本文選題：結核病 + 結核分枝桿菌�。� 參考：《中國疾病預防控制中心》2010年碩士論文

【摘要】： 結核病仍然是嚴重危害著人類健康的傳染病之一,隨著HIV/AIDS、耐藥結核的流行等,使結核病再次成為嚴重的全球性公共衛(wèi)生問題。我國結核病疫情嚴重,結核病患病人數(shù)位居世界第二,僅次于印度,被世界衛(wèi)生組織列為全球22個結核病高負擔國家之一。2000年全國結核病流行病學抽樣調查結果顯示44.5%(5.5億)的人口感染了結核菌,明顯高出全球1／3人口感染的水平。近幾年,我國傳染病疫情報,每年結核病新發(fā)病例100多萬例。因此,控制結核病的發(fā)生與流行是目前我國衛(wèi)生工作的重要任務之一。但由于種種原因,我國結核病的基礎性研究工作明顯滯后。 本研究采用抽樣調查方法,選擇江西省南昌市4個區(qū)、縣作為調查點,對該4個區(qū)、縣醫(yī)院2009年1-6月住院肺結核患者和擬診肺結核病例進行調查�，F(xiàn)場調查采用描述性流行病學方法,采用統(tǒng)一的調查表對所有擬診病例進行個案調查。同時收集患者的三份深咳痰(清晨痰,夜間痰和即時痰)。涂片鏡檢和痰培養(yǎng)分枝桿菌,同一病例的三份痰標本,任何一份鏡檢陽性,即判定為涂片陽性。同一病例的三份痰標本,任何一份培養(yǎng)陽性,即判定為培養(yǎng)陽性,確診結核病例。對培養(yǎng)出的分枝桿菌采用鑒別培養(yǎng)基進行菌種鑒定,以了解結核分枝桿菌、牛分枝桿菌和非結核分枝桿菌的感染狀況。采用比例法對臨床分離菌株進行了異煙肼、利福平、鏈霉素、乙胺丁醇等四種藥物的敏感性檢測。并通過EXCEL2003、spss 15.0統(tǒng)計軟件和卡方檢驗對結果數(shù)據(jù)進行統(tǒng)計學處理和分析,以P0.05為差異有統(tǒng)計學意義。 442例擬診病例中,男性315例,占71.3%,女性127例,占28.7%,男女比例為2.48：1。就診患者年齡最小的12歲,最大80歲。以60歲以上病例數(shù)最高(占35.30%),老年成為患病高峰。其次分別為41-60歲年齡組,占31.67%,以及21-40歲年齡組,占26.70%,20歲以下病例數(shù)構成比最低(占6.33%)。農(nóng)村結核病疫情突出,本次調查農(nóng)村患病人數(shù)為322例,占72.85%,城鎮(zhèn)患病人數(shù)為120例,占27.15%。農(nóng)民病例數(shù)為272例,占61.54%,外來務工人員等流動人口病例數(shù)為66例,占14.93%,明顯高于其他職業(yè)人群。本次調查復治病人有55例,占12.44%。9.72%的病例曾有幾天到幾年不等的不規(guī)律抗結核治療史。13.35%(59例)的病例周圍有結核病人,4.98%的病例具有密切的接觸史,65.38%的病例沒有接受過任何形式的防癆宣傳教育,不到半數(shù)(45.93%)的病例了解結核病的傳播途徑,雖具備一定的結核病知識,但是不能有意識地對自己進行防護。僅37.00%的病例因癥就診的首診醫(yī)院為結防所。 本研究對4個調查點432例擬診病例收集到的1296份痰標本進行了傳統(tǒng)的結核病細菌學檢測�？顾崛旧珯z測,陽性標本362份,陽性率27.93%；陰性934份,陰性率72.07%。被檢測的432例擬診病例中,涂片鏡檢陽性162例,陽性率為37.50%,陰性病例270例,陰性率為62.50%。1296份痰標本分枝桿菌培養(yǎng)陽性共382份,占29.48%,陰性914份,占70.52%。432例擬診病例中分枝桿菌培養(yǎng)陽性159例,占36.81%,全陰病例273例,占63.19%。涂片染色和細菌培養(yǎng)方法聯(lián)合應用,陽性率達40.97%,明顯高于單獨使用涂片染色或細菌培養(yǎng)的陽性率。 本研究對已分離到的120株分枝桿菌菌株進行了菌種鑒定。該120株菌來自120個病例。108株分離株被鑒定為結核分枝桿菌(MTB),占90.00%；1株為牛結核分枝桿菌(M. bovis),占0.83%；11株為非結核分枝桿菌(NTM),占9.17%。 對108株結核分枝桿菌進行了藥物敏感性試驗,對四種抗結核一線藥物(SM,RFP, INH, EMB)全部敏感的菌株為97株,占89.81%；耐藥菌株11株,占10.19%,其中,單耐藥菌株7株,占6.48%；多耐藥菌株4株,占3.70%。 現(xiàn)場流行病學調查結果顯示,442例擬診病例中,男性高于女性,農(nóng)村高于城鎮(zhèn),中老年、農(nóng)民和流動人口為高發(fā)人群。存在結核病不規(guī)范治療,占9.72%。65.38%的病例沒有接受過任何形式的防癆宣傳教育,結核病防治知識的宣教和普及工作急需加強。 細菌學檢測發(fā)現(xiàn)當?shù)亟Y核病病原較為復雜,包括結核分枝桿菌、牛分枝桿菌和非結核分枝桿菌,尤其是非結核分枝桿菌達9.17%,應該引起重視。 結核分枝桿菌的耐藥率達10.19%,其中,單耐藥菌株占6.48%；多耐藥菌株占3.70%。 對同一病人同時采用涂片染色檢查和細菌培養(yǎng)方法進行檢查,可明顯提高檢測陽性率。 本研究在一定程度上直接反映出江西省南昌地區(qū)結核病流行現(xiàn)狀,具有重要的流行病學意義,同時,也為結核病的預防控制工作提供了一份可靠的基礎科學數(shù)據(jù)。
