,由2014年的30.81％(3530/11 457)上升至2020年的50.73％(4185/8249)(x2趋势 =441.57,P＜0.01).30 692例患者的中位年龄为33(23,46)岁,年龄以25～34岁为主(32.69％,10 034/30 692),职业以家政、家务及待业为主(45.85％,14073/30 692).患者来源以因症就诊为主(44.22％,13 572/30 692),患者普遍存在就诊延误(47.12％,14 462/30 692).随着年份的变化,户籍类型省内市间流动占比逐年上升,由2014年的25.89％(914/3530)上升至2020年的36.39％(1523/4185)(x2 = 208.57,P＜0.01);患者来源于因症就诊的占比先降后升,由2014年的45.69％(1613/3530)降低至2017年的30.74％(1285/4180),再上升至2020年的57.51％(2407/4185)(x2=971.89,P＜0.01).流动人口肺结核流行期为每年的3～9月,发病高峰为4月和7月.流动人口患者主要集中在白云区和天河区,分别由2014年的13.85％(489/3530)和11.47％(405/3530)上升至2020年的24.64％(1031/4185)和16.94％(709/4185).结论 广州市流动人口结核病疫情依然严峻,流动人口肺结核呈现季节变化规律.患者以男性、青壮年为主,职业以家政、家务及待业为主,具有就诊延误率高的特征,且存在地区分布差异,应针对其流行特征制定相应的防控策略.

目的了解2014-2018年广州市海珠区结核病患者流行特征,为制定结核病防治措施提供依据.方法以2014-2018年《中国疾病预防控制信息系统》的子系统《结核病管理信息系统》(简称“《专报系统》”)中登记的广州市海珠区6555例结核病患者为研究对象,对2014-2018年海珠区结核病年均登记发病情况、不同时间和地区登记患者分布情况,以及人群特征进行统计分析.结果2014-2018年广州市海珠区共登记结核病患者6555例,年均登记发病率为79.86/10万(6555/8 208 100),其中户籍人口结核病患者共3529例,年均登记发病率为68.77/10万(3529/5 131 400),非户籍人口结核病患者共3026例,年均登记发病率为98.35/10万(3026/3 076 700).2014-2018年全区平均登记率分别为93.70/10万(1499/1 599 800)、85.08/10万(1373/1 613 700)、82.85/10万(1357/1 637 900)、73.12/10万(1216/1 663 100)、65.54/10万(1110/1 693 600),呈下降趋势(x2趋势=96.33,P=0.000).2014-2018年海珠区结核病以4月和9月登记患者例数较多,分别为631例(9.63％,631/6555)和605例(9.23％,605/6555).全区各街道均有登记患者,最高为南洲街,年平均登记率为136.99/10万(754/550 411);最低为南石头街,年平均登记率为57.26/10万(336/586 848).全区男性患者4545例,女性患者2010例,男∶女=2.3∶1;全区结核病患者以25～34岁年龄组为主,占21.88％(1434/6555),但户籍人口以55～64岁年龄组为主,占21.82％(770/3529);职业分布全区以家务及待业患者最高,占45.98％(3014/6555).结论2014-2018年广州市海珠区结核病疫情呈逐年下降趋势,疫情控制工作取得一定的成效,男性、25～34岁年龄组、南洲街、家务及待业人群是结核病防治的重点人群.

为探讨首次复治耐多药肺结核(MDR-PTB)患者行短程与标准化治疗的疗效并进行对比分析,作者收集了2009年3月至2014年3月广州市胸科医院门诊部诊治的既往有结核病病史、无基础疾病及严重并发症、曾仅给予常规一线抗结核药物治疗超过1个月、经实验室检测确诊的首次复治菌阳肺结核患者236例.将患者依就诊时间先后分为A、B组,各118例,两组患者分别进行耐多药筛查,共36例患者确诊为MDR-PTB,其中A组患者(21例)给予复治短程化疗方案[(2～3) H-R-Z-E-S/6 H-R-E,简称“短程组”],B组患者(15例)给予耐多药结核病标准复治方案[6Am-Z-Lfx-PAS(Cs)-Pto/18Z-Lfx-PAS(Cs)-Pto,简称“标准组”].分析两组患者治疗后的近远期临床疗效(包括痰菌阴转率、病灶吸收、药物不良反应及治疗转归).两组间计数资料的比较采用Fisher确切概率法检验.结果显示,短程组治疗9个月末时的痰菌阴转率(85.7％,18/21)较标准组(46.2％,6/13)明显提高(P=0.017),但在疗程结束时短程组和标准组的痰菌阴转率[85.7％(18/21)和84.6％(11/13)]、病灶显著吸收率[47.6％(10/21)和23.1％ (3/13)]、空洞闭合率[25.0％(3/12)和18.2％(2/11)]、治疗成功率[76.2％(16/21)和53.8％(7/13)]、失败率[23.8％(5/21)和46.2％(6/13)]差异均无统计学意义(P值分别为0.373、0.109、0.360、0.122、0.122).两组患者治疗过程中均未发生严重药物不良反应而暂停治疗,标准组中有1例出现药物性肝损伤经保肝治疗后缓解,5例出现尿酸升高因无关节疼痛症状未予处理;短程组中有4例出现尿酸升高,仅1例因关节疼痛给予对症治疗后好转,2例患者出现胃肠道反应经调整服药次数后缓解.提示复治短程化疗方案治疗首次复治MDR-PTB的临床近期疗效优于耐多药结核病标准化疗方案,但远期疗效差异无统计学意义.基于前者具有疗程短、药品便宜且易获得、严重药物不良反应无增加等特点,建议对于首次复治MDR-PTB患者首选复治短程化疗方案.

