老年结核病发病危险因素及主动筛查策略的效果研究进展

doi:10.3969/j.issn.2095-3755.2018.03.013

摘要/Abstract

摘要：

随着我国社会老龄化程度的加剧,老年结核病发病率呈上升趋势。老年人群为结核病患者中的重点人群,但该人群往往对结核病的认知存在局限,同时该人群结核病临床症状较为隐匿,常造成漏诊、误诊,延误最佳治疗时间。因此,在老年人群中积极推进主动筛查方式,可以弥补传统被动发现方式的不足,提高肺结核的检出率。作者通过对影响老年人群患结核病的危险因素进行总结,探索老年结核病防控策略及措施,旨在为全国范围内开展老年人结核病研究和制定政策措施提供借鉴和依据。

关键词: 结核, 肺, 老年人, 危险因素, 多相筛查, 综述

Abstract:

With increasing Chinese aging population, the incidence of tuberculosis in the elderly is on the rise. The elderly population is a key group among tuberculosis patients, but they often have limited knowledge of tuberculosis. In addition, the symptoms of tuberculosis in this population are relatively hidden, often causing missed diagnosis or misdiagnosis of tuberculosis and delaying the optimal treatment time. Therefore, actively promoting active screening methods in the elderly population can make up for the shortcomings of traditional passive discovery methods and improve the detection rate of tuberculosis. This paper summarizes the risk factors of tuberculosis in the elderly, and helps to explore prevention and control strategies and measures. It aims to provide reference and basis for the development of tuberculosis research and policy measures for the elderly nationwide.

Key words: Tuberculosis, pulmonary, Aged, Risk factors, Multiphasic screening, Review

秦楠,成君,王伟炳. 老年结核病发病危险因素及主动筛查策略的效果研究进展[J]. 结核病与肺部健康杂志, 2018, 7(3): 208-212. doi: 10.3969/j.issn.2095-3755.2018.03.013

Nan QIN,Jun CHENG,Wei-bing WANG. Research progress on risk factors and active screening strategies in senile tuberculosis[J]. Journal of Tuberculosis and Lung Health, 2018, 7(3): 208-212. doi: 10.3969/j.issn.2095-3755.2018.03.013

