| Objective:1.To provide reference for Tuberculosis prevention and control measures through the characteristics of tuberculosis epidemic in Liyang district.2.To provide the basis for the application of isothermal multiple self-matching initiated amplification(IMSA)in primary hospitals.Methods:1.This was a retrospective cohort study of the main epidemic characteristics and treatment outcome of tuberculosis in Liyang in recent years.(1)Data of 1092 registered patients with pulmonary tuberculosis in Liyang district from 2014 to 2017 were collected in the Tuberculosis Information Management System.Descriptive epidemiological survey method and SPSS 19.0 software were used for statistical analysis.To analyze the incidence trend of pulmonary tuberculosis(registration rate,smear positive rate and smear positive tuberculosis incidence),the time and area of onset,the sex,age and occupational distribution characteristics of patients,and the situation of new patients without any history of previous treatment and retreatrment patients.(2)Except for 25 of the 1092 patients those were not registered in time for treatment outcomes,the results of cure,treatment completed,death,failure and transfer to multi-drug resistance of the rest 1067 patients were analyzed.2.Analysis of sputum smear,acid fast staining,Roche bacteria culture and IMSA method in the detection of Mycobacterium tuberculosis.(1)1179 qualified sputum specimens were collected from patients with pulmonary tuberculosis registered in Liyang People's Hospital from January 2014 to April 2018.Sputum smear acid fast staining and Roche bacteria culture were conducted respectively,and the positive detection rate of Mycobacterium tuberculosis was analyzed and compared.(2)144 sputum specimens of suspected pulmonary tuberculosis patients in Liyang People's Hospital from October 2017 to April 2018 were examined by acid-fast staining,Roche's bacteria culture and IMSA to analyze the testing consistency of positive detection rate and specificity of the three methods.Results:1.The main epidemic characteristics and treatment outcome of tuberculosis in Liyang in recent years.(1)The main characteristics of tuberculosis in Liyang in recent years?The trends of incidenceThe average annual registration rate and average annual smear positive prevalence rate of patients with tuberculosis in Liyang city from 2014 to 2017 were 34.34/100,000 and 1242/100,000,respectively.The registration rate and smear positive rate decreased continuously from 2014 to 2016 but increased in 2017.There were 395 smear positive pulmonary tuberculosis patients and 697 smear negative patients,with an average-annual smear rate of 36.17%,which decreased continuously from 2014 to 2017.? Distribution of the tuberculosis patients.The highest number of tuberculosis patients registered in 4 years was in June,August and September,and the average cases were 116.And the lowest number of tuberculosis patients was 48 in February.86.08%of the tuberculosis patients were local residents.The highest number of tuberculosis registrations was Licheng town(27%).Prison(18%)and Shezhu town(10%)were followed.Male tuberculosis patients were more than females with ratio 3.53:1.The highest proportion of smear positive tuberculosis patients aged over 65 was 40.51%.Those with tuberculosis were the most likely to be farmers,accounting for 56.96%.937 of the 1092 tuberculosis patients were new patients(85.81%)and 155 were retreatment patients(14.19%).321 cases(81.27%)of the 395 cases smear-positive patients were new patients,and 74 cases(18.73%)were retreatment patients.(2)Treatment outcomes.The cure rate of initial smear positive and retreated smear positive patients was 86.12%and 66.67%,the failure rate was 3.15%and 10.14%,and the conversion rate to multi-drug resistant treatment was 2.21%and 8.70%,respectively.The difference was statistically significant(P<0.05).The completion rate of the new and retreatment patients were 95.5 7%and 94.44%.There was no significant difference between the two groups(P>0.05).The death rate accounted for 2.38%(22/926)of new patients and 3.55%(5/141)of retreatment patients,with no significant difference(P>0.05).2.Results of acid-fast staining of sputum smear,Roche bacteria culture and IMSA(1)The positive rate of acid-fast staining and Roche bacteria culture were 35.88%and 36.30%,respectively in the sputum smear of 1179 patients with tuberculosis from 2014 to 2017.P>0.05,with showing no statistical significance.(2)?Of the 144 sputum specimens from October 2017 to April 2018,122 were confirmed cases of tuberculosis and 22 were non-tuberculosis?The positive detection rate was 27.87%(34/122)by the sputum smear acid-fast staining,31.15%(38/122)by the Roche bacterial culture,and 40.98%(50/122)by the IMSA.The positive rate of IMSA was higher than that of acid-fast staining(P<0.05,the difference was statistically significant).There was no significant difference between IMSA and Roche's bacterial culture(P>0.05)and there was no significant difference between acid-fast staining and 'Roche's bacterial culture(P>0.05).‘?Among 122 sputum specimens from clinically confirmed pulmonary tuberculosis patients,34 cases were smear positive pulmonary tuberculosis group,the positive rate of Roche's bacterial culture was 88.24%,and the positive rate of IMSA was 100%.The difference was not statistically significant(P>0.05).In smear-negative pulmonary tuberculosis group(88 cases).The positive rate of Roche's bacterial culture was 9.09%,and that of IMSA was 18.18%.There was no significant difference(P>0.05).? The specificity of smear acid-fast staining and Roche's bacterial culture were 95.45%in 22 cases of non-tuberculosis and that of IMSA was 100%.?Comparison of consistency.IMSA and acid-fast staining showed good consistency(Kappa value was 0.720).The degree of consistency with the Roche bacterial culture was moderate(Kappa value was 0.596).Results:1.The main epidemic characteristics and treatment outcome of tuberculosis patients in Liyang City from 2014 to 2017 indicated that in tuberculosis prevention and control should pay more attention to summer and autumn,local people,prison areas,men,the elderly over 65 years old and farmers,and to strengthen the treatment of patients with recurrent smear and carry out the analysis of drug resistance.2.IMSA is a simple and rapid method for detection of Mycobacterium tuberculosis,with high positive detection rate and specificity,and good consistency.It is suitable for application in primary hospitals. |
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