台北市結核病流行趨勢與防治成效之研究

(1)

530 1994-2000 1996-1999

1992-1996

7.73% 9.93% 25-34 65

0.68% 47.2%

P < 0.01 47.2%

25-34 65

WHO 85%

( Epidemiology ( Control

( Tuberculosis

1

2000 68.2

²

2 1 9 4 8

2 9

X

(2)

2 0 0 0 70.14

3

1 9 9 1 - 2 0 0 0

1 9 9 9

1994-2000

( )

4

1996-1999

1TU PPD WHO

( Mantoux test )

⁵

48-

72 10mm

1 9 9 4 - 1 9 9 6

X

5 ( Annual Rate of Tuberculosis Infection, ARTI ) ARTI=1-(1-

Px)

^1/x

P x

6-7

( X

²

t e s t )

P < 0.01

1994-2000

1994 57.69 2000

88.91 27.34

51.37 7.73%

9.73% 1997

1994-2000

25-34 65

1994-1996

(3)

2 0 0 0

25-34 65

1996-1999 141,537

137,386 ( 97.1% ) 4,151 ( 2.9% ) 4,151

193 ( 4.65%) 0.68%

1996 6.27% 1999 3.80%

1 9 9 6 0 . 9 2 % 1 9 9 9

0.55% ( )

1992-1996

4,130 47.2%

16.1% 14.7% 9.2%

( )

6 5

( )

1992 38.3% 1995 52%

1996 43.9%

1994-2000

1 9 9 4 - 2 0 0 0

1996 1,020 64 (6.27) 0.92

1997 1,115 48 (4.30) 0.63

1998 1,312 54 (4.12) 0.60

1999 704 27 (3.80) 0.55

4,151 193 (4.65) 0.68

a

b

ARTI

1992-1996

^a

( % ) 1884 ( 47.2 )

643 ( 16.1 ) 5 ( 0.1 ) 369 ( 9.2 ) 300 ( 7.5 ) 585 ( 14.7 ) 207 ( 5.2 ) 3,993 ( 100.0 )

a

137

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2.7% 13.0%

3 7 . 1 % 1 3 . 2 %

1994 42.52 2000

70.14 1997

7 . 4

⁸

9

HIV

¹⁰

HIV 1985-

1 9 9 2

¹¹

1 7

HIV/AIDS

2 , 5 9 8 , 4 9 3

2,019 6 ( 0.3%)

H I V HIV/AIDS

25-34

81.14% 65

5 6 . 4 % 3 5 - 4 4

55.0% 15 1994-2000

57.23%

( )

1992-1996

(%)

X

²

595(52.6) 273(24.1) 1(0.1) 38( 3.4) 104(9.2) 68( 6.0) 52(4.6) 1131(100.0) P > 0.01 1284(44.9) 370(12.9) 4(0.1) 378(11.8) 196(6.9) 513(17.9) 155(5.4) 2860(100.0)

25 309(61.5) 89(17.8) 0(0.0) 3( 0.6) 23(6.6) 58(11.6) 9(1.8) 499(100.0) P < 0.01 25-44 583(52.3) 179(16.1) 1(0.1) 19( 1.7) 97(8.7) 203(18.2) 31(2.8) 1113(100.0)

45-64 490(48.2) 185(18.2) 2(0.2) 63( 6.2) 63(6.2) 145(14.3) 69(6.8) 1017(100.0) 65 502(37.2) 189(14.0) 2(0.1) 278(20.6) 106(7.8) 176(13.0) 98(7.3) 1351(100.0)

1277(56.0) 392(17.2) 1(0.1) 134( 5.9) 148(6.5) 238(10.4) 90(3.9) 2280(100.0) P < 0.01 233(43.9) 110(20.7) 3(0.6) 36( 6.8) 49(9.2) 63(11.9) 37(7.0) 531(100.0)

1214(44.7) 454(16.7) 3(0.1) 293(10.8) 203(7.5) 411(15.1) 140(5.2) 2718(100.0) P > 0.01 670(52.5) 189(14.8) 2(0.2) 76( 6.0) 97(7.6) 174(13.6) 67(5.3) 1275(100.0)

243(51.2) 136(28.6) 1(0.2) 20( 4.2) 30(6.3) 25( 5.3) 20(4.2) 475(100.0) P < 0.01 1096(76.3) 154(10.7) 1(0.1) 44( 3.1) 56(3.9) 66( 4.6) 20(1.4) 1437(100.0)

X

²

1992 194(38.3) 191(37.1) 0(0) 14( 2.7) 39(7.6) 56(10.9) 18(3.5) 515(100.0)

1993 418(52.1) 127(16.1) 0(0) 47( 5.9) 31(3.9) 154(19.2) 24(3.0) 803(100.0)

1994 393(47.0) 131(15.7) 2(0.2) 83( 9.9) 53(6.3) 128(15.3) 47(5.6) 837(100.0) P > 0.05 1995 446(52.0) 63( 7.3) 1(0.1) 98(11.4) 71(8.3) 115(13.4) 54(6.3) 858(100.0)

1996 430(43.9) 129(13.2) 2(0.2) 127(13.0) 96(9.8) 132(13.5) 64(6.5) 980(100.0)

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15 1994-1996

25-34 65

2000

25-34 HIV/AIDS

2000 HIV/AIDS 560

25-34 240 ( 43.2% )

6-7

A RT I 0 . 5 % 1% ARTI 5 0

13-14

1996-1999 7

( ARTI ) 1996 0.92% 1999

0.55% 0.1%

¹⁵

16.1% 14.7%

16-17

( DOTS )

6 5

( WHO ) 85%

18

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Pair-Dong Wang

This retrospective study evaluated epidemiological trends in tuberculosis and the performance of a TB con- trol program in Taipei. Data of all recorded tuberculosis cases from 1994 through 2000 obtained from the Tuberculosis Registry Center was used to analyze the trend of incidence. Tuberculin skin tests were also per- formed to estimate the prevalence and annual risk of tuberculosis infection in second-grade schoolchildren dur- ing the period 1996-1999. The management cards for all tuberculosis patients from 1992 to 1996 obtained from Taipei Municipal Chronic Disease Hospital were also reviewed. The results show that incidence of tuberculosis had an increasing trend during the study periods with an average annual increase of 7.73% and 9.93% for males and females, respectively. Age-specific incidence showed a similar trend with a clear predominance of cases oc- curring in patients aged 25-34 and 65+ years. This bimodal pattern became more apparent in 2000. In second- grade schoolchildren, the annual risk of tuberculosis infection was approximately 0.68% with a decreasing trend over the study period. The relatively low cure rate of TB, averaging 47.2%, did not change significantly during the study period. Cure rate was significantly associated with patient's age, patient status as a new or recurrent case, and the development of side effects due to treatment with antituberculosis drugs. Because of the low overall cure rate of 47.2%, this region of Taipei remains high TB rates. The inefficiency of the existing tuberculosis control pro- gram is largely to blame for the alarmingly high rates. The high percentage of recurrent cases and of cases in in- dividuals aged 25-34 and older than 65 present a severe challenge to effective management and form a chron- ic pool of infectious cases. Our findings suggest that in order to achieve the WHO target of cure in 85% of TB cases, focusing effort on the identification and treatment of these groups is mandatory. ( J Intern Med Taiwan 2005; 16: 26-32 )

Department of Internal Medicine, Taipei City Hospital,

Branch of Disease Control, Taipei, Taiwan