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目的探讨在结核病控制项目中肺结核病复发的流行病学特征及影响因素,为预防和控制结核病复发提供依据和对策。方法采取回顾性调查方法,追踪曾诊断为涂阳肺结核病并完成疗程,且治愈后复发的患者,资料用χ2检验进行分析。结果慈利县4 360例涂阳治愈的肺结核病例中有225例复发,总复发率为5.16%,其中男性复发率为5.22%,女性复发率为5.05%,两者差异无统计学意义(χ2=5.21,P>0.05)。复发率最高的是70岁以上年龄组,为25.12%,最低为<10岁年龄组为0复发,年龄组间差异有显著统计学意义(χ2=402.82,P<0.01)。判愈后最早出现复发病例是第3个月,占0.89%,判愈后复发最多是在<1年之内,占47.11%,复发时间差异有显著统计学意义(χ2=978.08,P<0.01)。已判愈的初治涂阳与已判愈的复治涂阳病例,差异有统计学意义(χ2=41.35,P<0.01)。复发病例以农民最多,占69.81%,复治后2个月末,痰菌阴转、胸部阴影吸收,占59.11%;复治期间死亡8例,占3.56%。结论控制结核病治愈后复发关键是对前3年治愈病例进行重点监测,对既往为复治涂阳肺结核病患者及既往治疗时痰菌阴转慢的患者应高度关注。结核病控制的重点人群是农民。
Objective To explore the epidemiological characteristics and influencing factors of tuberculosis relapse in tuberculosis control projects and provide the basis and countermeasures for the prevention and control of tuberculosis relapse. Methods A retrospective survey method was used to track patients who had been diagnosed as smear-positive pulmonary tuberculosis and completed the course of treatment and cured after recurrence. The data were analyzed by χ2 test. Results There were 225 cases of pulmonary tuberculosis cured in 4 360 smear-positive cases in Cili County, with a total recurrence rate of 5.16%, of which the recurrence rate was 5.22% in males and 5.05% in females, with no significant difference (χ2 = 5.21, P> 0.05). The highest recurrence rate was in the group over 70 years of age, accounting for 25.12%. The lowest was in the age group of <10 years with 0 recurrence. The difference between the age groups was statistically significant (χ2 = 402.82, P <0.01). The first recurrent cases were found in the third month after the cure, accounting for 0.89%. The maximum recurrence rate was 47.11% within <1 year after treatment, and the difference was significant (χ2 = 978.08, P <0.01) ). Has been cured of smear-positive and retreated smear positive cases, the difference was statistically significant (χ2 = 41.35, P <0.01). Recurrences accounted for 69.81% of the total number of peasants. At the end of 2 months after recuperation, sputum negative conversion and chest shadow absorption accounted for 59.11%. Eight patients died of retreatment (3.56%). Conclusion The key to control recurrence after TB cure is to focus on monitoring the cure cases in the first three years and pay more attention to the patients with past TB sputum smear positive pulmonary tuberculosis and retreatment sputum negative in the past. The key population for tuberculosis control is peasants.