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目的分析县级地区实施定点医院模式和疾控模式后结核病负担变化趋势,为完善结核病控制策略提供科学依据。方法南宁市共辖6县,其中隆安县于2005年起实行定点医院模式,其余各县均为疾控模式,本次研究以活动性肺结核病人发病率、死亡率、新发涂阳发现率和治愈率作为评价结核病负担和控制效果的指标,以定点医院模式实施时间作为研究起点,比较2005-2010年不同医防合作模式结核病负担变化趋势。结果南宁市6县2005-2010年登记率平均逐年下降4.3%~16.9%,发病率的下降幅度比登记率更为明显。定点医院模式死亡率平均逐年下降16.2%,新发涂阳治愈率平均逐年提高1.4%,疾控模式各县死亡率下降最快仅为13.7%,而新涂阳治愈率则逐年下降0.5%~0.8%,定点医院模式死亡率下降和治愈率上升的速度均超过疾控模式。疾控模式新涂阳发现率逐年提高0.6%~4.9%,而定点医院模式则下降2.0%。结论 2005-2010年不同医防合作模式地区结核病负担均呈下降趋势,结核病控制效果明显。两种模式相比,南宁市县级定点医院在提高治愈率和降低死亡率方面更具优势。
Objective To analyze the change tendency of TB burden after implementing fixed hospital mode and disease control mode in county level and provide scientific basis for improving TB control strategy. Methods Nanning City, a total of 6 counties under control, including Longan County in 2005 from the implementation of the designated hospital model, the remaining counties are disease control mode, this study with active tuberculosis morbidity, mortality, new smear found and The cure rate is used as an index to evaluate the burden and control effect of tuberculosis. Taking the implementation time of designated hospital mode as the research starting point, the change trend of TB burden in different modes of medical cooperation between 2005 and 2010 is compared. Results The enrollment rates of 6 counties in Nanning from 2005 to 2010 decreased by 4.3% ~ 16.9% year on year on average, the incidence rate of decline was more obvious than the registration rate. The death rate of designated hospitals decreased by an average of 16.2% year by year. The average cure rate of new smear-positive children increased by 1.4% annually on average. The mortality rate in all modes of disease control and control mode dropped only as fast as 13.7%, while the cure rate of new smear- 0.8%. The death rate of fixed-point hospitals and the rate of cure increased more than the disease-control mode. The new smear-positive rate of disease control mode increased by 0.6% ~ 4.9% year by year, while the fixed hospital mode decreased by 2.0%. Conclusion From 2005 to 2010, the burden of tuberculosis in different modes of medical cooperation and prevention has shown a downward trend, and tuberculosis control effect is obvious. Compared with the two modes, Nanning County designated hospitals have more advantages in improving the cure rate and reducing the mortality rate.