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目的探讨世行贷款/英国赠款中国结核病控制项目(以下简称WB/DFID项目)在新疆实施3年的效果。方法按照项目要求,对所有疑似肺结核病人实行免费拍摄胸片、免费痰涂片检查,对痰涂片阳性的肺结核病人免费提供抗结核药物治疗并全程督导管理。结果WB/DFID项目于2002年7月1日~2005年6月30日在新疆实施的3年来,经过全区广大结防工作者的积极努力,已经取得了阶段性成果,共接诊疑似肺结核病人192 174例,发现活动性肺结核病人58 166例,其中涂阳病人36 999例(占63.61%),新涂阳病人29 500例;涂阴病人20 926例(占35.98%);未查痰病人241例(占0.41%)。涂阳病人中,初治29 540例,复治7 459例,其中36 078例涂阳病人落实了全程督导,占97.51%;涂阳病人治疗满2个月末痰菌阴转率95.26%,满3个月末累计痰菌阴转率97.54%。从已结束疗程的22 266例涂阳病人的治疗转归队列分析看,治愈21,530例,治愈率96.69%,完成疗程78例,治疗成功率达到97.04%,达到了项目预期指标。新疆的初诊病人逐年增加,累计192 174例,其中就诊89 400例,占46.52%,转诊43 319例,占22.54%,集中推荐21 727例,占11.31%,日常推荐36 722例,占19.11%,其他1 006例,占0.52%;总的涂阳检出率是19.25%;转诊、集中推荐和日常推荐占53.00%,从而充分证明转诊、集中推荐和日常推荐是发现肺结核病人特别是传染性病人的主要途径。从初诊者就诊时的症状来分析涂阳检出率,咳嗽、咳痰3周以上和咯血的129 606例疑似肺结核病人中查出涂阳病人计30 786例,涂阳检出率23.75%,而咳嗽、咳痰3周以内和其他的病人中涂阳检出率为11.83%,前者是后者的2倍,证明咳嗽、咳痰3周以上和咯血是肺结核病人发现的高危人群。结论实施WB/DFID项目,推行DOTS策略是加快结核病疫情控制步伐的必由之路。
Objective To investigate the effect of World Bank Loan / British Grant China TB Control Project (WB / DFID) for three years in Xinjiang. Methods In accordance with the project requirements, all suspected pulmonary tuberculosis patients were given free chest radiographs, free sputum smear tests, anti-TB drug treatment free of sputum smear-positive pulmonary tuberculosis patients and full supervision and management. Results The WB / DFID project, which was carried out in Xinjiang since July 1, 2002 to June 30, 2005, has achieved initial success through the active efforts of a large number of prevention and treatment workers throughout the region. The total number of suspected TB cases A total of 192 174 patients were found, of which 58 166 were active pulmonary tuberculosis patients, including 36 999 smear positive patients (63.61%), 29 500 new smear positive patients, 20 926 smear negative patients (35.98%), and no sputum smear 241 patients (0.41%). Smear-positive patients, the initial treatment of 29 540 cases, 7 459 cases of retreatment, of which 36 078 cases of smear-positive patients implemented full supervision, accounting for 97.51%; smear-positive patients sputum bacterial conversion rate of 95.26% at the end of 2 months At the end of 3 months, the sputum negative conversion rate was 97.54%. From the completed treatment of 22 266 smear positive patients treatment outcome cohort analysis, 21,530 cases were cured, the cure rate was 96.69%, 78 cases completed the treatment, the treatment success rate reached 97.04%, reaching the project expected indicators. The number of newly diagnosed cases in Xinjiang increased year by year with a total of 192 174 cases, of which, 89 400 cases were treated (46.52%), 43 319 cases were referred (22.54%), 21 727 cases were highly recommended (11.31%) and 36 722 cases were routinely recommended, accounting for 19.11 %, The other 1 006 cases, accounting for 0.52%; the total positive smear detection rate was 19.25%; referral, focus on recommended and daily recommended accounted for 53.00%, which fully proved that referral, focus on recommendations and daily recommendations are found in patients with tuberculosis Is the main way of infectious patients. The prevalence of smear-positive, cough, expectoration of sputum for more than 3 weeks and hemoptysis of 129 606 suspected pulmonary tuberculosis cases were detected in 78 786 cases of smear-positive patients from the first visit when symptoms were diagnosed. The detection rate of smear positive was 23.75% The cough, sputum within 3 weeks and other patients in the smear positive rate was 11.83%, the former is twice the latter, to prove that cough, sputum more than 3 weeks and hemoptysis are high-risk TB patients found. Conclusion The implementation of the WB / DFID project and the implementation of the DOTS strategy are the only ways to speed up the control of tuberculosis outbreaks.