乌干达坎帕拉市四年间经细菌学确诊的肺结核病例检出趋势。
A four-year trend in pulmonary bacteriologically confirmed tuberculosis case detection in Kampala-Uganda.
机构信息
TRACK TB Project, Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, Kampala, Uganda.
AIDS Information Centre (AIC), Musajja Alumbwa Road, Mengo, Kisenyi, Kampala, Uganda.
出版信息
BMC Pulm Med. 2019 May 10;19(1):91. doi: 10.1186/s12890-019-0853-3.
BACKGROUND
The management and control of pulmonary bacteriologically confirmed (PBC) tuberculosis (TB) also known as infectious TB is important not only to monitor for resistance but also to check for severity, treatment response and limit its spread.
METHOD
A retrospective analysis of diagnosis smear results of PBC TB patients in Kampala district registered between January 2012 and December 2015 at 65 TB diagnosis and treatment units (DTUs) was done.
RESULTS
Of the 10,404 records; 6551 (63.0%) belonged to PBC TB patients, 3734 (57.0%) of whom were male. Sputum smear microscopy was the diagnostic test most commonly used 4905 (74.9%) followed by GeneXpert testing, 1023 (15.6%). Majority, 1951 (39.8%), of the PBC TB patients had a smear positivity grading of 3+ (> 10 acid-fast bacillus (AFB)/Fields). Public facilities diagnosed more PBC TB patients compared to private facilities, 3983 (60.8%) vs 2566 (39.2%). From 2012 through 2015, there was a statistically significant increase in PBC TB patients enrolled on anti-TB treatment from 1389 to 2194 (p = 0.000). The percentage of HIV positive co-infected PBC TB patients diagnosed decreased from 597(43%) to 890(40.6%) (p = 0.000) within same period. Linkage to HIV care improved from 229 (34.4%) in 2012 to 464 (52.1%) in 2015 (p = 0.000). The treatment success rate (TSR) for PBC TB patients improved from 69% in 2012 to 75.5% by end of 2015 (p = 0.001) with an improvement in cure rate from 52.3% to 62% (p = 0.000). There was an observed significant decrease in TB related mortality from 8.9 to 6.4% (p = 0.013).
CONCLUSION
The proportion of diagnosed PBC TB patients increased from 2012 to 2015. PBC TB patients diagnosed with 3+ smear positivity grading results consistently contributed to the highest proportion of diagnosed PBC TB patients from 2012 to 2015. This could be due to the delay in diagnosis of TB patients because of late presentation of patients to clinics. A prospective study of PBC TB patients diagnosed with 3+ smear positivity grading may elucidate the reasons for the delay to diagnosis. Further, we propose a study of wider scope to estimate how many people a single PBC TB patient is likely to infect with TB before being diagnosed and treated.
背景
对经细菌学证实的（PBC）肺结核（TB）患者（也称为传染性 TB）的管理和控制不仅对于监测耐药性很重要，而且对于检查严重程度、治疗反应和限制其传播也很重要。
方法
对 2012 年 1 月至 2015 年 12 月期间在坎帕拉区的 65 个结核病诊断和治疗单位（DTU）登记的 PBC TB 患者的诊断涂片结果进行了回顾性分析。
结果
在 10404 份记录中；6551 份（63.0%）属于 PBC TB 患者，其中 3734 份（57.0%）为男性。痰涂片显微镜检查是最常用的诊断检测方法，有 4905 例（74.9%），其次是 GeneXpert 检测，有 1023 例（15.6%）。大多数 PBC TB 患者（3983 例，39.8%）的痰涂片阳性分级为 3+（>10 个抗酸杆菌（AFB）/视野）。与私人机构相比，公共设施诊断出更多的 PBC TB 患者，分别为 3983 例（60.8%）和 2566 例（39.2%）。2012 年至 2015 年，接受抗结核治疗的 PBC TB 患者人数从 1389 人增加到 2194 人，这一趋势具有统计学意义（p=0.000）。在同一时期，诊断为 HIV 合并感染的 PBC TB 患者比例从 597 例（43%）下降到 890 例（40.6%）（p=0.000）。从 2012 年的 229 例（34.4%）到 2015 年的 464 例（52.1%），HIV 护理的关联性得到了改善（p=0.000）。PBC TB 患者的治疗成功率（TSR）从 2012 年的 69%提高到 2015 年的 75.5%（p=0.001），治愈率从 52.3%提高到 62%（p=0.000）。TB 相关死亡率从 8.9%下降到 6.4%（p=0.013）。
结论
从 2012 年到 2015 年，诊断出的 PBC TB 患者比例有所增加。从 2012 年到 2015 年，3+涂片阳性分级诊断出的 PBC TB 患者始终占所有诊断出的 PBC TB 患者的最大比例。这可能是由于患者就诊时病情较晚，导致结核病患者的诊断延迟。对 3+涂片阳性分级诊断出的 PBC TB 患者进行前瞻性研究可能有助于阐明诊断延迟的原因。此外，我们建议进行一项范围更广的研究，以估计每例 PBC TB 患者在被诊断和治疗之前可能感染多少人患有结核病。
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