【摘要】 目的 通过收集、分析各个可能存在结核病患者信息的个案系统数据,探索病例存量研究和捕获-再捕获方法 在评价中国结核病监测系统敏感性中的应用。方法 根据方便抽样原则,选取东部(浙江省浦江县)、中部(河南省长垣县)、西部(广西壮族自治区宜州市)省份和直辖市(上海市黄浦区)作为研究地区;通过查阅文献、专家研讨等多种形式,选取医疗机构病案资料、基本公共卫生服务项目、健康档案、医疗保险、药店处方、乡村医生(社区卫生工作站)工作记录、民政救助系统和艾滋病疫情监测系统等8个医疗、社会公共卫生系统作为研究参照系统,采用病例存量研究和捕获-再捕获方法,对8个参照系统2014年1月1日至12月31日登记记录的结核病患者数据进行调查和分析,以评价利用各系统数据实施病例存量研究和捕获-再捕获方法 的可行性,并匹配判定调查地区可能存在的未报告的结核病患者。结果 8个备选的参照系统中,药店处方不存在可分析的个案记录系统。基本公共卫生服务项目中共发现6例结核病记录,但仅在2个地区有独立的记录,且覆盖范围不完整,记录内容不统一。乡村医生(社区卫生工作站)工作记录在3个地区存在,共发现8例记录,但诊断能力和记录格式相差较大。健康档案中共发现10例记录,但关于结核病的记录大多为既往史,难以提取有用的发病信息。民政救助、艾滋病疫情监测系统中结核病相关信息仅各有1例结核病记录。医疗机构病案资料中共发现85例结核病患者的记录,但数据存储形式多样化、机构间数据不共享。医疗保险在本次调查中共发现96例结核病患者的记录,数据记录相对完善、容易获取。调查共发现有确诊结核病患者的161例记录,在传染病网络直报系统中报告132例,未报告29例。29例未报告患者中,25例来自医疗保险系统,1例来自健康档案,3例来自医疗机构病案资料。其中4例为肺外结核患者,1例为结核性胸膜炎,12例为复治涂阴患者,3例为陈旧性肺结核患者,9例为实际漏报的活动性肺结核患者。结论 现阶段病例存量研究在中国适宜于开展漏报调查以评估结核病监测系统敏感性,但无法利用现有参照系统数据通过捕获-再捕获方法 直接估算结核病疫情。更多还原

【Abstract】 Objective To explore the application of Inventory Study and Capture-Recapture Method（CMR）in assessing sensitivity of Chinese Tuberculosis（TB） surveillance system through collecting and analyzing data from systems which may exist tuberculosis（TB） patients records.Methods Selected 4 townships of Zhejiang,Henan,Guangxi and Shanghai province or province-level municipality according to convenience sampling,through paper review and experts discussing,select medical institutions（hospitals）,residents health profile,medical insurance systems,Prescription of Pharmacies,Routine logs of village/community doctors,HIV surveillance system,Home Relief system and Public Health Projects as references systems.To search TB related records registered from Jan.1^st to Dec.31^th of 2014 in these systems,to evaluate the feasibility of implementing inventory study and CMR method by using these data,and find out the potential underreporting TB cases.Results In the 8 alternative reference systems:prescriptions of pharmacies haven’t suitable individual cases for analysis.Six TB records were found in Public Health Projects,but it only existed in 2 sites,also didn’t cover all population,and the records were not unified Routine logs of village/community doctors were available in 3 sites which contained 8 TB records,but their record formulas were very different.The records of TB in residents health profiles were mostly post history but not current state despite 10 detected TB records.And TB cases in Home Relief system and HIV surveillance system were extremely few,,only 1 record was found in each system.The medical records in hospitals provided 85 records,but not all of them were e-records and there wasn’t a data sharing mechanism.The records of medical insurance system were complete and easy to access,which provided 96 records.One hundred and sixty one confirmed TB cases were found in the investigation,among them 132 cases have been reported in the infectious diseases reporting system（IDRS） and other 29 cases were not successfully matched.Among these 29 cases,25 cases were from medical insurance systems,1 from residents health profiles,3 from hospitals.Four of them were extrapulmonary TB,1 tuberculous pleurisy,12 retreated smear negative pulmonary TB,3 obsolete cases and 9 underreported confirm TB cases.Conclusion Inventory study is suitable to be used in evaluating TB underreporting level for assessing sensitivity of China’s TB surveillance system.But it’s not applicable to estimate TB incidence by analyzing existing data resources through CMR method.更多还原