Analysis of tuberculosis screening for newly enrolled students in Hunan Province from 2018 to 2020
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摘要:
目的 了解湖南省入学新生结核病的筛查情况, 为学校结核病控制工作提供参考依据。 方法 对2018—2020年湖南省入学新生开展结核病筛查, 并采用描述性分析、χ2检验对筛查结果进行统计学分析。 结果 2018—2020年, 湖南省在校学生肺结核发病率平均为20.90/10万, 呈逐年下降的趋势(χ趋势2=89.45, P < 0.01), 学校肺结核的筛查率平均为87.30%, 入学新生肺结核筛查率平均为86.81%, 均呈逐年下降的趋势(χ趋势2值分别为2 843.34, 183 443.77, P值均 < 0.01)。入学新生肺结核可疑症状比例、肺结核患者接触史比例、学生人群中活动性肺结核患者比例分别为0.53%, 0.21%, 1.73/万, 在3年间呈逐年下降趋势(χ趋势2值分别为8 624.05, 2 215.48, 99.14, P值均 < 0.01)。PPD强阳性/IGRA阳性比例、影像学检查疑似肺结核改变比例、病原学阳性比例分别为1.52%, 0.20%, 12.40%, 在3年间呈逐年上升的趋势(χ趋势2值分别为529.18, 147.65, 25.89, P值均 < 0.01)。有肺结核可疑症状比例、有肺结核患者接触史比例、胸部影像学检查有疑似肺结核改变比例、PPD强阳性/IGRA阳性率、学生人群肺结核比例在地区类型和学校类型中差异均有统计学意义(χ2值分别为529.18, 8 823.13, 705.63, 2 068.03, 1 299.00, 4 318.73, 33.12, 2 329.07, 35.80, 1 781.65, P值均 < 0.01);病原学阳性率在地区类型和学校类型中差异均无统计学意义(P值均＞0.05)。 结论 入学新生筛查率呈上升趋势, 学生肺结核发病率呈下降趋势。高中入学新生PPD强阳性/IGRA阳性率、学生人群肺结核比例等均最高, 需加大对高中新生的筛查力度, 有条件的地区可考虑开展高二学生的结核病筛查。 Abstract:Objective To understand tuberculosis screening for newly enrolled students in Hunan Province and to provide reference for scholl-based tuberculosis (TB) prevention and control. Methods During 2018 to 2020, TB screening was carried out for newly enrolled students in Hunan Province, and the screening results were statistically analyzed by descriptive analysis and χ2 test. Results In 2018-2020, the average incidence rate of TB among students in Hunan Province was 20.90/100 000, with a decreasing trend by year (χtrend2=89.45, P < 0.01), the screening rate of TB in schools was 87.30%, and the screening rate for newly enrolled students was 86.81%, with downward trend by year (χtrend2=2 843.34, 83 443.77, P < 0.01). The proportion of suspicious symptoms, close contact, and active pulmonary TB patients among students were 0.53%, 0.21%, and 1.73/10 000, respectively, with decreasing trends by year(χtrend2=8 624.05, 2 215.48, 99.14, P < 0.01). The proportion of strong positive PPD/ IGRA positive, changes in imaging examination and culture-positive of mycobacterium tuberculosis were 1.52%, 0.20% and 12.40%, with increasing trends by year (χtrend2=529.18, 147.65, 25.89, P < 0.01). There were statistically significant differences in the proportion of suspicious symptoms, close contact, strong positive PPD/positive IGRA, changes in imaging examination and the proportion of patients with tuberculosis in the regional classification and school classification (χ2=529.18, 8 823.13, 705.63, 2 068.03, 1 299.00, 4 318.73, 33.12, 2 329.07, 35.80, 1 781.65, P < 0.01). There was no statistically significant difference in the proportion of culture-positive of mycobacterium tuberculosis in the regional classification and school classification (P>0.05). Conclusion The screening rate of newly enrolled student showed an upward trend, and the incidence rate of tuberculosis among students showed downward trend. Newly enrolled students among fresh students in high school have the highest PPD positive/IGRA positive rate and the proportion of pulmonary tuberculosis in the student population. It is necessary to increase the screening among fresh students in high school. In areas with conditions, tuberculosis screening of senior two students can be considered. -
