近日，澳大利亚悉尼乌考克医学研究所Guy B. Marks小组在研究中取得进展。他们探讨了在结核病高发地区进行全社区结核病筛查的效果。该项研究成果发表在2019年10月3日出版的《新英格兰医学杂志》上。

研究小组在越南金瓯省进行了一项集群随机的对照试验，以评估与仅标准被动病例检测相比，主动社区范围筛查的有效性，以降低结核病的患病率。从2014年开始，对60个干预小组中15岁以上的参与者，无论其是否有症状，均通过对自发咳痰样本进行快速核酸扩增检验的方式进行肺结核筛查，每年一次，连续3年。与此同时，60个对照小组在这3年间均未进行主动筛查。

在第4年的肺结核患病率调查中，研究组检验了干预组中42150名和对照组中41680名参与者。最终干预组中有53名患肺结核，发病率为每100万人126例，对照组中有94名，发病率为每100万人226例，差异具有统计学意义。干预组中2012年出生的儿童结核病感染率为3.3%，对照组为2.6%，差异不显著。

总之，对于越南金瓯省15岁以上人群进行3年的全社区范围筛查，与仅行标准被动病例检测相比，可显著降低第四年的肺结核发病率。

据悉，世界卫生组织为消灭全球范围的结核病设定了雄心勃勃的目标，但以目前的进度来看尚无法实现。

附：英文原文

Title: Community-wide Screening for Tuberculosis in a High-Prevalence Setting

Author: Guy B. Marks, Nhung V. Nguyen, Phuong T.B. Nguyen, Thu-Anh Nguyen, Hoa B. Nguyen, Khoa H. Tran, Son V. Nguyen, Khanh B. Luu, Duc T.T. Tran, Qui T.N. Vo, Oanh T.T. Le, Yen H. Nguyen, Vu Q. Do, Paul H. Mason, Van-Anh T. Nguyen, Jennifer Ho, Vitali Sintchenko, Linh N. Nguyen, Warwick J. Britton, Greg J. Fox

Issue&Volume: Vol 381 No 14

Abstract: 

BACKGROUND
The World Health Organization has set ambitious targets for the global elimination of tuberculosis. However, these targets will not be achieved at the current rate of progress.

METHODS
We performed a cluster-randomized, controlled trial in Ca Mau Province, Vietnam, to evaluate the effectiveness of active community-wide screening, as compared with standard passive case detection alone, for reducing the prevalence of tuberculosis. Persons 15 years of age or older who resided in 60 intervention clusters (subcommunes) were screened for pulmonary tuberculosis, regardless of symptoms, annually for 3 years, beginning in 2014, by means of rapid nucleic acid amplification testing of spontaneously expectorated sputum samples. Active screening was not performed in the 60 control clusters in the first 3 years. The primary outcome, measured in the fourth year, was the prevalence of microbiologically confirmed pulmonary tuberculosis among persons 15 years of age or older. The secondary outcome was the prevalence of tuberculosis infection, as assessed by an interferon gamma release assay in the fourth year, among children born in 2012.

RESULTS
In the fourth-year prevalence survey, we tested 42,150 participants in the intervention group and 41,680 participants in the control group. A total of 53 participants in the intervention group (126 per 100,000 population) and 94 participants in the control group (226 per 100,000) had pulmonary tuberculosis, as confirmed by a positive nucleic acid amplification test for Mycobacterium tuberculosis (prevalence ratio, 0.56; 95% confidence interval [CI], 0.40 to 0.78; P<0.001). The prevalence of tuberculosis infection in children born in 2012 was 3.3% in the intervention group and 2.6% in the control group (prevalence ratio, 1.29; 95% CI, 0.70 to 2.36; P=0.42).

CONCLUSIONS
Three years of community-wide screening in persons 15 years of age or older who resided in Ca Mau Province, Vietnam, resulted in a lower prevalence of pulmonary tuberculosis in the fourth year than standard passive case detection alone. 

DOI: 10.1056/NEJMoa1902129

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1902129