Blaha H, Heilig B, Schreiber M A, Styblo K
Central Hospital for Respiratory Disease, Gauting, Munich, FRG.
Tubercle. 1988 Dec;69(4):255-65. doi: 10.1016/0041-3879(88)90048-7.
A central surveillance register for all bacillary pulmonary tuberculosis cases reported in Bavaria (population in excess of 10 million) was established from 1974 to 1976. The aim of the study was to discover the quality and efficiency of health services delivery to the population in the field of tuberculosis under routine conditions, and to find out the relapse rate after cessation of chemotherapy in expatients who were found to be negative 2 years after starting chemotherapy. A total of 7850 German patients with bacillary pulmonary tuberculosis were diagnosed in Bavaria from 1974 to 1976 corresponding to an average annual rate of 25.7 per 100,000 population: 71% of them were smear-positive and 29% were positive by culture only. Reactivations formed 25% of all bacteriologically confirmed cases. Most (71%) smear-positive new cases were discovered because of symptoms. Of the 5157 cases of bacteriologically confirmed pulmonary tuberculosis reported during 1975 and 1976, 4% died from tuberculosis, 1% from sequelae of tuberculosis and 9% from causes other than tuberculosis. A further 3% of patients had drug side-effects, 3% were uncooperative, 2% emigrated or had no permanent address and 1% had no chemotherapy or no information on treatment. The overall results of treatment were very satisfactory: sputum conversion among 3991 patients in the group with complete treatment was achieved in 97.4% at 2 years, and in those with incomplete treatment in 96.2%. The duration of chemotherapy was long, i.e. 19 months or more in two thirds of the patients. The average reactivation rate during the 3rd, 4th and 5th follow-up years was 0.8% annually; it was higher among males than females and the rate increased with age. Of the 157 patients found to be bacteriologically positive at 2 years after the start of chemotherapy 46 died during the 3-year observation period and 109 were alive at 5 years, 23 of whom were harbouring tubercle bacilli.
1974年至1976年，为巴伐利亚州（人口超过1000万）所有报告的细菌性肺结核病例建立了一个中央监测登记册。该研究的目的是在常规条件下，了解结核病领域向民众提供卫生服务的质量和效率，并找出化疗开始2年后被判定为阴性的出院患者化疗停止后的复发率。1974年至1976年，巴伐利亚州共诊断出7850例德国细菌性肺结核患者，平均年发病率为每10万人25.7例：其中71%痰涂片阳性，29%仅培养阳性。再激活病例占所有细菌学确诊病例的25%。大多数（71%）痰涂片阳性新病例是因症状被发现的。在1975年和1976年报告的5157例细菌学确诊的肺结核病例中，4%死于结核病，1%死于结核病后遗症，9%死于结核病以外的原因。另有3%的患者有药物副作用，3%不合作，2%移民或无固定住址，1%未接受化疗或无治疗信息。治疗的总体结果非常令人满意：完全治疗组的3991例患者中，2年时痰菌转阴率为97.4%，不完全治疗组为96.2%。化疗疗程较长，三分之二的患者化疗持续时间为19个月或更长。在第3、4和5次随访年期间，平均年复发率为0.8%；男性高于女性，且复发率随年龄增加。化疗开始2年后细菌学检测呈阳性的157例患者中，46例在3年观察期内死亡，109例在5年时存活，其中23例仍携带结核杆菌。
