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目的:对西班牙马德里一所三级医院1990年1月—2002年12月就诊的本国出生居民和移民进行结核病患病情况的比较分析。结果:全人群结核病(TB)年发病率从1990年的141/10万降低到2002年的73/10万;但是, TB疫情在移民群体中呈现上升趋势(从1990年的1%上升到2002年的27%),在1 353名移民中诊断TB98例(总的检出率为7.2%)。移民组TB患者的平均年龄30岁(6～77),男性占54%,大部分来自拉丁美洲(55%)和非洲(37%),在抵达西班牙后2年内被诊断的TB占69%。在接受检查的病人中,结核菌素阳性占88%。6%的病人合并艾滋病病毒感染,而本国出生居民组TB患者合并艾滋病病毒感染率为37%(P<0.001)。在2组中,肺结核都是最常见的类型(移民组79%,本国出生居民组80%),痰涂片阳性率不存在差异(分别是70%和75%)。移民组的原发耐药率显著高于本国出生居民组(移民组13%,本国出生居民组<6%,P<0.05)。移民组强化期都采用了四联药方案。总体上,82%的病人治愈,1例病人死于播散性疾病(1%),17例病人的随访数据不全(17%)。结论:移民组TB患病时的临床症状与本国出生居民组相似,但其发病的危险因素与本国出生居民组已知的危险因素不同。由于移民组的高原发耐药率,强化期的治疗应给予四联用药,直至药敏结果出来。
OBJECTIVE: To compare and analyze the prevalence of tuberculosis among domestic-born residents and immigrants visiting a tertiary hospital in Madrid, Spain from January 1990 to December 2002. Results: The annual rate of TB in the whole population decreased from 141.1 million in 1990 to 73/10 in 2002; however, TB outbreaks showed an upward trend among immigrant groups (from 1% in 1990 to 2002 27% of the year), TB98 cases were diagnosed among 1 353 immigrants (the overall detection rate was 7.2%). The average age of TB patients in the immigrant group was 30 years (6 to 77), with 54% of men, mostly from Latin America (55%) and Africa (37%), with 69% diagnosed within 2 years of arrival in Spain. Among the patients examined, tuberculin positive was 88%. Six percent of patients had HIV infection, while TB patients in their native-born group had a combined HIV prevalence of 37% (P <0.001). In both groups, tuberculosis was the most common type (79% in immigrant group and 80% in resident group), and there was no difference in sputum smear positive rates (70% and 75%, respectively). The rate of primary resistance in the immigrant group was significantly higher than that in their native-born group (13% in immigrant group and <6% in native-born group, P <0.05). Intensification of immigrant groups have adopted a quadruple drug program. Overall, 82% of patients were cured, 1 patient died of disseminated disease (1%), and 17 patients had incomplete follow-up data (17%). CONCLUSIONS: The clinical symptoms of migrating TB were similar to those of their native birth group, but their risk factors were different from those known to their native birth group. Due to the high rate of primary resistance in the immigrant group, intensive treatment should be given in quadruplicate until the susceptibility results come out.