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目的对贵州省肺结核流行最严重地区的肺结核病例进行复核诊断,了解其诊断的准确性,调查分析肺结核报告发病率较高的原因,为采取针对性的有效防控措施提供依据。方法由综合调查专家组核实县级3家医疗卫生机构肺结核报告情况,对阴性痰涂片,肺结核患者的X线胸片进行复查,结合病案资料判断诊断的准确性,随机入村现场调查肺结核防治管理。结果医院报告肺结核病例784例,漏报9例,漏报率为1.13%。结防机构排除重复报告170例、网络专报系统无重复报告病例。复核肺结核病例诊断370例,符合率为83.24%,结防机构诊断符合率高于医院,差异有统计学意义(χ2=9.096,P<0.05)。复核阴性痰涂片80张,符合率100%。中断治疗的肺结核病例追踪率为76.57%,追踪到位率79.82%。规则服药完成率68.33%。结论当地肺结核报告病例存在过诊情况,实际发病率为287/10万,比贵州省平均报告发病率133.47/10万高出1倍以上。由于特殊的地理环境条件,当地许多防治措施难以到位,需进一步采取强有力的综合防治措施遏制肺结核流行。
Objective To diagnose and diagnose cases of tuberculosis in the most endemic areas of tuberculosis in Guizhou Province, understand the accuracy of diagnosis, investigate and analyze the causes of the high incidence of tuberculosis reports, and provide basis for effective and preventive measures. Methods The report of tuberculosis in 3 medical institutions of county level was verified by the expert group of comprehensive investigation. The negative sputum smears and tuberculosis patients were reviewed with X-ray. The accuracy of diagnosis was judged according to the medical record data. . Results The hospital reported 784 cases of tuberculosis, missing 9 cases, the false negative rate was 1.13%. Results of prevention and treatment institutions ruled out repeated reports of 170 cases, network reporting system without duplication of cases. Three hundred and fourteen cases of pulmonary tuberculosis were diagnosed. The coincidence rate was 83.24%. The coincidence rate of tuberculosis prevention and treatment was higher than that of the hospital. The difference was statistically significant (χ2 = 9.096, P <0.05). Negative sputum smear review 80, in line with the rate of 100%. Interrupted treatment of tuberculosis cases tracking rate of 76.57%, tracking the success rate of 79.82%. Regular medication completion rate of 68.33%. Conclusion The diagnosis of pulmonary tuberculosis cases in China was present. The actual incidence rate was 287/10 million, more than double the average reported incidence of 133.47 / 100,000 in Guizhou Province. Due to special geographical environment conditions, many local prevention and control measures are difficult to put in place, and further comprehensive and effective prevention and control measures need to be taken to stop the tuberculosis epidemic.