[Abstract]:Tuberculosis is still one of the infectious diseases seriously endangering human health. With the HIV/AIDS, the epidemic of drug-resistant tuberculosis and so on, tuberculosis has become a serious global public health problem. In China, the epidemic of tuberculosis is serious, the number of patients with tuberculosis is second in the world, second only to India, the world's WHO is listed as the 22 highest tuberculosis in the world. The national tuberculosis epidemiology sample survey in one of the country's.2000 shows that 44.5% (550 million) of the population infected with tuberculosis bacteria, obviously higher than the global 1 / 3 population infection level. In recent years, China's infectious diseases and epidemic information and about 1000000 new cases of tuberculosis in China annually. Therefore, control of the occurrence and epidemic of tuberculosis is the current health of our country. One of the important tasks of the work. However, due to various reasons, the basic research work of tuberculosis in China is obviously lagging behind.
In this study, 4 districts of Nanchang, Jiangxi Province, were selected to investigate the cases of tuberculosis and tuberculosis in the 4 districts, and the county hospitals were hospitalized in 1-6 months of 2009. A descriptive epidemiological method was used and a unified questionnaire was used to investigate all the cases. Three deep expectoration (early phlegm, nocturnal phlegm and instant phlegm). Smear microscopy and sputum culture of Mycobacterium phlegm, three sputum specimens of the same case, any positive smear positive, three sputum specimens of the same case, any positive, or positive, confirmed tuberculosis cases. The infection status of Mycobacterium tuberculosis, Mycobacterium bovis and Mycobacterium tuberculosis was detected by the identification medium, and the sensitivity of four drugs, isoniazid, rifampicin, streptomycin and ethambutol was detected by proportion method, and the statistical software and card of EXCEL2003, SPSS 15 were used. The results of the statistical analysis and analysis of the results were statistically significant by P0.05.