目的:探讨分析激素在不同年龄段结核性胸膜炎患者的临床疗效.方法:回顾性分析152例结核性胸膜炎患者,其中青年患者84例,中年患者45例,老年患者23例,在进行常规治疗的基础上均应用强的松,比较三组年龄段患者的临床治疗效果.结果:中老年组胸膜炎患者治疗后胸水消退较慢,易出现胸膜肥厚,治疗有效率低于青年组.结论:应用激素联合常规疗法治疗结核性胸膜炎的临床疗效显著,针对不同年龄段患者选择个体化治疗方案,早期抗痨治疗,联合激素的合理应用,可取得较好的临床疗效.

Objective To investigate the interaction between rifampin(RFP)and levofloxacin(LVFX)in retreatment of smear positive pulmonary tuberculosis(TB). Methods One hundred retreated smear positive TB patients admitted to our hospital between January 2013 and December 2015 were randomly divided into two groups:the control group in 50 patients with only RFP treatment,and the treatment group in 50 patients with both RFP and LVFX treatments. The RFP plasma concentration was tested 0.5 h,1 h,and 2 h after intake of medicine. Sputum smear test was performed at the end of February,May,August and September to investigate the interaction between RFP and LVFX in retreatment of smear positive TB. Results The plasma concentration of RFP did not show significant difference(P > 0.05)between the control group and the treatment group at 0.5 h,1 h,and 2 h after intake of medicine. As the treatment time went on,the level of smear positive gradually decreased. The sputum smear positive rate after 2,5,8,and 9 months of treatment showed significant difference between the control group and the treatment group. After 8 months of treatment,the ratio of stabilized patients and patients under treatment also showed significant difference(P<0.05). Conclusion Rifampicin and levofloxacin have no antagonism effect in retreatment of smear positive TB,and RFP and LVFX can be used together to treat the repeated smear positive TB.

Objective To investigate the screening and treatment for mycobacterium tuberculosis (Mtb)/human immunodeficiency virus(HIV)co-infection in the Guangzhou. Methods 13697 cases of tuberculosis and 9093 cases of HIV-infected or AIDS were collected and analyzed by two-way screening in six administrative regions of Guangzhou between 2013 and 2014. Prognosis of the patients treated for Mtb/HIV co-infection was also followed. Results Among patients with pulmonary tuberculosis registered from 2013 to 2014 ,the HIV antibody test rate was 18.77%(2571/13926),and 0.19%(5/2571) was positive. The detection rate of reachable patients with HIV/AIDS screened for tuberculosis was 1.87%(170/9093). Of those,past-registered patients with HIV/AIDS were statistically different from newly-registered ones on the tuberculosis positive rate(χ2=9.333,P<0.01);the two-way detection rate of Mtb/HIV co-infection was statistically varied between HIV/AIDS patients and tuberculosis patients (χ2=38.055,P<0.01). The cure rate for initial and retreated smear-positive pulmonary tuberculosis of the Mtb/HIV co-infected patients were 69.23%and 42.86%,respectively;the total treatment success rate and total mortality rate were 72.05% and 8.70%,respectively. Conclusions Two-way screening of Mtb/HIV infection is the main way to discover the co-infection of Mtb/HIV. The anti tuberculosis organization and the anti epidemic organization should strengthen their cooperation to improve the success rate of treatment for the Mtb/HIV co-infected patients.