图/表 2

参考文献 42

[1]	World Health Organization . Global tuberculosis report 2017. Geneva: World Health Organization, 2017.
[2]	全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告. 中国防痨杂志, 2012,34(8):485-508.
[3]	李亮 . 老年结核病流行概况. 结核病健康教育, 2005,( 2):7-8.
[4]	Kuo MC, Lin SH, Lin CH , et al. Type 2 diabetes: an independent risk factor for tuberculosis: a nationwide population-based study. PLoS One, 2013,8(11):e78924. doi: 10.1371/journal.pone.0078924 URL
[5]	朱红, 王建华 . 2型糖尿病并发肺结核病的危险因素探讨. 中华流行病学杂志, 2006,27(1):58-62.
[6]	Leung CC, Lam TH, Chan WM , et al. Diabetic control and risk of tuberculosis: a cohort study. Am J Epidemiol, 2008,167(12):1486-1494. doi: 10.1093/aje/kwn075 URL pmid: 18400769
[7]	Vallerskog T, Martens GW, Kornfeld H . Diabetic mice display a delayed adaptive immune response to Mycobacterium tuberculosis. J Immunol, 2010,184(11):6275-6282. doi: 10.4049/jimmunol.1000304 URL
[8]	Duangrithi D, Thanachartwet V, Desakorn V , et al. Impact of diabetes mellitus on clinical parameters and treatment outcomes of newly diagnosed pulmonary tuberculosis patients in Thailand. Int J Clin Pract, 2013,67(11):1199-1209. doi: 10.1111/ijcp.12215 URL
[9]	Velayutham BR, Nair D, Chandrasekaran V , et al. Profile and response to anti-tuberculosis treatment among elderly tuberculosis patients treated under the TB Control programme in South India. PLoS One, 2014,9(3):e88045. doi: 10.1371/journal.pone.0088045 URL
[10]	Arora VK, Bedi RS . Geriatric tuberculosis in Himachal Pradesh-a clinico-radiological profile. J Assoc Physicians India, 1989,37(3):205-207. URL pmid: 2768162
[11]	Murin S, Bilello KS . Respiratory tract infections: another reason not to smoke. Cleve Clin J Med, 2005,72(10):916-920. doi: 10.3949/ccjm.72.10.916 URL pmid: 16231688
[12]	Feng Y, Kong Y, Barnes PF , et al. Exposure to cigarette smoke inhibits the pulmonary T-cell response to influenza virus and Mycobacterium tuberculosis. Infect Immun, 2011,79(1):229-237. doi: 10.1128/IAI.00709-10 URL
[13]	Oshi DC, Oshi SN, Alobu I , et al. Profile and treatment outcomes of tuberculosis in the elderly in southeastern Nigeria, 2011—2012. PLoS One, 2014,9(11):e111910. doi: 10.1371/journal.pone.0111910 URL
[14]	Neyrolles O, Quintana-Murci L . Sexual inequality in tuberculosis. PLoS Med, 2009,6(12):e1000199. doi: 10.1371/journal.pmed.1000199 URL
[15]	Ukwaja KN, Alobu I, Nweke CO , et al. Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study. BMC Health Serv Res, 2013,13:25. doi: 10.1186/1472-6963-13-25 URL
[16]	Chan-Yeung M, Cheung AH, Dai DL , et al. Prevalence and determinants of positive tuberculin reactions of residents in old age homes in Hong Kong. Int J Tuberc Lung Dis, 2006,10(8):892-898.
[17]	祖丽娅·沙塔尔. 乌鲁木齐市老年人肺结核影响因素的病例对照研究. 乌鲁木齐: 新疆医科大学, 2017.
[18]	胡嘉, 孟旭, 邱林西 . 江西省贫困地区老年人结核病患病影响因素. 中国老年学杂志, 2017,37(16):4130-4132. doi: 10.3969/j.issn.1005-9202.2017.16.099 URL
[19]	谢欣, 唐利红, 黄晓霞 , 等. 上海市某区菌阳肺结核患者密切接触者结核分枝杆菌潜伏感染及其相关因素. 中华结核和呼吸杂志, 2016,39(12):944-947. doi: 10.3760/cma.j.issn.1001-0939.2016.12.008 URL
[20]	Noertjojo K, Tam CM, Chan SL , et al. Contact examination for tuberculosis in Hong Kong is useful. Int J Tuberc Lung Dis, 2002,6(1):19-24. doi: 10.1258/0956462021924514 URL pmid: 11931396
[21]	Behr MA, Hopewell PC, Paz EA , et al. Predictive value of contact investigation for identifying recent transmission of Mycobacterium tuberculosis. Am J Respir Crit Care Med, 1998,158(2):465-469. doi: 10.1164/ajrccm.158.2.9801062 URL
[22]	中华人民共和国卫生部疾病预防控制局, 中华人民共和国卫生部医政司, 中国疾病预防控制中心. 中国结核病防治规划实施工作指南(2008年版). 北京: 中国协和医科大学出版社, 2009: 20-21.
[23]	Kuznetsov VN, Grjibovski AM, Mariandyshev AO , et al. A comparison between passive and active case finding in TB control in the Arkhangelsk region. Int J Circumpolar Health, 2014,73:23515. doi: 10.3402/ijch.v73.23515 URL pmid: 24563859
