重庆市2015—2020年学校结核病防控工作评估

庞艳; 吴成果; 汪清雅

doi:10.16835/j.cnki.1000-9817.2021.12.003

重庆市2015—2020年学校结核病防控工作评估

doi: 10.16835/j.cnki.1000-9817.2021.12.003

重庆市结核病防治所区县防治科，400050

基金项目:

重庆市科卫联合医学科研项目 2021MSXM142

详细信息

作者简介:
庞艳(1985-)，女，重庆市人，硕士，副主任医师，主要从事结核病防治工作

通讯作者:
汪清雅，E-mail：15902381223@126.com

中图分类号: R521 R193 R184
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- 文章访问数: 546
- HTML全文浏览量: 223
- PDF下载量: 75
- 被引次数: 0
出版历程
- 收稿日期: 2021-07-26
- 修回日期: 2021-08-18
- 网络出版日期: 2021-12-23
- 刊出日期: 2021-12-25

Evaluation of tuberculosis prevention and control in schools of Chongqing from 2015 to 2020

Disrtict and County Control Division, Institute of Tuberculosis Prevention and Treatment of Chongqing, Chongqing(400050), China

摘要

摘要: 目的了解学校结核病防治工作体系运行现状和日常防控措施落实情况，为进一步强化学校结核病防控工作提出有针对性的建议。方法使用学校结核病防治工作现况调查表，采用分层随机抽样方法抽取重庆市39个区县156所初中、78所高中、6所大学开展现场问卷调查，采用SPSS 25.0对数据进行描述性分析和χ²检验。结果 2015—2020年初中、高中、大学的结核病年均筛查率分别为58.84%，71.71%，84.41%，差异有统计学意义(χ²=61 247.39，P < 0.01);年均检出率分别为8.69/10万、50.89/10万、36.51/10万，差异有统计学意义(χ²=101.20，P < 0.01);2015—2020年各学段新生入学体检结核病筛查率均有逐年上升的趋势(χ_趋势²值分别为70 052.10，86 182.82，22 213.56，P值均 < 0.01)，其中初中和高中的结核病患者检出率有逐年上升的趋势(χ_趋势²值分别为9.27，12.23，P值均 < 0.01)。2015—2020年初中、高中新生入学体检结核病开展症状筛查、询问接触史、结核菌素皮肤试验及胸片筛查的比例均有逐年提高的趋势(χ²值分别为129.10，118.10，206.92，37.67;108.79，84.90，139.84，51.82，P值均 < 0.01)，大学胸片筛查比例有逐年提高的趋势(χ_趋势²=18.33，P < 0.01)。2019年大学在建立学校结核病防控责任制、将学校结核病防控工作纳入学校年度工作计划、开展学生因病缺勤登记和病因追查工作等方面比例较低，分别为50.00%，0，16.67%，与初中、高中相比差异有统计学意义(P值均 < 0.05);2019年初中、高中和大学在校学生结核病患病率分别为33.75/10万、90.10/10万、54.20/10万，差异有统计学意义(χ²=104.36，P < 0.01)。结论 2015—2020年重庆市新生入学体检结核病筛查比例明显提高，高中仍是学校结核病防控工作的重点。提高体检结核病筛查率、加强和规范学校体检筛查工作、建立明确的防控工作责任制，是预防和控制结核病在校园传播的有效手段。
- 结核，肺 /
- 组织和管理 /
- 患病率 /
- 学生
Abstract: Objective To understand the current situation of school tuberculosis prevention and control system and the implementation of daily prevention and control measures, and to provide a reference for strengthening the prevention and control of tuberculosis in schools. Methods A random sampling method was used to select schools where on-site questionnaire survey was carried out, including 156 junior high schools, 78 senior high schools and 6 universities. SPSS 25.0 was used for descriptive analysis and chi square test. Results The average annual screening rates of junior high school, senior high school and university from 2015 to 2020 were 58.84%, 71.71% and 84.41% respectively, and the difference was statistically significant (χ²=61 247.39, P < 0.01). The average annual TB detection rates were 8.69/10⁵, 50.89/10⁵ and 36.51/10⁵ respectively, and the difference was statistically significant (χ²=101.20, P < 0.01). The screening rate of TB screening in 2015-2020 years increased by year(χ_trend²=70 052.10, 86 182.82, 22 213.56, P < 0.01). The detection rate of TB among junior high schools and high schools has been increasing year by year(χ_trend²=9.27, 12.23, P < 0.01). From 2015 to 2020, the proportion of tuberculosis screening, contact history, PPD and chest screening increased by year in junior high school and senior high school freshmen, and the difference was statistically significant (χ²=129.10, 118.10, 206.92, 37.67; 108.79, 84.90, 139.84, 51.82, P < 0.01). The proportion of chest X-ray screening in universities increased by year(χ_trend²=18.33, P < 0.01). In 2019, poor performance on TB control in universities mainly included, including the school responsibility system for tuberculosis prevention and control, the school's annual TB work plan and absenteeism registration and etiology tracing, the proportion was 50.00%, 0 and 16.67% respectively, compared with junior high school and senior high school, the difference was statistically significant(P < 0.05). The prevalence rates of junior high school, senior high school and university students were 33.75/10⁵, 90.10/10⁵ and 54.20/10⁵ respectively in 2019, and the difference was statistically significant (χ²=104.36, P < 0.01). Conclusion The proportion of TB screening for freshmen in Chongqing increased significantly during 2015-2020. High school students are still the focus of school-based tuberculosis prevention and control. Improving the proportion of tuberculosis screening, strengthening and standardizing physical examination and screening, and establishing a clear responsibility system for prevention and control are effective means to prevent and control the spread of tuberculosis on campus.
- Tuberculosis, pleural /
- Organization and administration /
- Prevalence /
- Students