目的 了解广州市海珠区在校学生结核病核心知识知晓率现状、对结核病态度及相关行为,为进一步加强学校结核病健康教育工作提供依据.方法 采用分层整群随机抽样的方法随机选取海珠区内6所学校268名学生进行问卷调查,采用描述性分析、卡方检验.结果 学生结核病知识总知晓率为76.4％,女生结核病知识知晓率比男生高,高中生比大学生和初中生高,市内学生比市外学生知晓率高;户籍是市内的学生更愿意去了解结核病,女生比男生高,市内比市外的学生更加愿意成为志愿者;对于出现结核病疑似症状,大学生更为主动地寻求医生帮助,女学生在自己得了肺结核后会更加主动提醒周围人去检查.结论 学生对结核病的总知晓率仍偏低,以后的结核病健康教育应进一步针对学生的不同特征采取更合适的方式进行宣传,提高学生对结核病的知晓率,促使其形成正确的态度和行为.

目的 探讨以循证依据的个案管理对提高耐药肺结核患者治疗依从性的影响.方法 选择78例耐药结核患者为研究对象,随机抽样分为观察组和对照组,观察组采取循证个案管理进行护理干预,对照组按护理常规进行护理.结果 观察组治疗依从性、按时复查率、痰菌转阴率、治愈率显著优于对照组(P＜0.05).结论 循证护理可以提高治疗依从性和临床效果,从而降低患者的医疗费用,提高耐药结核患者的护理质量.

目的 了解广州市涂阳肺结核患者(以下称“指示患者”)家庭密切接触者中活动性肺结核检出情况及有关影响因素.方法 采用整群分层随机抽样方法抽取广州市6个区的2011年1月至2011年12月在广州市结核病防治所登记的涂阳肺结核患者家庭密切接触者5664名进行结核病筛查现况调查,接受结核病筛查的家庭密切接触者5206名,对＜15岁的家庭密切接触者629名进行结核菌素纯蛋白衍生物(BCG-PPD)皮肤试验,其中结核菌素反应硬结平均直径≥15 mm或伴有水泡或溃破等强阳性反应的儿童144名;对≥15岁人群4577名拍摄胸片,胸片提示肺部有异常阴影者进行痰涂片和痰培养检查,用SPSS 16.0软件统计分析,计数资料及率的比较采取x2检验,P＜0.05为差异有统计学意义.结果 指示患者家庭密切接触者中活动性肺结核患者检出率为3.6％(187/5206),痰涂片阳性患者检出率为0.7％(36/5206),痰菌阳性患者检出率为1.3％(66/5206).629例15岁以下儿童BCG-PPD皮肤试验一般阳性和中度阳性的485名,强阳性144名,BCG-PPD皮肤试验强阳性儿童活动性肺结核检出率5.6％(8/144).指示患者家庭密切接触者中,男、女性活动性肺结核患者检出率分别为3.7％(86/2348)和3.5％(101/2858),差异无统计学意义(x2=0.062,P＞0.05).与指示患者是夫妻、父母或兄弟姐妹关系的密切接触者检出率分别为4.4％(74/1675)、4.3％(34/794)和5.7％(29/507),与指示患者是儿女或其他关系的检出率分别为2.4％(40/1682)和1.8％(10/548),不同关系组比较差异有统计学意义(x2=23.119,P＜0.01).初治指示患者家庭密切接触者检出率3.9％(160/4131),比复治指示患者家庭密切接触者检出率2.5％(27/1075)高,两组比较差异有统计学意义(x2=4.566,P＜0.05).结论 涂阳肺结核患者家庭密切接触者筛查是主动发现肺结核患者的有效手段,特别是初治指示患者的家庭密切接触者需更加注意,与指示患者是夫妻、父母或兄弟姐妹关系者是结核病筛查的重点.

目的 探讨循证护理在社区流动人口结核病人用药问题中的应用,以提高病人的服药依从性.方法 根据流动人口结核病患者的特点、服用抗结核药物应具备的知识,提出问题,检索中国医院数字图书馆、万方医学网及中国知网等数据库和手工检索有关医学期刊、专著,查找高质量的护理证据,并根据病人实际情况及循证证据制定针对性的护理干预措施.结果 纳入相关文献资料证据表明:①大多数流动人口坚持治疗决心相对较差,与其对疾病的认知水平低,对知识的接受能力差,经济收入低下及无医疗保障有关;②肺结核治愈的关键是全程、规律服药,患者能否坚持规律用药,与其对肺结核病知识的了解程度有密切关系;③常用抗痨药物大都有不同程度的不良反应,药物副反应高是患者未能坚持疗程的主要原因之一;④服药依从性低可导致肺结核治疗的失败,使初治者产生耐药性,从而使初治者变为复治者,甚至不能治愈,成为社会的传染源[1].综合文献信息并结合患者具体情况,全疗程实施有针对性的用药指导,循环互动式健康教育,患者遵医嘱按时复查、主动配合治疗等方面循证护理组均显著优于常规组.结论 将循证护理应用到流动人口结核病人的用药指导中,可提高病人对抗痨药物的认知水平及药物不良反应的应对能力,更好地完成整个治疗疗程,从而提高流动人口结核病人的遵医行为.