[24]	Bjerregaard-Andersen M, da Silva ZJ, Ravn P , et al. Tuberculosis burden in an urban population: a cross sectional tuberculosis survey from Guinea Bissau. BMC Infect Dis, 2010,10:96. doi: 10.1186/1471-2334-10-96 URL
[25]	van’t Hoog AH, Meme HK, Laserson KF , et al. Screening strategies for tuberculosis prevalence surveys: the value of chest radiography and symptoms. PLoS One, 2012,7(7):e38691. doi: 10.1371/journal.pone.0038691 URL
[26]	彭红, 许卫国, 翟祥军 , 等. 江苏农村社区一般人群胸部X线摄片主动筛查肺结核的效果评估. 中国防痨杂志, 2014,36(12):1029-1035. doi: 10.3969/j.issn.1000-6621.2014.12.007 URL
[27]	张纪宏, 顾其华, 张庆东 , 等. 农村社区慢性咳嗽患者线索调查主动发现结核病人的效果分析. 中国初级卫生保健, 2006,20(9):18-21. doi: 10.3969/j.issn.1001-568X.2006.09.008 URL
[28]	Ohmori M, Wada M, Mitarai S , et al. Tuberculosis control in health care facilities for the elderly, from the viewpoint of risk management. Kekkaku, 2006,81(2):71-77.
[29]	张灿有, 王黎霞, 张慧 , 等. 不同发现策略应用于老年肺结核患者发现的成本效果研究. 中国防痨杂志, 2013,35(10):793-798.
[30]	Coffman J, Chanda-Kapata P, Marais BJ , et al. Tuberculosis among older adults in Zambia: burden and characteristics among a neglected group. BMC Public Health, 2017,17(1):804. doi: 10.1186/s12889-017-4836-0 URL pmid: 5639764
[31]	王芸, 许琳, 邱玉冰 , 等. 主动筛查方式下云南省6个偏远农村肺结核患病情况分析. 现代预防医学, 2014,41(19):3606-3608,3620.
[32]	张琳, 李小谋, 鲜小萍 . 西安市灞桥区2016年65岁以上老年人口结核病筛查的效果分析. 中国防痨杂志, 2017,39(4):428-430.
[33]	陈伟, 李洋洋, 成君 , 等. 我国三个县(区)≥65岁老年人口结核病患病情况的抽样调查分析. 中国防痨杂志, 2015,37(10):1061-1066. doi: 10.3969/j.issn.1000-6621.2015.10.011 URL
[34]	成君, 赵飞, 夏愔愔 , 等. 既往结核病患者中肺结核患病状况及发现策略研究. 中国防痨杂志, 2015,37(10):1024-1029.
[35]	瞿媛, 普丽, 苏丽敏 , 等. 玉溪市红塔区重点人群肺结核主动筛查模式探究. 实用预防医学, 2017,24(8):971-973.
[36]	Mupere E, Schiltz NK, Mulogo E , et al. Effectiveness of active case-finding strategies in tuberculosis control in Kampala, Uganda. Int J Tuberc Lung Dis, 2013,17(2):207-213. doi: 10.5588/ijtld.12.0160 URL pmid: 23317956
[37]	Yadav RP, Nishikiori N, Satha P , et al. Cost-effectiveness of a tuberculosis active case finding program targeting household and neighborhood contacts in Cambodia. Am J Trop Med Hyg, 2014,90(5):866-872. doi: 10.4269/ajtmh.13-0419 URL
[38]	Zwerling AA, Sahu M, Ngwira LG , et al. Screening for tuberculosis among adults newly diagnosed with HIV in Sub-Saharan Africa: A cost-effectiveness analysis. J Acquir Immune Defic Syndr, 2015,70(1):83-90. doi: 10.1097/QAI.0000000000000712 URL
[39]	Dasgupta K, Schwartzman K, Marchand R , et al. Comparison of cost-effectiveness of tuberculosis screening of close contacts and foreign-born populations. Am J Respir Crit Care Med, 2000,162(6):2079-2086. doi: 10.1164/ajrccm.162.6.2001111 URL
[40]	Sekandi JN, Dobbin K, Oloya J , et al. Cost-effectiveness analysis of community active case finding and household contact investigation for tuberculosis case detection in urban Africa. PLoS One, 2015,10(2):e117009.
[41]	Kranzer K, Lawn SD, Meyer-Rath G , et al. Feasibility, yield, and cost of active tuberculosis case finding linked to a mobile HIV service in Cape Town, South Africa: a cross-sectional study. PLoS Med, 2012,9(8):e1001281. doi: 10.1371/journal.pmed.1001281 URL
[42]	Steingart KR, Schiller I, Horne DJ , et al. Xpert ^® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev, 2014, (1):CD009593.

第一作者	年份	地区	人群	ACF方法	ACF检出率 (/10万)	PCF登记率 (/10万)
Bjerregaard- Andersen^[24]	2004—2007	几内亚	老年人群	问卷筛查+胸部X线摄影检查+痰涂片	701	NA
张纪宏^[27]	2004	中国江苏	老年人群	问卷筛查+胸部X线摄影检查+痰涂片	5263	NA
Ohmori^[28]	2002—2004	日本	老年人群	胸部X线摄影检查	2080	1230
Coffman^[30]	2013—2014	赞比亚	老年人群	胸部X线摄影检查	700	500
王芸^[31]	2004—2007	几内亚	老年人群	问卷筛查+胸部X线摄影检查+痰涂片	701	NA
张琳^[32]	2016	中国西安	老年人群	问卷筛查+胸部X线摄影检查+痰涂片	1320	NA
陈伟^[33]	2012	中国浙江、河南、云南	老年人群	问卷筛查+胸部X线摄影检查+痰涂片	1073	NA
瞿媛^[35]	2015	中国云南	老年人群	问卷筛查+胸部X线摄影检查+痰涂片+Xpert	82	18