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目的对宜昌市“中盖结核病项目”利用创新技术和手段发现和诊疗耐药结核病患者情况进行评价,为耐多药肺结核患者发现及诊疗提供政策指导。方法收集整理2011-2014年中盖结核病项目在宜昌市实施前后各2年期间发现登记的137例(53,84)耐多药肺结核患者数、实验室诊断时间间隔、诊断反馈治疗时间间隔、等待治疗时间间隔、患者纳入治疗率等指标进行对比分析。结果 2011-2012年(中盖结核病项目实施之前)耐多药肺结核患者发现数为53例,2013-2014年(中盖结核病项目实施之后)发现耐药肺结核患者数为84例,发现数增加了1.58倍,项目实施前后耐多药肺结核患者在痰阳性肺结核患者中检出率分别为1.86%(53/2 851)和4.51%(84/1 861)(χ2=28.11,P<0.01);实验室诊断平均时间分别为74.49 d和1.52 d,诊断时间平均缩短72.97 d(t=53.298,P﹤0.01);项目实施前后(29名,72名)接受治疗患者中,诊断反馈治疗时间平均分别为22.5 d和11.2 d,项目实施后诊断反馈治疗时间缩短11.3 d(t=10.01,P﹤0.01);等待治疗时间间隔平均分别为98.14 d和14.20 d平均治疗时间可提前83.94 d(t=47.52,P﹤0.01);项目实施前后耐多药肺结核患者治疗率分别为54.72%(29/53)和85.71%(72/84),治疗率增加30.99%(χ2=16.12,P<0.01),以上数据分析,差异均有统计学意义。结论中盖结核病项目利用创新技术和手段,在耐多药肺结核患者的早发现、早诊断和早治疗方面发挥了重要促进作用,对耐药肺结核疫情的控制意义重大,值得借鉴应用推广。
Objective To evaluate the detection and diagnosis of drug-resistant TB patients by using innovative technologies and methods in Yichang-Zhongzhong TB project, and provide policy guidance for the detection and treatment of MDR-TB patients. Methods A total of 137 cases (53,84) of MDR-TB patients, laboratory diagnosis interval, diagnosis and feedback treatment interval, and waiting interval between the 2011-2014 CCFL TB project in each 2 years before and after implementation of Yichang City were collected. Treatment time interval, patients included in the treatment rate and other indicators for comparative analysis. Results The number of MDR-TB cases was found to be 53 cases between 2011 and 2012 (before the implementation of the TBM-TB project). In 2013-2014 (after the TB-TB project was implemented), the number of drug-resistant TB cases was 84 and the number of cases was increased 1.58 times. The detection rates of multidrug-resistant tuberculosis patients in sputum positive pulmonary tuberculosis patients before and after the project were 1.86% (53/2 851) and 4.51% (84/1 861) respectively (χ2 = 28.11, P <0.01) The average time for diagnosis was 74.49 days and 1.52 days, respectively, and the diagnosis time was shortened by 72.97 days (t = 53.298, P <0.01). The average time for diagnosis and feedback treatment before and after the project was implemented was 29 22.5 d and 11.2 d respectively. The treatment time of diagnosis and feedback treatment after project implementation was shortened by 11.3 days (t = 10.01, P <0.01). The waiting time for treatment was 98.14 days on average and 83.94 days on 14.20 days (t = 47.52, P <0.01). The treatment rates of MDR-TB patients before and after the project implementation were 54.72% (29/53) and 85.71% (72/84) respectively, and the treatment rate increased by 30.99% (χ2 = 16.12, P <0.01) Analysis, the differences were statistically significant. CONCLUSION: The middle-cap tuberculosis project has played an important role in early detection, early diagnosis and early treatment of MDR-TB patients by using innovative technologies and methods. It is of great significance to control the outbreak of drug-resistant pulmonary tuberculosis and is worthy of reference and application.