采用中国疾病预防控制中心结核病参比实验室2009年设计的全国结核病实验室调查表,对2010、2015和2018年北京市市级及区(县)级结核病防治机构(简称“结防机构”)实验室专业技术人员人力资源相关信息、实验室仪器设备及病原学检查开展项目等信息进行调查,并对调查结果进行对比分析.共发送调查表55份,回收55份调查问卷,有效问卷率为100.0％.2010、2015和2018年北京市结防机构实验室人力资源情况:(1)在性别方面,男∶女分别为1∶2.8(16/44)、1∶3.4(15/51)、1∶2.4(23/55);(2)从事相关工作＞5年人员分别为73.3％(44/60)、65.2％(43/66)和69.2％(54/78);(3)职称构成方面,各年均为以初级职称人员比例最高,分别占56.7％(34/60)、62.1％(41/66)和51.3％(40/78);(4)专职人员分别占78.3％(47/60)、74.2％(49/66)和88.5％(69/78).2010年北京市全部实验室均配备生物安全柜,全部结防机构实验室可以进行抗酸杆菌涂片及培养检测,市结防所具备开展药物敏感性试验的能力;2015年市结防所即具备了分子生物学临床诊断的能力;2018年北京市各级结防机构大力发展分子生物学诊断技术,GeneXpert MTB/RIF检测覆盖率为100.0％(19/19).可见,北京市各级结防机构实验室人力资源的现状表现为人员数量增长缓慢、中高级职称比例较低、专职人员比例较高.北京市各级结防机构实验室目前仪器配置及病原学检查项目开展可以满足国家的要求.

Objective To evaluate the efficacy of the new treatment regimen versus the standardized scheme for the initial treatment of smear-positive tuberculosis in the elderly.Methods A total of 302 elderly patients meeting the inclusion and exclusion criteria were selected from 14 tuberculosis-designated medical institutions in Beijing.The patients received the initial treatment of smear-positive tuberculosis from January 2014 to August 2016 in the combined prospective and retrospective study.All patients were divided into observation group(n=63)receiving treatment with 6L2 HELfx regimen from August 1,2015 to August 31,2016,and control group (n =239) receiving treatment with 6L2HELfx regimen from January 1,2014 to January 31,2015.The nation-unified standard chemotherapy regimen 2RHZE/4RH was used in tuberculosis medical service institutions for all patients.The differences between the two groups were analyzed and compared in the completion of treatment,negative conversion of sputum culture or smear,adverse drug reactions and treatment outcome.Results The completion rate of long-course therapy was significantly higher in the observation group than in control group [90.5％ (57/63) vs.79.5％ (190/239),x2 =4.034,P =0.045].The rate of negative conversion of sputum culture or smear at the end of the 2nd month was higher in the observation group than in control group,but had no significant difference[87.0％ (47/54)vs.81.6％(155/190),x2 =0.879,P=0.349].The incidence of adverse reactions was much lower in observation group than in control group[46.0％ (29/63) vs.65.3％ (156/239),x2 =7.777,P =0.005].The success rate of treatment(cure or completion of long-course therapy)was higher in observation group than in control group [90.5％ (57/63) vs.77.4％ (185/239),x2 =5.350,P =0.021].ConclusioNS As compared with the standard chemotherapy regimen,the L and Lfxcontaining treatment regimen has better effects,higher success rate of treatment and less adverse reactions in elderly patients with the initial treatment of smear-positive tuberculosis.

