中国结核病流行状况，1990-2010 年；基于全国调查数据的纵向分析。

Tuberculosis prevalence in China, 1990-2010; a longitudinal analysis of national survey data.

机构信息

Chinese Center for Disease Control and Prevention, Beijing, China.

China Office, The Bill & Melinda Gates Foundation, Beijing, China.

出版信息

Lancet. 2014 Jun 14;383(9934):2057-2064. doi: 10.1016/S0140-6736(13)62639-2. Epub 2014 Mar 18.

DOI:10.1016/S0140-6736(13)62639-2

PMID:24650955

Abstract

BACKGROUND

China scaled up a tuberculosis control programme (based on the directly observed treatment, short-course [DOTS] strategy) to cover half the population during the 1990s, and to the entire population after 2000. We assessed the effect of the programme.

METHODS

In this longitudinal analysis, we compared data from three national tuberculosis prevalence surveys done in 1990, 2000, and 2010. The 2010 survey screened 252,940 eligible individuals aged 15 years and older at 176 investigation points, chosen by stratified random sampling from all 31 mainland provinces. All individuals had chest radiographs taken. Those with abnormal radiographs, persistent cough, or both, were classified as having suspected tuberculosis. Tuberculosis was diagnosed by chest radiograph, sputum-smear microscopy, and culture. Trained staff interviewed each patient with tuberculosis. The 1990 and 2000 surveys were reanalysed and compared with the 2010 survey.

FINDINGS

From 1990 to 2010, the prevalence of smear-positive tuberculosis decreased from 170 cases (95% CI 166-174) to 59 cases (49-72) per 100,000 population. During the 1990s, smear-positive prevalence fell only in the provinces with the DOTS programme; after 2000, prevalence decreased in all provinces. The percentage reduction in smear-positive prevalence was greater for the decade after 2000 than the decade before (57% vs 19%; p<0.0001). 70% of the total reduction in smear-positive prevalence (78 of 111 cases per 100,000 population) occurred after 2000. Of these cases, 68 (87%) were in known cases-ie, cases diagnosed with tuberculosis before the survey. Of the known cases, the proportion treated by the public health system (using the DOTS strategy) increased from 59 (15%) of 370 cases in 2000 to 79 (66%) of 123 cases in 2010, contributing to reduced proportions of treatment default (from 163 [43%] of 370 cases to 35 [22%] of 123 cases) and retreatment cases (from 312 [84%] of 374 cases to 48 [31%] of 137 cases; both p<0.0001).

INTERPRETATION

In 20 years, China more than halved its tuberculosis prevalence. Marked improvement in tuberculosis treatment, driven by a major shift in treatment from hospitals to the public health centres (that implemented the DOTS strategy) was largely responsible for this epidemiological effect.

FUNDING

Chinese Ministry of Health.

摘要

背景

中国在上世纪 90 年代扩大了结核病控制规划（基于直接观察治疗短期疗程 [DOTS] 策略），覆盖了一半人口，并在 2000 年后覆盖了全部人口。我们评估了该规划的效果。

方法

在这项纵向分析中，我们比较了 1990 年、2000 年和 2010 年三次全国结核病患病率调查的数据。2010 年的调查在 176 个调查点对 252940 名年龄在 15 岁及以上的符合条件的个体进行了筛查，这些调查点是从中国大陆所有 31 个省份的分层随机抽样中选择的。所有个体都进行了胸部 X 光检查。对 X 光片异常、持续咳嗽或两者兼有者，分类为疑似结核病。通过胸部 X 光、痰涂片显微镜检查和培养来诊断结核病。经过培训的工作人员对每位结核病患者进行了访谈。我们重新分析了 1990 年和 2000 年的调查，并与 2010 年的调查进行了比较。

结果

从 1990 年到 2010 年，涂阳肺结核的患病率从每 10 万人中有 170 例（95%CI 166-174）下降到 59 例（49-72）。在 20 世纪 90 年代，涂阳患病率的下降仅发生在实施 DOTS 规划的省份；2000 年后，所有省份的患病率都有所下降。与 2000 年前相比，2000 年后的十年间涂阳患病率的降幅更大（57%比 19%；p<0.0001）。涂阳患病率总降幅的 70%（每 10 万人中有 78 例）发生在 2000 年后。其中，68 例（87%）为已知病例，即调查前已诊断为结核病的病例。在这些已知病例中，由公共卫生系统（采用 DOTS 策略）治疗的比例从 2000 年的 370 例中的 59 例（15%）增加到 2010 年的 123 例中的 79 例（66%），这导致治疗失败率（从 370 例中的 163 例[43%]降至 123 例中的 35 例[22%]）和复治病例率（从 374 例中的 312 例[84%]降至 137 例中的 48 例[31%]）降低，差异均有统计学意义（均 P<0.0001）。