China Office, International Union Against Tuberculosis and Lung Disease, Beijing, China Clinical Center on Tuberculosis, China CDC, Beijing, China The Affiliated Hospital of Guiyang Medical College, Guiyang City, Guizhou Province, China Tai'an Central Hospital, Tai'an City, Shandong Province, China Dingxi Number 2 Hospital, Anding District, Gansu Province, China Jinan Central Hospital, Lixia District, Jinan City, Shandong Province, China Shijiazhuang Number 2 Hospital, Shijiazhuang City, Hebei Province, China Medecins sans Frontieres, Medical Department, Operational Research Unit, Brussels Operational Center, Luxembourg World Diabetes Foundation, Gentofte, Denmark Stop-TB Department, World Health Organization, Geneva, Switzerland International Union Against Tuberculosis and Lung Diseases, Paris, France London School of Hygiene and Tropical Medicine, London, UK.
Trop Med Int Health. 2012 Oct;17(10):1302-8. doi: 10.1111/j.1365-3156.2012.03069.x. Epub 2012 Jul 25.
There is a high burden of both diabetes (DM) and tuberculosis (TB) in China, and as DM increases the risk of TB and adversely affects TB treatment outcomes, there is a need for bidirectional screening of the two diseases. How this is best performed is not well determined. In this pilot project in China, we aimed to assess the feasibility and results of screening DM patients for TB within the routine healthcare setting of five DM clinics.
Agreement on how to screen, monitor and record was reached in May 2011 at a national stakeholders meeting, and training was carried out for staff in the five clinics in July 2011. Implementation started in September 2011, and we report on 7 months of activities up to 31 March 2012. DM patients were screened for TB at each clinic attendance using a symptom-based enquiry, and those positive to any symptom were referred for TB investigations.
In the three quarters, 72% of 3174 patients, 79% of 7196 patients and 68% of 4972 patients were recorded as having been screened for TB, resulting in 7 patients found who were already known to have TB, 92 with a positive TB symptom screen and 48 of these newly diagnosed with TB as a result of referral and investigation. All patients except one were started on anti-TB treatment. TB case notification rates in screened DM patients were several times higher than those of the general population, were highest for the five sites combined in the final quarter (774/100 000) and were highest in one of the five clinics in the final quarter (804/100 000) where there was intensive in-house training, special assignment of staff for screening and colocation of services.
This pilot project shows that it is feasible to carry out screening of DM patients for TB resulting in high detection rates of TB. This has major public health and patient-related implications.
中国糖尿病（DM）和结核病（TB）负担沉重，由于 DM 增加了患 TB 的风险并对 TB 治疗结果产生不利影响，因此需要对这两种疾病进行双向筛查。如何最好地进行筛查尚不确定。在本项目试点中，我们旨在评估在五家 DM 诊所的常规医疗保健环境中对 DM 患者进行 TB 筛查的可行性和结果。
2011 年 5 月在一次全国利益相关者会议上就如何筛查、监测和记录达成一致意见，并于 2011 年 7 月对五家诊所的工作人员进行了培训。2011 年 9 月开始实施，我们报告截至 2012 年 3 月 31 日的 7 个月活动情况。在每个诊所就诊时，通过基于症状的询问对 DM 患者进行 TB 筛查，对任何症状呈阳性的患者进行 TB 调查。
在三个季度中，72%的 3174 名患者、79%的 7196 名患者和 68%的 4972 名患者被记录为接受了 TB 筛查，结果发现 7 名已知患有 TB 的患者、92 名 TB 症状筛查阳性患者，其中 48 名因转诊和调查新诊断为 TB。除一名患者外，所有患者均开始接受抗 TB 治疗。筛查 DM 患者的 TB 病例报告率高于一般人群数倍，在最后一个季度的五个监测点中最高（774/100000），在最后一个季度中一个监测点中最高（804/100000），该监测点对工作人员进行了密集的内部培训，专门分配人员进行筛查，并提供集中服务。
本试点项目表明，对 DM 患者进行 TB 筛查是可行的，可显著提高 TB 的检出率。这具有重大的公共卫生和患者相关意义。