目的 分析一起学校聚集性结核病疫情,探讨在疫情处置中对接触者进行胸片随访的意义.方法 2016年3月17日至4月17日,北京市大兴区某职业培训学校共发现活动性肺结核患者21例,构成聚集性结核病疫情.疫情发生后,对全校3490名师生进行了结核菌素(PPD)皮肤试验及胸部X线摄影筛查.对筛查发现的65例胸片异常者进行了3次痰涂片及2次痰分枝杆菌培养,确诊患者39例;对313例单纯PPD皮肤试验强阳性者,进行预防性化学治疗.为及时发现续发患者,确定疫情3个月后对全校除活动性肺结核患者以外的师生进行第1次胸部X线摄影随访.此后,疫情处置中又开展了3次胸部X线摄影随访,问隔时间分别为3个月、6个月、8个月.在每次随访时,打印出本次确诊患者胸片,与其以往胸片(电子版)进行比较,观察其肺内病灶是否有变化或遗漏,并做好相关记录.采用SPSS 18.0软件对数据进行统计学分析,计数资料的比较采用x2检验,以P＜0.05为差异有统计学意义.结果 至结案时,本次疫情共发现活动性肺结核患者162例.疫情发生时患者的发现率为1.7％(60/3490),随后进行的4次胸片随访的患者检出率分别为1.6％(50/3031)、0.7％ (19/2650)、0.8％(15/1860)和0.2％(2/1134).疫情发生3个月后第1次胸部X线摄影随访时,活动性肺结核患者的检出率明显高于其他3次随访,差异有统计学意义(x2 =23.73,P＜0.05).4次胸部X线摄影随访共确诊延迟发现患者17例,在疫情发生3个月后进行第1次胸部X线摄影随访时发现15例,在第2次和第3次胸部X线摄影随访时,延迟发现患者均为1例,第4次胸部X线摄影随访时无延迟发现患者.延迟发现率分别为30.0％(15/50)、5.3％(1/19)、6.7％(1/15)和0.0％.第1次胸部X线摄影随访时患者的延迟发现率明显高于其他3次,差异有统计学意义(x2=7.89,P＜0.05).结论 学校聚集性结核病疫情发生后进行胸片随访,尤其在疫情发生3个月后,可及时发现新发患者及遗漏诊断患者,有效控制疫情发展,在较为严重的学校结核病疫情处置过程中是一种非常有效的手段.

Objective To evaluate the implementation situation of tuberculosis (TB) infection control meas ures in the health institutions,in order to understand the status of TB infection control in China and to provide reference for making relevant policies and measures.Methods Four provinces in the eastern,central and western regions of China respectively were selected by the purposive sampling.And a total of 241 health institutions in 12 provinces were chosen as research site." TB infection control questionnaire for TB preventive and control institution" was designed according to the "Chinese TB infection prevention and control manual" and "Chinese TB infection control standard operating procedures".The situation of TB infection control was investigated by the questionnaire.Results Among the 241 health institutions,80.1％ (193/241) and 89.6％ (216/241) of the institutions respectively had TB infection control regulations and TB referral mechanism.Only 24.5 ％ (59/241) of institutions had the special funds for TB infection control.Only 33.2％ (80/241) of institutions had evaluated the layout design for TB infection control.Only 48.1％ (116/241) of institutions arranged the patients with cough symptoms to separate waiting area.Only 29.9％ (72/241) of the institutions took relevant measures to shorten the time of TB patients staying in the institutions.43.9％ (93/212) and 40.4％ (40/99) of the institutions had mechanical ventilation devices in 212 health institutions with TB outpatient and 99 health institutions with TB ward respectively.The proportion of the health care workers who wore medical protective masks (N95) when they collected sputum specimens and worked in TB outpatient was 66.4％ (160/241) and 66.5％ (141/212) respectively.And only 13.7％ (33/241) of the institutions could implement fit-test regularly for the medical protective masks (N95).Conclusion The investment of TB infection control in health institutions was inadequate,and the relevant control measures was not implemented well in China.It was needed to enhance the monitoring and evaluation of TB infection control in partition of waiting and visiting,ventilation and disinfection,and medical protective masks (N95) for health care workders,and so on.

目的 了解“知信行”理论在我国结核病防治领域应用现状及存在的问题.方法 采用系统综述的方法,检索2015年5月前我国以中文形式发表的“知信行”在结核病防治领域应用的文献并进行描述性分析.检索数据库为“中国知网(CNKI),万方数据库,维普中文科技期刊数据库”,通过主题词检索,共查到文献1789篇.按照纳入与排除标准最终纳入文献144篇.结果 本研究纳入文献起自1999年,2007年前共发表13篇,占9.03％(13/144);2007年增至14篇,占9.72％(14/144);2009年达高峰,为23篇,占15.97％(23/144);此后出现下降趋势,至2013年再次上升.研究内容以了解“知信行”现状为最多,有62篇,占43.06％(62/144).可分出知识、态度或信念、行为(即“知信行”)三类题目者106篇,占73.61％(106/144);仅包括一类或两类题目者28篇,占19.44％(28/144);未介绍或仅介绍部分题目者10篇,占6.94％(10/144).“知信行”三类问题间具有相关性者57篇,占53.77％(57/106);采用“知信行”理论进行行为研究者22篇,占38.60％(22/57),占纳入文献总数的15.28％(22/144).结论 2007年是“知信行”在我国结核病防治领域研究文献发表的分界点,已发表文献中大部分文献未设定知、信、行三类问题或问题间元相关性,仅少量文献采用“知信行”理论进行了行为研究.