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表 1 重庆市2015—2020年不同教育阶段新生入学体检结核病筛查率比较

Table 1. Tuberculosis screening results of new students from 2015 to 2020 in different educational stages of Chongqing

年份	初中				高中				大学
年份	人数	接受结核病检查人数	发现肺结核患者数	检出率/10^-5	人数	接受结核病检查人数	发现肺结核患者数	检出率/10^-5	人数	接受结核病检查人数	发现肺结核患者数	检出率/10^-5
2015	75 792	28 389(37.46)	0	0	77 193	39 243(50.84)	5	12.74	43 644	30 778(70.52)	8	25.99
2016	82 679	32 295(39.06)	0	0	80 477	41 845(52.00)	16	38.24	42 933	31 008(72.22)	5	16.12
2017	90 119	38 368(42.57)	1	2.61	83 513	43 321(51.87)	20	46.17	46 806	33 816(72.25)	14	41.40
2018	105 122	63 381(60.29)	4	6.31	87 208	70 948(81.35)	47	66.25	48 337	46 920(97.07)	23	49.02
2019	118 026	89 531(75.86)	15	16.75	92 081	82 030(89.08)	43	52.42	47 450	46 943(98.93)	16	34.08
2020	114 855	93 184(81.13)	10	10.73	91 957	90 101(97.98)	56	62.15	53 146	48 848(91.91)	21	42.99
合计	586 593	345 148(58.84)	30	8.69	512 429	367 488(71.71)	187	50.89	282 316	238 313(84.41)	87	36.51
χ_趋势²值		70 052.10		9.27		86 182.82		12.23		22 213.56		2.74
P值		< 0.01		< 0.01		< 0.01		< 0.01		< 0.01		0.10
注： ()内数字为筛查率/%。

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表 2 重庆市2015—2020年不同学段新生入学体检结核病筛查方法选择率比较

Table 2. Comparison of the methods of screening tuberculosis for new students from 2015 to 2020 in different educational stages of Chongqing

年份	初中(n=156)				高中(n=78)				大学(n=6)
年份	症状筛查	询问接触史	结核菌素皮肤试验	胸片	症状筛查	询问接触史	结核菌素皮肤试验	胸片	症状筛查	询问接触史	结核菌素皮肤试验	胸片
2015	43(27.56)	40(25.64)	18(11.54)	16(10.26)	17(21.79)	18(23.08)	11(14.10)	16(20.51)	3(50.00)	3(50.00)	0	1(16.67)
2016	43(27.56)	41(26.28)	19(12.18)	17(10.90)	17(21.79)	18(23.08)	10(12.82)	16(20.51)	3(50.00)	3(50.00)	0	1(16.67)
2017	49(31.41)	47(30.13)	28(17.95)	21(13.46)	22(28.21)	23(29.49)	15(19.23)	20(25.64)	3(50.00)	3(50.00)	0	5(83.33)
2018	82(52.56)	79(50.64)	66(42.31)	36(23.08)	45(57.69)	44(56.41)	44(56.41)	34(43.59)	4(66.67)	4(66.67)	0	6(100.00)
2019	108(69.23)	102(65.38)	95(60.90)	45(28.85)	57(73.08)	56(71.79)	58(74.36)	46(58.97)	4(66.67)	4(66.67)	0	6(100.00)
2020	116(74.36)	110(70.51)	109(69.87)	47(30.13)	60(76.92)	59(75.64)	63(80.77)	43(55.13)	4(66.67)	4(66.67)	0	6(100.00)
χ_趋势²值	129.10	118.10	206.92	37.67	108.79	84.90	139.84	51.82	0.77	0.77	—	18.33
P值	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	0.38	0.38	—	< 0.01
注： ()内数字为选择率/%。