Key words:
- Tuberculosis, pulmonary /
- Incidence /
- Tuberculin test /
- Students
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表 1 不同组别湖南省入学新生肺结核筛查率比较
Table 1. Comparison of the rates of pulmonary tuberculosis screening for newly enrolled student in different groups in Hunan Province
组别 选项 学校筛查(所) 学生筛查 应筛查数 实筛查数 χ2值 P值 应筛查数 实筛查数 χ2值 P值 年份 2018 22 605 17 161(75.92) 2 843.34* < 0.01 2 963 596 2 350 867(79.32) 183 443.77* < 0.01 2019 24 375 22 479(92.22) 3 530 021 3 134 637(88.80) 2020 26 906 24 859(92.39) 3 735 782 3 394 689(90.87) 地区类型 城区 26 351 23 042(87.44) 0.80 0.37 6 430 797 5 671 883(88.20) 29 149.20 < 0.01 乡镇 47 535 41 457(87.21) 3 798 602 3 208 310(84.46) 学校类型 学前教育 36 582 32 072(87.67) 119.75 < 0.01 2 047 090 1 806 883(88.27) 206 245.09 < 0.01 小学 25 709 22 138(86.11) 2 736 578 2 294 150(83.83) 初中 9 050 7 926(87.58) 2 384 925 1 958 189(82.11) 高中(含中等职业学校) 2 150 1 976(91.91) 1 833 270 1 619 408(88.33) 大专及以上 395 387(97.97) 1 227 536 1 201 563(97.88) 注：()内数字为筛查率/%；*为趋势χ2值。 
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表 2 不同组别湖南省入学新生肺结核筛查项目比较
Table 2. Comparison of the methods of screening tuberculosis for newly enrolled student in Hunan Province
项目 选项 肺结核可疑症状 肺结核患者接触史 人数 检出人数 χ2值 P值 人数 检出人数 χ2值 P值 年份 2018 2 247 806 18 847(0.84) 8 624.05* < 0.01 2 135 770 6 682(0.31) 2 215.48* < 0.01 2019 2 800 014 17 002(0.61) 2 738 846 6 243(0.23) 2020 3 288 160 8 666(0.26) 3 238 456 4 073(0.13) 地区类型 城区 5 293 982 24 825(0.47) 1 156.84 < 0.01 5 169 333 9 167(0.18) 705.63 < 0.01 乡镇 3 041 998 19 690(0.65) 2 943 739 7 831(0.27) 学校类型 学前教育 1 723 236 5 343(0.31) 8 823.13 < 0.01 1 711 534 1 818(0.11) 2 068.03 < 0.01 小学 2 140 160 9 895(0.46) 2 141 160 4 704(0.22) 初中 1 852 922 15 981(0.86) 1 788 187 4 220(0.24) 高中(含中等职业学校) 1 527 271 11 037(0.72) 1 454 906 4 743(0.33) 大专及以上 1 092 391 2 259(0.21) 1 017 285 1 513(0.15) 项目 选项 PPD/IGRA 胸部影像学 人数 检出人数 χ2值 P值 人数 检出人数 χ2值 P值 年份 2018 866 493 10 953(1.26) 529.18* < 0.01 424 597 656(0.15) 147.65* < 0.01 2019 1 062 222 16 501(1.55) 491 194 834(0.17) 2020 1 294 324 21 539(1.66) 497 233 1 319(0.27) 地区类型 城区 2 100 974 35 708(1.70) 1 299.00 < 0.01 1 210 216 2 299(0.19) 33.12 < 0.01 乡镇 1 122 065 13 285(1.18) 202 808 510(0.25) 学校类型 学前教育 41 043 343(0.84) 4 318.73 < 0.01 4 103 4(0.10) 2 329.07 < 0.01 小学 193 771 883(0.46) 35 147 24(0.07) 初中 1 408 635 17 137(1.22) 87 848 408(0.46) 高中(含中等职业学校) 1 420 370 27 638(1.95) 168 060 1 066(0.63) 大专及以上 159 220 2 992(1.88) 1 117 866 1 307(0.12) 注：()内数字为检出率/%；*为趋势χ2值。
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表 3 不同组别湖南省入学新生肺结核筛查结果比较
Table 3. Comparison of the results of screening tuberculosis for newly enrolled student in Hunan Province
项目 选项 活动性肺结核 病原学阳性 人数 检出人数 检出率/10万 χ2值 P值 人数 阳性人数 阳性率/% χ2值 P值 年份 2018 2 350 867 630 2.68 99.14* < 0.01 630 44 6.98 25.89* < 0.01 2019 3 134 637 402 1.28 402 62 15.42 2020 3 394 689 500 1.47 500 84 16.80 地区类型 城区 5 671 883 1 091 1.92 35.80 < 0.01 1 091 139 12.74 0.40 0.53 乡镇 3 208 310 441 1.37 441 51 11.56 学校类型 学前教育 1 806 883 5 0.03 1 781.65 < 0.01 5 0 0.00 0.21** 小学 2 294 150 13 0.06 13 2 15.38 初中 1 958 189 296 1.51 296 28 9.46 高中(含中等职业学校) 1 619 408 724 4.47 724 87 12.02 大专及以上 1 201 563 494 4.11 494 73 14.78 注：*为趋势χ2值，**为Fisher确切概率法。
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