Among the 442 cases of diagnosis, 315 were male, 71.3% and 127 women, accounting for 28.7%. The proportion of men and women was 12 years old, and the maximum was 80 years old. The highest number of cases was 60 years old (35.30%), and the elderly became the peak of the disease. The second was 41-60 years old, 31.67%, and 21-40 age group, accounting for 26.70% and under 442 years of age. The constituent ratio is the lowest (6.33%). The epidemic situation of rural tuberculosis is prominent, the number of rural diseases in this survey is 322 cases, accounting for 72.85%, and the number of urban diseases is 120 cases, accounting for 272 cases of 27.15%. farmers, accounting for 61.54%, the number of migrant workers and other migrant workers is 66 cases, accounting for 14.93%, obviously higher than other occupational groups. This survey has 55 patients with 55 retreated patients 55. For example, the cases of 12.44%.9.72% had a history of.13.35% (59 cases) with a history of irregular anti tuberculosis treatment for several days to several years, and 4.98% of the cases had a close contact history. 65.38% of the cases had not received any form of anti tuberculosis propaganda and education, and less than half (45.93%) of cases knew the transmission route of tuberculosis, although it had a way to understand the transmission of tuberculosis. A certain amount of tuberculosis knowledge is available, but not consciously. Only 37% of the cases are diagnosed as the first aid hospital.
In this study, 1296 sputum specimens collected from 432 cases of 4 survey cases were examined by traditional tuberculosis bacteriology test. Acid stain detection, positive specimens were 362, positive rate 27.93%, negative 934, negative rate 72.07%. were detected in 432 cases of diagnosis, smear positive 162 cases, positive rate 37.50%, negative case 270 cases, negative cases. The sex rate of Mycobacterium tuberculosis in 62.50%.1296 phlegm specimens was 382, accounting for 29.48% and negative 914, accounting for 159 cases of Mycobacterium tuberculosis in 70.52%.432 cases, 36.81% and 273 cases of full Yin, accounting for the combination of 63.19%. smear staining and bacterial culture, with the positive rate of 40.97%, which was obviously higher than that of smear stain alone or fine. The positive rate of bacteria culture.
In this study, 120 strains of Mycobacterium strains isolated were identified. The 120 strains from 120 cases were identified as Mycobacterium tuberculosis (MTB), accounting for 90%, 1 Mycobacterium tuberculosis (M. bovis), 0.83% and 11 non tuberculous Mycobacterium (NTM), accounting for 9.17%..
108 strains of Mycobacterium tuberculosis were tested for drug sensitivity. 97 strains of SM, RFP, INH, EMB were all sensitive to 97, 89.81%, 11, 10.19%, of which 7, 6.48%, and 4, 3.70%..
The results of the field epidemiological survey showed that in 442 cases, the male was higher than the female, the rural area was higher than the town, the middle age and the old, the peasants and the floating population were the high incidence. There was no standardized treatment for tuberculosis. The cases of 9.72%.65.38% did not accept any form of anti tuberculosis propaganda education. The education and popularization of tuberculosis prevention and control knowledge were in urgent need. Strengthen.
Bacteriological detection found that the local tuberculosis pathogens were more complex, including Mycobacterium tuberculosis, Mycobacterium bovis and non tuberculosis mycobacterium, especially 9.17% of non tuberculosis mycobacterium, which should be paid attention to.
The drug resistance rate of Mycobacterium tuberculosis was 10.19%, of which 6.48% were single resistant strains, and 3.70%. was multidrug-resistant strains.
Smear staining and bacterial culture were used to check the positive rate of the same patient.
This study, to a certain extent, directly reflects the epidemic situation of tuberculosis in Nanchang area of Jiangxi Province, and has important epidemiological significance. At the same time, it also provides a reliable basic scientific data for the prevention and control of tuberculosis.
【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】：2010
【分類號】：R52;R181.3

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