目的分析广州市海珠区落实相关强化措施后,肺结核疑似患者转诊及追踪的效果。方法以实施强化措施的2011年疑似病例为研究组,实施前2010年疑似病例为对照组,分析比较实施前后肺结核患者的转诊及追踪变化情况。结果实施后肺结核患者转诊到位率是57.09%,追踪到位率是90.03%,均较实施前有显著提高(p<0.05)。结论通过强化管理制度的落实,加强行政管理力度,加强非结防机构转诊追踪工作的宣传、培训和考核,能提高结核病的转诊和追踪效果,有利于结核病控制工作的开展和深入。

目的 分析广州市海珠区落实相关强化措施后,肺结核疑似患者转诊及追踪的效果.方法 以实施强化措施的2011年疑似病例为研究组,实施前2010年疑似病例为对照组,分析比较实施前后肺结核患者的转诊及追踪变化情况.结果 实施后肺结核患者转诊到位率是57.09%,追踪到位率是90.03%,均较实施前有显著提高(p<0.05).结论 通过强化管理制度的落实,加强行政管理力度,加强非结防机构转诊追踪工作的宣传、培训和考核,能提高结核病的转诊和追踪效果,有利于结核病控制工作的开展和深入.

Objective To investigate the tuberculosis (TB) knowledge among the floating population in Guangzhou, in order to provide basis for health education of tuberculosis knowledge among floating population. Methods A self-administrative questionnaire survey was conducted among the floating population diagnosed with TB in first visit in Guangzhou Chest Hospital from Oct. 1st to Dec. 30th, 2010. Results Overall awareness rates on TB relevant knowledge among surveyed people were 59. 75 %. The majority of them knew the infectivity, transmission routes and curability of TB, while less of them knew the main symptoms and free policies on TB. The scores of TB relevant knowledge were lower in age group ≥40(Z= -2. 016, P =0. 044) and in group with low educational levels (Z = - 2. 604, P = 0. 009 ) . Logistic regression analysis identified that the age factor had significant influence on scores of knowledge( OR =0. 306,P = 0.027). Conclusion There was little knowledge about TB in Haizhu District, Guangzhou, and it is important to provide health education widely and effectively.

Objective To observe the influences of smoking cessation on curative effects of pulmonary tuberculosis and provided highlights for health education of pulmonary tuberculosis. Methods 424 case with new pulmonary tuberculosis from Jul.2009 to Jun.2010 as study object,were divided into smoking cessation groups,smoking groups,and no smoking groups.Compare the difference of the curative effects of the three groups. Results In smear positive patients,the rates of sputum smear negative conversion at the end of 2th months is 85.7%,67.6%,and 89.1%,there was significant difference between smoking cessation groups and smoking groups(p=0.040),and there was no difference between smoking cessation groups and no smoking groups(p=0.519). Conclusion Smoking cessation can increase the rates of sputum smear negative conversion at the end of 2th months,and the health education about smoking cessation need to be enhanced.

目的 分析广州市海珠区肺结核防控措施中,实施激励机制(营养和交通补贴)对流动人口肺结核患者依从性及治疗情况的影响,为进一步制定推广结核病的防控补贴措施提供参考.方法 对广州市海珠区结核病防治所2009年1月-2010年12月期间登记流动人口肺结核痰菌阳性的患者共575例,以签约方式将病人分为A、B两组.A组是:签约同意在本所规律治疗、查痰,按规定完成整个疗程,享受激励机制补贴的流动人口涂阳肺结核患者,共335例;B组是:不确定在本所规律治疗、查痰、完成整个疗程,放弃激励机制补贴的流动人口涂阳肺结核患者,共240例.对结核病人登记本、月报、季报、年报以及相关结核病人登记管理卡和流动人口肺结核患者交通/营养费补助领取单进行资料整理和分析.结果 A组初治和复治患者的服药依从性分别达到92.64%和94.44%,复查依从性分别达到90.97%和91.67%,2个月末痰菌阴转率分别达到90.30%和88.89%,均超过了结控对结核病人管理的要求指标.B组初治和复治患者的服药依从性分别为84.54%和75.76%,复查依从性分别为77.29%和72.73%,2个月末痰菌阴转率分别为87.92%和78.79%.结论 激励机制对流动人口肺结核患者依从性有激励作用,能提高肺结核患者规则治疗率,从而达到提高结核病的管治疗效,应加以进一步推广.