Research And Analysis On Tuberculosis Screening Test Of Students In Shijiazhuang City

Part one Cost-effectiveness Study of Student Tuberculosis Screening Strategy in Shijiazhuang CityObjective:By exploring the cost effectiveness of different screening strategies for students with tuberculosis in Shijiazhuang City,the optimal discovery strategies for active tuberculosis and latent tuberculosis infection were identified,which provided scientific basis for formulating and selecting students'tuberculosis discovery strategies.Methods:By collecting and collating the literature,information on screening tests for students with active tuberculosis and latent tuberculosis infections was extracted and aggregated into different screening techniques.We collected cost and effect parameters and their distribution range,constructed decision tree model for cost effect analysis,and determined the optimal strategy plan for student tuberculosis screening.All parameters were constructed sensitivity analysis to study the stability of the decision tree model.Result:1 A total of six screening protocols were identified in this study:(1)active screening;(2)tuberculin screening test(TST);(3)IGRAs-T.SPOT.TB screening test;(4)IGRAs-QFT screening test;(5)TST combined with T.SPOT.TB screening test;(6)TST combined with QFT screening test.2 According to the overall cost-effectiveness ratio of the screening strategy,the minimum cost principle for screening active pulmonary tuberculosis patients,and the minimum cost-effectiveness ratio for screening patients with latent tuberculosis,the cost-effectiveness ratio of the active screening strategy is the smallest.3 According to the principle of the largest number of screenings,the TST screening strategy is the optimal solution.According to the best screening effect of active tuberculosis,the screening effect of active screening strategy is optimal.According to the optimal principle of screening for latent tuberculosis infection,the TST screening program is optimal.4 From the results of the Tornado Diagram,the unit cost of the tuberculin skin test(Cost-TST),the unit cost of X-ray examination(Cost-Xray)and the probability of BST inoculation with TST?10 mm(pBCG-TST)have the greatest influence on the model.Two-factor sensitivity analysis was performed on the variable Cost-TST and the variable Cost-Xray.Three-factor sensitivity analysis of these three variables showed no variable sensitivity,which was consistent with the baseline value study results.Conclusion:1 By constructing a decision tree model,active screening,tuberculin screening test(TST),IGRAs-T.SPOT.TB screening test,IGRAs-QFT screening test,TST combined T.SPOT.TB screening test and TST combined with QFT screening test were compared—Analysis of the cost-effectiveness of six screening programs on tuberculosis findings in students over 15 years old in Shijiazhuang City.The results showed that the tuberculin skin test found the largest number of active tuberculosis and latent tuberculosis infections,which is the best choice for students in Shijiazhuang City for tuberculosis screening.The active screening strategy has the lowest cost-effectiveness and complements other strategies.It is recommended that the application of tuberculin skin test in Shijiazhuang City be combined with the active screening strategy as a discovery strategy for students'tuberculosis.2 TST combined with QFT-GIT trial found that patients with active tuberculosis have higher specificity,but their cost is relatively high.It is recommended that students with low tuberculosis infection rate and economically developed areas in China should be used as a means of students'tuberculosis screening.Part two Analysis of screening results of pulmonary tuberculosis among students in Shijiazhuang CityObjective:To understand the characteristics of the new students suffering from pulmonary tuberculosis and tuberculosis epidemic in Shijiazhuang,provide basis for the prevention and control of school tuberculosis.Methods:Tuberculin Skin Test(PPD)was conducted on 173,680freshmen from 2015 to 2016 in each district and county of Shijiazhuang City,and further X-ray examination was performed to study the infection and distribution of tuberculosis.Result:1 A total of 130 active pulmonary tuberculosis students were detected in the PPD trial for two years.The general positive rate of new student's tuberculin skin test was 13.40%(23306/173980),and the strong positive rate was 4.10%(7069/173980).The positive and strong positive rates of urban fresh PPD tests were higher than those of rural areas(?~2 values were 260.78,81.67,P values were<0.001).The positive rate and strong positive rate of female students were higher than that of male students(?~2 values were 50.60,503.94,P<0.001).The positive rate of tuberculin skin test was different in different learning stages.The general positive rate and strong positive rate of PPD test increased with the school segment.The BCG scar by the school segment found that the strong positive rate of PPD test in the group without BCG scar of the primary school students was higher than that of the BCG scar group(?~2=9.84,P=0.002).The strong positive rate of tuberculin skin test in students with a history of exposure to tuberculosis was higher than that in patients without exposure to tuberculosis(?~2=56.15,P<0.001).2 The comparison of the two reagents showed that the general positive rate of TB-PPD group was higher than BCG-PPD(?~2=888.92,P<0.001),while the strong positive rate was lower than that of BCG-PPD group(?~2=710.27,P<0.001).Conclusion:1 The tuberculin skin test was used to screen tuberculosis students in Shijiazhuang City.The results showed that the tuberculosis infection in Shijiazhuang City was not optimistic.Through gender stratification,the infection rate of tuberculosis in girls is higher than that of boys;according to the stratification of the semester,the infection of Mycobacterium tuberculosis is mainly concentrated in middle schools and universities.It is recommended to strengthen the screening of girls,middle schools and university populations.2 Screening of tuberculosis in Shijiazhuang students by using two tuberculin reagents(TB-PPD and BCG-PPD)found that TB-PPD reagent is suitable for testing whether BCG vaccine is successfully vaccinated.The BCG-PPD reagent is suitable for screening for active tuberculosis and latent tuberculosis infection.