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表 3 重庆市2019年学校结核病防治工作制度落实报告率的学段间比较

Table 3. Comparison of implementation of school tuberculosis prevention and control system in 2019

调查项目	初中(n=156)	高中(n=78)	大学(n=6)	P值^*
建立了一把手总负责、分管校长具体抓的学校结核病防控责任制	145(92.95)	71(91.03)	3(50.00)	0.01
2019年将学校结核病防控工作纳入学校年度工作计划	132(84.62)	67(85.90)	0	< 0.01
目前有学校结核病疫情报告人	151(96.79)	77(98.72)	5(83.33)	0.15
学校/校区配置卫生技术人员/保健老师	139(89.10)	76(97.44)	5(83.33)	0.04
2019年学校/校区卫生技术人员/保健老师及教职员工参加了结核病防治知识培训	126(80.76)	67(85.90)	4(66.67)	0.28
2019年学校/校区开展学生因病缺勤登记和病因追查工作	150(96.15)	76(97.44)	1(16.67)	< 0.01
注： *为Fisher检验对应的P值; ()内数字为报告率/%。

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参考文献(17)

[1]	World Health Oragnization. The top 10 causes of death[R]. Geneva: World Health Organization, 2018.
[2]	World Health Oragnization. World health for statistics 2020: monitoring health for the SDGs[R]. Geneva: World Health Oragnization, 2020.
[3]	陈卉, 夏愔愔, 张灿有, 等. 2014—2018年全国学生肺结核疫情变化趋势及特征分析[J]. 中国防痨杂志, 2019, 41(6): 662-668. doi: 10.3969/j.issn.1000-6621.2019.06.013 CHEN H, XIA Y Y, ZHANG C Y, et al. Epidemic trends and characteristics of pulmonary tuberculosis in students in China from 2014 to 2018[J]. Chin J Antituberc, 2019, 41(6): 662-668. doi: 10.3969/j.issn.1000-6621.2019.06.013
[4]	白丽琼. 是危机, 还是机遇: 湖南省桃江县发生学校结核病聚集性疫情的思考[J]. 实用预防医学, 2018, 25(1): 1-2, 61. doi: 10.3969/j.issn.1006-3110.2018.01.001 BAI L Q. A crisis or an opportunity: reflections of tuberculosis clusters in schools in Taojiang County, Hunan Province[J]. Pract Prev Med, 2018, 25(1): 1-2, 61. doi: 10.3969/j.issn.1006-3110.2018.01.001
[5]	成君, 夏愔愔, 刘二勇, 等. 学校结核病突发疫情处置的思考[J]. 中国防痨杂志, 2018, 40(2): 145-148. doi: 10.3969/j.issn.1000-6621.2018.02.006 CHENG J, XIA Y Y, LIU E Y, et al. Thinking on the disposal of tuberculosis outbreak in schools[J]. Chin J Antituberc, 2018, 40(2): 145-148. doi: 10.3969/j.issn.1000-6621.2018.02.006
[6]	国务院办公厅. 国务院办公厅关于印发"十三五"全国结核病防治规划的通知[J]. 中华人民共和国国务院公报, 2017(7): 32-37. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYB201707007.htm General Office of the State Council of the People's Republic of China. Notice of the General Office of the state council on issuing the 13th five-year plan of the national tuberculosis control[J]. Gazette of the State Council of the People's Republic of China, 2017(7): 32-37. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYB201707007.htm
[7]	国家卫生和计划生育委员会办公厅, 教育部办公厅. 关于印发学校结核病防控工作规范(2017版) 的通知[A]. 2017-06-29. General Office National Health and Family Planning Commission, General Office of the Ministry of Education. Standard of tuberculosis prevention and control in schools(2017)[A]. 2017-06-29.
[8]	国家卫生健康委员会办公厅, 国家发展改革委办公厅. 关于开展"十三五"全国结核病防治规划终期评估的通知[A]. 2020-08-31. General Office of the State Health Commission of the people's Republic of China, General Office of the national development and Reform Commission of the people's Republic of China. Circular on the final assessment of the 13th Five-Year national TB control program[A]. 2020-08-31.