目的 对荧光显微镜检测抗酸杆菌的应用进行评价.方法 5个结核病专业诊疗机构共收集2157份标本,每份标本均采用荧光染色(FS)、萋-尼染色(Z-N染色)镜检.其中1245份标本同时进行传统培养检查,并且以培养结果为最终的金标准,计算FS和Z-N染色镜检方法的敏感度、特异度和正确指数[正确指数=(敏感度+特异度)-1=1-(假阴性率+假阳性率)].所有结果采用SPSS 17.0统计软件完成配对x2检验,以P＜0.05为差异有统计学意义.结果 全部标本荧光染色镜检阳性率为10.8％(234/2157),萋-尼染色镜检阳性率为8.8％(190/2157),两种镜检方法阳性率差异有统计学意义(x2=25.473,P＜0.001).初诊标本经荧光染色镜检的阳性率为15.9％(179/1127),萋尼染色阳性率为13.2％(149/1127),荧光染色镜检检出抗酸杆菌的能力较萋-尼染色高20.1％;两种镜检方法检查初诊标本的阳性率,差异有统计学意义(x2=18.000,P＜0.001).同时完成涂片和培养的标本,荧光染色镜检阳性率13.8％(172/1245),培养阳性率15.2％(189/1245),两者比较差异无统计学意义(x2=2.173,P=0.140).同时完成涂片和培养的初诊标本,荧光染色镜检阳性率16.4％％(128/781),培养阳性率19.7％(154/781),分离培养阳性率较荧光染色阳性率高20.3％,差异有统计学意义(x2=7.861,P＜0.01).荧光染色镜检的敏感度为60.3％(114/189)、特异度为94.5％(998/1056),假阴性率为39.7％(75/189)、结果正确指数为0.548,萋-尼染色镜检相应指标分别是56.6％(107/189),97.1％(1025/1056),43.4％(82/189)和0.537.结论 与萋-尼染色镜检比较,荧光染色镜检具有更高的敏感度和很好的特异度;能够提高工作效率,降低工作强度,适合在工作量较大、人力资源紧张的基层实验室开展.

Objective To describe drug resistance spectrums of tuberculosis(TB)isolates from multidrug-resistant tuberculosis(MDR-TB)suspects,to assess the treatment effect of domestic drug group of MDR-TB and to explore the MDR-TB control strategy which is applicable in Beijing.Methods During the period of April 2008to March 2013,1124MDR-TB suspects were detected by sputum culture in 21 651patients with active tuberculosis.Drug susceptibility test(DST)was applied to the microbe-positive cultural substances of 885 MDR-TB suspects with strains of Mycobacterium tuberculosis complex,277diagnosed MDR-TB patients were treated by domestic drug prescription,and the treatment management methods were selected according to the patient's situation,and the adverse effect and therapeutic effect were observed.Results During the 5years of implementation,MDR-TB patients accounted for 32.1%(284/885)of the MDR-TB suspects with Mycobacterium tuberculosis strains.The proportion of the strains which were sensitive to both the first and the second-line drugs were 21.4%(133/620).Because 7MDRTB patients conducted DST again during treatment,there were actually 277 MDR-TB patients detected.Classified management methods were applied to the 277MDR-TB cases,127cases(45.9%)were treated with the second-line drugs in TB control institutes,among whom 76cases(59.8%)had side effects.The cure rate of the 93 MDR-TB patients who had treatment outcomes were 63.4%(59/93).The proportions of MDR-TB patients maintained the original treatment regimen or referred to a specialized hospital were 17.7%(49/277)and 13.0%(36/277).Conclusion It is essential for the suspected MDR-TB to conduct DST timely to,get early detection of MDR-TB cases and to develop an appropriate treatment regimen to control the spread of multi-drug resistant TB.The classified management for MDR-TB patients gets the ideal effect.

