本文關鍵詞： 肺結核 患者發(fā)現 決策樹 成本-效果分析　出處：《中國疾病預防控制中心》2013年碩士論文　論文類型：學位論文

【摘要】：目的通過研究肺結核患者不同發(fā)現策略的成本效果,確定在肺結核可疑癥狀者和重點人群中開展肺結核患者發(fā)現的最優(yōu)策略,為衛(wèi)生決策者因地制宜制定肺結核患者發(fā)現策略提供科學依據。 方法 1.通過文獻研究確定針對活動性肺結核患者的不同診斷技術組合； 2.通過文獻研究、人群歸因危險分值排序和可行性考慮,確定適合在我國開展肺結核患者發(fā)現工作的重點人群； 3.建立決策樹模型,收集參數和參數敏感度分析范圍,進行成本-效果分析確定每種人群的最優(yōu)策略,進行敏感度分析檢驗模型的穩(wěn)定性； 4.匯總不同人群的最優(yōu)策略的成本效果,考慮相互之間的交叉重復,獲得最優(yōu)策略應用于全人群的成本效果。 結果 1.確定了5種肺結核患者發(fā)現策略：策略1：對目標人群先進行胸部X線檢查和痰涂片鏡檢,對有臨床表現或X線檢查懷疑肺結核但涂片檢查陰性者進行固體痰培養(yǎng)；策略2：對目標人群先進行線索調查,然后對線索調查獲得的可疑癥狀者和該目標人群中主動就診的可疑癥狀者進行胸部X線檢查和痰涂片鏡檢,對有臨床表現或X線檢查懷疑肺結核但涂片檢查陰性者進行固體痰培養(yǎng)；策略3：對目標人群先進行詢問癥狀和胸部X線檢查,任何一項有異常者進行痰涂片檢查,對涂陰者做痰培養(yǎng)；策略4：對目標人群先進行詢問癥狀和胸部X線檢查,任何一項有異常者進行痰涂片LED鏡檢,對涂陰者做痰培養(yǎng)；策略5：對目標人群先進行詢問癥狀和胸部X線檢查,任何一項有異常者進行GeneXpert檢查。 2.確定的重點人群為老年人、糖尿病患者和涂陽肺結核患者密切接觸者。 3.對于可疑癥狀者,策略2是進行患者發(fā)現的最大效果策略,策略4為最高效率策略；對于老年人群,策略3是進行患者發(fā)現的最大效果策略,策略1為最高效率策略；對于糖尿病患者和涂陽密接者,策略4是進行肺結核患者發(fā)現的最大效果策略,策略1為最高效率策略；敏感度分析顯示各參數在設定的范圍內變化不影響模型分析的結果。 4.最大效果策略應用于全人群花費的成本為1720.5萬元,能夠發(fā)現2367例肺結核患者；最高效率策略應用于全人群花費的成本為279.8萬元,能夠發(fā)現1387例肺結核患者。 結論 1.使用痰涂片LED鏡檢替代痰涂片傳統(tǒng)鏡檢能夠獲得更高的收益； 2.為了發(fā)現更多的肺結核患者,可疑癥狀者應采用策略2,老年人群應采用策略3,糖尿病患者和涂陽密接者應采用策略4； 3.為了實現最高效的肺結核患者發(fā)現,可疑癥狀者應采用策略4,老年人群、糖尿病患者和涂陽密接者應采用策略2； 4.現階段,對所有的重點人群單獨開展肺結核患者發(fā)現不符合成本效益原則,未來可以考慮在具有多重危險因素的人群中做進一步的研究。
[Abstract]:Objective to study the cost effect of different detection strategies for pulmonary tuberculosis patients, and to determine the best strategy for the detection of pulmonary tuberculosis patients among suspected symptoms and key population. To provide scientific basis for health decision makers to formulate strategies for finding tuberculosis patients according to local conditions. Method 1. To determine the different diagnostic techniques for active pulmonary tuberculosis patients through literature research; 2.Through the literature research, the classification of population attribution risk and the feasibility consideration, the key population suitable for TB discovery in China was determined. 3. Establish the decision tree model, collect the parameters and their sensitivity analysis range, make cost-effect analysis to determine the optimal strategy for each population, and test the stability of the model by sensitivity analysis. 4. Sum up the cost effect of the optimal strategy of different population, consider the crossover between each other, and obtain the cost effect of the optimal strategy applied to the whole population. Results 1. Five strategies for finding pulmonary tuberculosis patients were determined. Strategy 1: chest X-ray examination and sputum smear examination were performed on the target population first. Solid sputum culture was performed on patients with clinical manifestations or suspected pulmonary tuberculosis but negative smear examination. Strategy 2: the target group was investigated with clues first, and then chest X-ray examination and sputum smear examination were carried out on the suspicious symptoms obtained by the clue investigation and the suspicious symptoms of the target group. Solid sputum culture was performed on patients with clinical manifestations or suspected pulmonary tuberculosis but negative smear examination. Strategy 3: the target population was examined for symptoms and chest X-ray, any abnormal sputum smear examination and sputum culture for negative smear; Strategy 4: ask for symptoms and chest X-ray examination of the target population first, any one of the abnormal sputum smear LED examination, the smear negative for sputum culture; Strategy 5: ask the target group for symptoms and chest X-ray examination, any abnormal for GeneXpert examination. 2. The key population was the elderly, diabetic patients and smear positive pulmonary tuberculosis patients in close contact. 3. For patients with suspicious symptoms, strategy 2 is the most effective strategy for patient detection, and strategy 4 is the highest efficiency strategy. For the elderly, strategy 3 was the most effective strategy for patient discovery, and strategy 1 was the highest efficiency strategy. For diabetic patients and smear positive patients, strategy 4 was the most effective strategy for finding pulmonary tuberculosis, and strategy 1 was the highest efficiency strategy. Sensitivity analysis shows that the variation of the parameters within a given range does not affect the results of the model analysis. 4. The cost of applying the maximum effect strategy to the whole population is seventeen million two hundred and five thousand yuan, which can detect 2 367 cases of pulmonary tuberculosis. The maximum efficiency strategy cost two million seven hundred and ninety-eight thousand yuan to apply to the whole population, and can detect 1, 387 cases of pulmonary tuberculosis. Conclusion 1. The use of sputum smear LED to replace the traditional sputum smear examination can obtain higher income. 2. In order to find more patients with pulmonary tuberculosis, strategy 2 should be used for suspicious symptoms, strategy 3 should be adopted for the elderly, and strategy 4 should be used for diabetics and smear positive persons. 3. In order to find the most effective pulmonary tuberculosis patients, strategy 4 should be adopted for suspicious symptoms, and strategy 2 should be adopted for the elderly, diabetes patients and smear positive persons. 4. At this stage, it is not cost-effective to identify tuberculosis patients in all key populations alone, and further research in populations with multiple risk factors could be considered in the future.
【學位授予單位】：中國疾病預防控制中心
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R521

