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目的探讨更全面的发现肺结核病例的检查诊断程序。方法在采用通用的胸透筛查法发现肺结核患者的基础上,采用症状查痰法,对有症状且≥3周者,直接做痰结核分枝杆菌检查,并拍摄X线胸片,对按胸透筛查法和症状查痰法发现的患者进行比较;对肺结核诊断程序改进后的结核病患者的发现情况进行分析。结果采用症状查痰法发现活动性肺结核新病例900例,比胸透筛查法多发现活动性肺结核患者73例,患者发现率提高8·8%(73/827);发现涂阳肺结核病例262例,比胸透筛查法多发现活动性肺结核患者30例,患者发现率提高12·9%(30/232);培养阳性肺结核病例360例,比胸透筛查法多发现患者63例,患者发现率提高21·2%(63/297)。症状查痰法发现新病例的细菌学检查阳性者的比例高于胸透筛查法,胸透筛查法发现新病例中,涂片阳性者占28·1%(232/827),痰菌培养阳性者占35·9%(297/827);而症状查痰法发现新病例中,涂片阳性者占29·1%(262/900),痰菌培养阳性者占40·0%(360/900)。症状查痰法多检出的活动性肺结核患者73例中,涂阳和菌阳患者的比例均很高,分别为41·1%(30/73)和86·3%(63/73),较胸透筛查法的检出涂阳比例(28·1%)和菌阳比例(35·9%)高。结论采用症状查痰法比胸透筛查法发现的活动性肺结核患者增加,特别是菌阳肺结核患者的发现率增加21·2%,使这些患者得到及时诊断,有利于结核病传染源的控制。
Objective To explore a more comprehensive examination and diagnosis program of pulmonary tuberculosis cases. Methods Based on the common thoracic screening method found in patients with pulmonary tuberculosis, based on the symptoms of sputum smear method, for those who have symptoms and ≥ 3 weeks, sputum directly to do Mycobacterium tuberculosis examination, and X-ray film, Chest X-ray screening and symptomatic sputum finding patients were compared; the improvement of tuberculosis diagnostic programs to detect tuberculosis patients were analyzed. Results A total of 900 new cases of active pulmonary tuberculosis were found by symptomatic sputum aspiration. Compared with chest X-ray screening, 73 cases of active tuberculosis were found, and the detection rate was increased by 8.8% (73/827). A smear positive pulmonary tuberculosis case 262 Cases, more than thoracic screening method found that 30 cases of active tuberculosis patients, the detection rate increased by 12.9% (30/232); culture of positive pulmonary tuberculosis in 360 cases, more than chest screening screening method found in 63 patients, The patient discovery rate increased by 21.2% (63/297). Symptoms sputum examination found that the proportion of new cases of bacteriological positive than chest screening method, chest X-ray examination found new cases, smear positive accounted for 28.1% (232/827), sputum bacteria Positive cases accounted for 35.9% (297/827), while smear positive symptoms accounted for 29.1% (262/900) and sputum culture positive cases (40.0%) in newly diagnosed cases 360/900). Among the 73 cases of active pulmonary tuberculosis detected by symptomatic sputum aspirations, the proportion of smear-positive and bacilli-positive patients was very high, 41.1% (30/73) and 86.3% (63/73) respectively, The detection rate of smear-positive (28.1%) and bacilli-positive (35.9%) were higher than that of chest screening. Conclusions The number of patients with active pulmonary tuberculosis detected by the chest X-ray examination with symptomatic sputum aspiration method is increased, especially 21.2% of those with positive bacilli and pulmonary tuberculosis. These patients are diagnosed in time and are conducive to the control of the source of tuberculosis.