Objective To explore the status and effect of standard treatment regimens of retreatment pulmonary tuberculosis patients in Beijing.Methods This was a retrospective study.The bacteriologically confirmed retreated pulmonary tuberculosis cases registered from 2009 to 2010 in Beijing were enrolled and divided into rifampin-sensitive(138 cases) and rifampin-resistant(39 cases)groups,according to the results of drug susceptibility test.The cases in each group were divided into isoniazid-sensitive and isoniazid-resistant groups.There were 114 cases sensitive to both isoniazid and rifampin,24 resistant to isoniazid and sensitive to rifampin,12 sensitive to isoniazid and resistant to rifampin,and 27 resistant to both isoniazid and rifampin.Standard treatment regimens(2HRZES/6HRE)were applied,and the effect was retrospectively analyzed.Results In isoniazid-sensitive and resistant groups,the sputum conversion rates were 92.9%(117/126)and 66.7%(34/51),and the treatment success rates were 87.3%(110/126)and 60.8%(31/51)respectively.There was no statistical significant difference in the sputum conversion and the treatment success between two groups(χ2 MH value were 2.183 and 1.974,both PMH value >0.05).In rifampin-sensitive and resistant groups,the sputum conversion rates were 94.2%(130/138) and 53.8%(21/39),and the treatment success rates were 88.4%(122/138) and 48.7%(19/39) respectively.The differences in the sputum conversion and the treatment success between two groups were statistical significant(χ2 MH values were 16.199 and 12.686,both PMH value <0.001).Conclusion The effect of standard regimens of rifampin-sensitive pulmonary tuberculosis has been approved,while the rationality of applying standard regimens to those rifampin-resistant cases needs to be discussed.

Objective This study aims to summarize the evidence on the prevalence of tuberculosis(TB) disease among health care workers(HCWs),and to evaluate its associated factors.Methods According to purposive sampling method,select 22 health institutions in Beijing,Inner Mongolia and Shanghai.Analyze data collected from HCWs who were investigated by questionnaires about TB infection control status between October and December in 2010.Results A total of 5235 HCWs were investigated,the annual TB prevalence is 664.76/100 000(174/26 175) and the annual prevalence of smear-positive TB is 191.02/100 000(50/26 175).The result of logistic regression analysis indicates that male(Adjusted OR=1.9,95%CI=1.3-2.7,P<0.05)、working in TB institutions(Adjusted OR=1.8,95%CI=1.1-2.8,P<0.05)or lung hospitals(Adjusted OR=2.5,95%CI=1.1-3.6,P<0.05)、working in TB out-patient(Adjusted OR=2.3,95%CI=1.3-4.1,P<0.05)、the time of close contact with TB patients up to 15 hours per week(Adjusted OR=2.2,95%CI=1.1-4.3,P<0.05)、without the system of TB infection control(Adjusted OR=1.7,95%CI=1.2-2.3,P<0.05)、smoke(Adjusted OR=2.8,95%CI=1.2-2.9,P<0.05) can increase the risk of Mycobacterium tuberculosis infection.Conclusion The prevalence of TB in HCWs investigated was high,which indicates that the TB infection control measures are not enough.There is a need to strengthen the TB infection control practice to lower the Mycobacterium tuberculosis infection.

Objective To understand the condition of the second-line drug susceptibility testing in multidrug-resistant tuberculosis(MDR-TB) patients in Binzhou city from 2009 to 2011 and to provide evidences for making the treatment regimens.Methods The absolute concentration method was used in drug susceptibility testing with 4 kind of second-line anti-TB drug in 41 confirmed MDR-TB cases.Results In 41 MDR-TB cases,14.6% was resistant to KM,9.8% was resistant to AMK,7.3% was resistant to LFX and 4.9% was resistant to CPM.65.9% of the MDR-TB strains were sensitive to the 4 kind of second-line anti-TB drugs,and XDR-TB accounted for 2.4%.Conclusions The second-line anti-TB drug susceptibility testing will help us to make the standard individual treatment regimens for the MDR-TB patients.

Objective To evaluate the clinical diagnostic value of real-time FQ-PCR assay for the detection of Mycobacterium tuberculosis(MTB)/non-tuberculous mycobacteria(NTM). Methods 420 specimens were detected by real-time FQ-PCR,and the results were compared with those of AFB smear and culture. Results The sensitivity of FQ-PCR was 48.5%,in which the sensitivity in bacterium-positive and bacterium-negative specimens were 95.8% and 14.5%,respectively.The specificity,positive predictive value and negative predictive value of FQ-PCR were 99.3%,99.1% and 55.5%,respectively.1 of 388 sputum specimens was NTM-positive by FQ-PCR,which was confirmed by DNA sequencing.32 NTM isolates were confirmed by FQ-PCR and DNA sequencing.Their accuracy was 100%. Conclusions The real-time FQ-PCR was a simple,rapid and specific assay for the detection of Mycobacterium tuberculosis/non-tuberculous mycobacteria in a sealed tube.