[9]	成君. 《新生入学体检结核病检查规范》解读[J]. 中国防痨杂志, 2020, 42(9): 987-989. doi: 10.3969/j.issn.1000-6621.2020.09.018 CHENG J. Interpretation of the specification of tuberculosis examination for student entrance physical examination[J]. Chin J Antituberc, 2020, 42(9): 987-989. doi: 10.3969/j.issn.1000-6621.2020.09.018
[10]	疾病预防控制局. 关于印发中国学校结核病防控指南的通知[A]. 2020-10-16. Bureau of Disease Control of Prevention of the Ministry of Health of China. Notice on printing and issuing the guidelines for tuberculosis prevention and control in chinese schools[A]. 2020-10-16.
[11]	柳巍, 曾令城, 张慧, 等. 西安市大学新生结核病筛查结果分析[J]. 中国学校卫生, 2016, 37(2): 313-315. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201602053.htm LIU W, ZENG L C, ZHANG H, et al. Analysis of tuberculosis screening results of freshmen in Xi'an university[J]. Chin J Sch Health, 2016, 37(2): 313-315. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201602053.htm
[12]	魏倩, 王仕昌, 王美花, 等. 2017年山东省新生入学及教职工结核病筛查现况调查[J]. 预防医学论坛, 2020, 26(12): 903-911. https://www.cnki.com.cn/Article/CJFDTOTAL-YXWX202012008.htm WEI Q, WANG S C, WANG M H, et al. Analysis on current situation of tuberculosis screening among freshmen and teaching and administrative staff, Shandong Province, 2017[J]. Prev Med Trib, 2020, 26(12): 903-911. https://www.cnki.com.cn/Article/CJFDTOTAL-YXWX202012008.htm
[13]	庞艳, 胡代玉, 吴成果, 等. 2015—2016年重庆市学校肺结核疫情监测结果[J]. 疾病监测, 2017, 32(8): 670-673. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJC201708013.htm PANG Y, HU D Y, WU C G, et al. Surveillance for tuberculosis in schools in Chongqing, 2015-2016[J]. Dis Surveill, 2017, 32(8): 670-673. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJC201708013.htm
[14]	庞艳, 刘英, 汪清雅, 等. 2016年重庆市学校结核病疫情流行概况分析[J]. 实用预防医学, 2018, 25(1): 10-13. doi: 10.3969/j.issn.1006-3110.2018.01.004 PANG Y, LIU Y, WANG Q Y, et al. Epidemic situation of tuberculosis in schools in Chongqing Municipality, 2016[J]. Pract Prev Med, 2018, 25(1): 10-13. doi: 10.3969/j.issn.1006-3110.2018.01.004
[15]	庞艳, 吴成果, 漆莉, 等. 2014—2019年重庆市学生结核病时空特征流行病学分析[J]. 疾病监测, 2021, 36(2): 167-171. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJC202102019.htm PANG Y, WU C G, QI L, t al. Spatial Temporal clustering of tuberculosis in students in Chongqing, 2014-2019[J]. Dis Surveill, 2021, 36(2): 167-171. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJC202102019.htm
[16]	陈静, 沈鑫, 潘启超. 明确职责关口前移规范防控: 《上海市学校结核病防控工作规范(2018版)》解读[J]. 上海预防医学, 2018, 30(10): 833-835. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYI201810008.htm CHEN J, SHEN X, PAN Q C. Clear responsibility, press forward and standardize prevention and control: interpretation of Work Specification for TB Prevention and Control in Schools of Shanghai (version 2018)[J]. Shanghai J Prev Med, 2018, 30(10): 833-835. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYI201810008.htm
[17]	李春, 郑海伦, 罗萍, 等. 2010—2019年北京市大兴区某中学高中部青海藏族集体来京学生肺结核疫情处置分析[J]. 中国防痨杂志, 2020, 42(12): 1318-1322. doi: 10.3969/j.issn.1000-6621.2020.12.013 LI C, ZHENG H L, LUO P, et al. Analysis on epidemic and management of tuberculosis among senior middle school students from Qinghai Tibetans in a school of Daxing District of Beijing from 2010 to 2019[J]. Chin J Antituberc, 2020, 42(12): 1318-1322. doi: 10.3969/j.issn.1000-6621.2020.12.013