CAJ | 학술논문

目的：调查≥65岁肺结核可疑症状者、糖尿病患者、肺结核密切接触者（三类重点人群）中活动性肺结核患病率。方法采用目的抽样方法选择山东省3个县市为研究现场，利用当地≥65岁老年人健康体检项目，并纳入肺结核检查，对2013年1-9月登记的三类重点人群实施X线胸片和痰涂片检查。结果9041名检查对象中共检出活动性肺结核82例，受检者中粗患病率为9.1‰。肺结核可疑症状兼糖尿病患者、糖尿病患者、可疑症状者中活动性肺结核患病率分别为115.0‰、3.4‰、0.9‰，糖尿病兼肺结核密切接触者、肺结核可疑症状兼密切接触者及密切接触者中均未检出活动性肺结核；不同老年人群活动性肺结核患病率差异有统计学意义（χ2＝697.478， P＝0.000）。糖尿病患者中活动性肺结核患病率是非糖尿病患者的18倍（RR＝17.951），是肺结核可疑症状者的4倍（RR＝3.860）；单因素分析显示糖尿病与活动性肺结核的患病率具有相关性（χ2＝46.637，P＝0.000），糖尿病患病时间延长，其发生肺结核的危险性增高（RR＞1）。结论患糖尿病的老年群体中活动性肺结核患病率较高，应对糖尿病患者、肺结核可疑症状者实施重点人群筛查策略。
목적：조사≥65세폐결핵가의증상자、당뇨병환자、폐결핵밀절접촉자（삼류중점인군）중활동성폐결핵환병솔。방법채용목적추양방법선택산동성3개현시위연구현장，이용당지≥65세노년인건강체검항목，병납입폐결핵검사，대2013년1-9월등기적삼류중점인군실시X선흉편화담도편검사。결과9041명검사대상중공검출활동성폐결핵82례，수검자중조환병솔위9.1‰。폐결핵가의증상겸당뇨병환자、당뇨병환자、가의증상자중활동성폐결핵환병솔분별위115.0‰、3.4‰、0.9‰，당뇨병겸폐결핵밀절접촉자、폐결핵가의증상겸밀절접촉자급밀절접촉자중균미검출활동성폐결핵；불동노년인군활동성폐결핵환병솔차이유통계학의의（χ2＝697.478， P＝0.000）。당뇨병환자중활동성폐결핵환병솔시비당뇨병환자적18배（RR＝17.951），시폐결핵가의증상자적4배（RR＝3.860）；단인소분석현시당뇨병여활동성폐결핵적환병솔구유상관성（χ2＝46.637，P＝0.000），당뇨병환병시간연장，기발생폐결핵적위험성증고（RR＞1）。결론환당뇨병적노년군체중활동성폐결핵환병솔교고，응대당뇨병환자、폐결핵가의증상자실시중점인군사사책략。
Objective To conduct a survey on the prevalence of active pulmonary tuberculosis among 65 year olds or above. Study subjects would include those with characteristics of TB suspicious symptoms,diabetes and close contacts. Methods Purpose-sampling method was applied to choose 3 counties in Shandong province as the study sites,relying on the local basic public health service,for those elderly under 65 years old or above. The study team would introduce the process and contents of this study to the subjects followed by chest X-ray and sputum smears on those registered tuberculosis suspects,patients with diabetes,TB close contacts in the past 2 years,from January to September,2013. Results 82 active pulmonary TB cases were identified among 9 041 cases who received the examination,with a crude prevalence rate as 9.1‰. From patients having both suspicious TB and diabetic symptoms,patients with diabetes or having suspicious symptoms of TB,the prevalence rates of active TB were 115‰,3.4‰,0.9‰respectively. No active pulmonary TB case was found in the TB close contacts,patients with diabetes,or those people with suspicious TB symptoms. TB prevalence rates among all the above mentioned groups were significantly different(χ2=697.478, P=0.000). Prevalence rate of active pulmonary TB with diabetes was 18 times(RR=17.951)higher than those non-diabetic patients,and 2 times higher than those with suspicious symptoms (RR=3.860). Results from single factor analysis showed that diabetes were closely related to the prevalence of pulmonary tuberculosis(χ2=46.637,P=0.000),the longer duration of diabetes and the higher risk of tuberculosis (RR>1). Conclusion Our data showed that active pulmonary TB prevalence was high in elderly diabetes patients which suggesting that‘Key crowd screening program’should be introduced into case-finding strategy on TB,with special focus on TB patients with diabetes or those people having suspicious symptoms of TB.