Objective To understand the implementation status of "Handbook of Chinese control and prevention of TB infection" in four health-care facilities. Methods Data was collected through " Monitoring and evaluation form of TB infection control in health care facilities" which is a supplement of the handbook and analysis was made on the data. Results Six doctors and nurses fell ill with TB in three health-care facilities with sick records from 2005 to 2009.In four health-care facilities,only one and two facilities conducted regular monitoring and maintenance of ventilation equipment respectively;none carried out the fitness tests of medical protective masks and relevant training;only two facilities carried out TB infection control health education publicity activities to TB patients and general public. Conclusion The overall implementation situation of "Handbook of Chinese control and prevention of tuberculosis infection" is good in general,however,we need to take further effective measures to strengthen TB infection control monitoring and evaluation,ventilation,masks wearing fitness test and publicity activities.

Objective To understand the yield of active tuberculosis cases among household contacts of sputum smear positive pulmonary tuberculosis(PTB) patient and factors affecting the yield of household contact investigation.Methods This study used the multi-stage stratified cluster sampling method and select eight counties from four provinces as the study sites.Smear positive PTB Patients registered in 2008 and their household close contacts were investigated.Results The yield of active tuberculosis was 2.7% in household close contacts of smear positive PTB cases,and the yield of smear positive PTB was 0.6%.The major risk factors of active tuberculosis among close contacts include: gender of the index case,whether have cough symptoms,sputum smear result,contact's age,the relationship between contact and index case,education level of the close contact,whether live in the same room.Conclusions Household close contact investigation of smear positive PTB patient is an effective mean in active PTB detection.

Objective To understand the treatment status and the effect of retreatment smear positive pulmonary tuberculosis in Beijing. Methods Local retreatment smear positive cases registered during 2006—2007 were selected. Analysis was made in terms of age, place for initial treatment, treatment institution, initial management mode, drug susceptibility test (DST) before retreatment and the complication, treatment outcome of the cases with standardized chemotherapy regimen and non-standard regimen. Results Results Among the total 223 cases, middle-aged patients account for 65.5%. 54 cases did DST before retreatment, 25 were drug resistant, the drug resistant rate was 46.3%(25/54), multi-drug resistant rate was 13.0%(7/54). 170 cases adopted standardized regimen, accounting for 76.2%, For them, average cure rate was 75.9% and the cure rate for patients failing in initial treatment was 50%. 53 cases adopted non-standard regimen, accounting for 23.8%. Reasons for non-standard regimen were explained as drug resistance, adverse drug reaction, or accompanied by complications. Conclusions In order to improve the cure rate of the retreatment cases, DST for the first and the second line drugs should be done for patients failing in initial treatment based on the standardized chemotherapy regimen. For patients who could not fit for standard regimen, individualized regimen should be developed based on the result of the DST and patient’s situation.

Objective To describe drug resistance profiles of TB isolates from patients at risk of multidrug tuberculosis(MDR-TB),and to observe the effects and adverse reactions of domestic drugs on treatment of MDR-TB,so as to summarize the regimen for MDR-TB control in Beijing.Methods To find the MDR-TB patients,all TB isolates from suspected MDR-TB patients were tested by the first-line drug susceptibility testing(DST).The MDR-TB patients received the standard regimen:6 E.Z.Lfx.Pto.Ak / 12-18 E.Z.Lfx.Pto.Results Of these MDR-TB suspects,44.7% were sensitive to all anti-tuberculosis drugs;11.2% were resistant to only one anti-tuberculosis drug and 37.1% were MDR-TB strains.A total of 37 MDR-TB cases were treated by a MDR-TB regimen between Apr.2008 and Apr.2009.Of these 37 cases,29 were treated for more than 6 months.The negative conversion rates of sputum smear and culture were 75.9% and 78.3% respectively at the end of the sixth month.Conclusion Under the condition of using the domestic second-line drugs for 18-24 months,the negative conversion rates of the sputum smear were all above 75.0% at the end of the sixth month.The effect of the early stage treatment for MDR-TB is satisfactory.

北京市结核病控制工作,在北京市政府和卫生局的领导下,开放改革30年来,克服各种困难,开拓创新,针对难点开展科学研究和国际合作取得了卓有成效的成果.1978年在总结经验的基础上,制订了适合北京实际情况的结核病控制技术政策,并在实践中不断完善,使北京市结核病疫情大幅下降,涂阳结核病患病率由1979年的127/10万下降到1990年的16/10万,平均年递降率达17%,此后北京市结核病疫情一直保持比较低的水平,达到国内领先,进入国际先进行列.