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背景:此项结核病研究是由一家非政府组织在尼泊尔东部8个丘陵及山区地区实施的。 目的:评价筛查接触者对病例发现的作用。 设计:对1996-1998年诊断并登记的“首登病例”(index cases),即涂片阳性、涂片阴性和肺外结核病例的接触者进行回顾性队列研究。首登病例的家庭成员为接触者,接触者经痰检筛查,2份痰涂片阳性者确定为涂阳肺结核病例。 结果:大约从50％(668)的登记病人中确定接触者;在确定的接触者中75％(2298)送检1个或以上的痰标本。从接触者中共筛查出14例(0.61％)涂阳肺结核病例,除1例外,13例涂阳肺结核病人都是从涂阳肺结核首登病例的接触者中检出的。从涂阳菌量≥2+的首登病例接触者中检出的涂阳肺结核病人是涂阳菌量1+者的7.2倍(P=0.04)。 讨论:在这样的背景下,从涂阴肺结核或肺外结核病人的家庭接触者中用痰检筛查是不合适的。为了评价筛查没有症状的涂阳肺结核病例接触者的实用性以及通过筛查痰菌量大(≥2+)病例的接触者是否可以改善费用效益,有必要进一步的评估。
Background. This study on tuberculosis was conducted by a non-governmental organization in eight hills and mountainous areas in eastern Nepal. Purpose: To evaluate the role of screening contacts in case finding. Design: A retrospective cohort study of contact cases diagnosed and enrolled as index cases in 1996-1998, smear-positive, smear-negative and extra-pulmonary tuberculosis cases. The first member of the family history of contacts as contacts, contacts by sputum screening, two sputum smear positive were identified as smear positive pulmonary tuberculosis cases. Results: Approximately 50% (668) of the registered patients were identified as contacts; 75% (2298) of the identified contacts tested for one or more sputum samples. A total of 14 cases (0.61%) of smear positive pulmonary tuberculosis cases were screened out from contacts. All but one were detected in 13 cases of smear positive pulmonary tuberculosis patients from contacts who made the first visit to smear positive tuberculosis. Smear-positive pulmonary tuberculosis patients were detected 7.2 times more likely to be smear-positive than those with smear-positive bacteria ≥2 + (P = 0.04). Discussion: In this context, screening for sputum from family contacts of smear-negative or extra-pulmonary tuberculosis patients is not appropriate. In order to evaluate the utility of screening contacts for smear-positive pulmonary tuberculosis without symptoms and whether cost-effectiveness can be improved by screening for contacts with large sputum counts (≥2 +), further evaluation is warranted.