【參考文獻】

相關期刊論文 前10條

1 高建華;江超穗;覃志國;岑貞業(yè);李穎;黃江梅;;2010年百色市結核病人和HIV/AIDS雙向篩查結果分析[J];應用預防醫(yī)學;2011年05期

2 曹廣華;支玉紅;;艾滋病病毒感染者和艾滋病患者中結核病篩查結果分析[J];疾病監(jiān)測;2006年08期

3 K.Slama;C-Y.Chiang;D.A.Enarson;K.Hassmiller;A.Fanning;P.Gupta;C.Ray;劉北斗;何廣學;;吸煙與結核病:定性系統(tǒng)綜述與Meta分析[J];國際結核病與肺部疾病雜志(中文版);2007年04期

4 A.Sanchez;B.Larouze;A.B.Espinola;J.Pires;D.Capone;G.Gerhardt;V.Cesconi;M.J.Procopio;M.Hijjar;V.Massari;徐漢城;何廣學;;在結核病高疫情監(jiān)獄進行入監(jiān)篩查結核病?里約熱內盧監(jiān)獄的案例[J];國際結核病與肺部疾病雜志(中文版);2009年04期

5 楊華林,端木宏謹,王黎霞;對不同人群采用不同方法肺結核病人檢出率的研究[J];實用預防醫(yī)學;2005年01期

6 王海英;蔣彩花;王俊玲;趙靜;鄧云峰;劉志敏;;山東省某監(jiān)獄勞教人員結核病篩查結果分析[J];中國防癆雜志;2009年06期

7 屠德華;;迎接結核病控制的創(chuàng)新時代[J];中國防癆雜志;2010年03期

8 李建明;尚金花;徐文生;張立軍;賈秀峰;;山東省東營市農村地區(qū)肺結核病患者篩查方法的探討[J];中華流行病學雜志;2006年06期

9 王偉炳;王法弟;徐飚;朱建福;沈偉;肖喜榮;姜慶五;;經濟較發(fā)達農村地區(qū)結核病慢性咳嗽線索篩查的成本效果研究[J];中華流行病學雜志;2006年10期

10 朱鳳東;孫波;徐飚;焦加華;單永梅;董青;王偉炳;馮雨明;;蘇北農村線索篩查結核病人成本效果分析[J];中國農村衛(wèi)生事業(yè)管理;2008年08期

，

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