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背景:在南印度的Tirrvallur地区,作为DOTS项目的一部分,肺结核病人的发现主要由卫生机构(HF)来完成;另外,作为正在进行的一项流行病学研究的组成部分,通过社区调查(CS)对成人进行筛检也可以发现一部分病例。目的:对一年内由HF和CS发现的所有病人的社会人口学、临床学、细菌学特征以及治疗结局进行比较。结果:在32663名受调查的成人患者中共发现100例涂阳以及 116例涂阴肺结核病人;在65例已经开始化疗的涂阳病例中,44例已治愈。与HF病人相比,CS病人一方面年龄偏大(AOR=1.9)、男性较多(AOR=2.7)、文化程度较低(AOR=1.7)、居住条件较差(AOR=2.0);另一方面CS病人咳嗽3周以上(AOR=3.4)的比例以及涂阳比例较低(AOR=4.2)。在61名新发现涂阳CS病人中,40人报告有胸痛症状;其中32人(80％)已经就诊过,但未确诊。结论:即使在结核病高流行地区,社区调查对于肺结核病例发现也价值甚微。通过社区调查所发现的病例症状轻、传染性小,而且不到一半的人已经治愈。诊断性检查应面向年长、文化程度低的男性。
Background: In the Tirrvallur region of South India, as part of the DOTS project, the discovery of TB was mainly done by the health agency (HF); in addition, as part of an ongoing epidemiological study, community surveys (CS ) Screening adults also found some cases. PURPOSE: To compare the socio-demographic, clinical, bacteriological characteristics and treatment outcomes of all patients within one year of HF and CS. RESULTS: A total of 100 smear-positive and 116 smear-negative tuberculosis cases were found in 32,663 adult patients surveyed; 44 of the 65 smear-positive cases that had started chemotherapy were cured. Compared with HF patients, CS patients were older (AOR = 1.9), older men (AOR = 2.7), lower education (AOR = 1.7) and poor living conditions (AOR = The CS patients cough for more than 3 weeks (AOR = 3.4) and the proportion of smear positive (AOR = 4.2). Forty-one of 61 newly diagnosed smear-positive CS patients reported chest pain symptoms; 32 (80%) had been treated but not diagnosed. Conclusion: Community surveys are of little value in the detection of tuberculosis cases, even in areas with a high prevalence of tuberculosis. Cases found through community surveys have symptoms that are mild, infective, and less than half have been cured. Diagnostic tests should be targeted at older, less-educated men.