2016-2020年河南省学生肺结核发现延迟及影响因素分析  

Analysis of pulmonary tuberculosis case-finding delay and its influencing factors among students in Henan province,2016-2020

作　　者：杜文琼 李帆 庄严[1] 王侃[1] 胡慧懿[1] 孟丹 孙定勇[1] 徐吉英[1] DU Wenqiong;LI Fan;ZHUANG Yan;WANG Kan;HU Huiyi;MENG Dan;SUN Dingyong;XU Jiying(Institute for Tuberculosis Control and Prevention,Henan Center for Disease Control and Prevention,Zhengzhou,Henan 450000,China;The Third Affiliated Hospital of Zhengzhou University)

机构地区：[1]河南省疾病预防控制中心结核病预防控制所,河南郑州410000 [2]郑州大学第三附属医院

出　　处：《现代疾病预防控制》2023年第10期721-727,共7页MODERN DISEASE CONTROL AND PREVENTION

基　　金：河南省医学科技攻关计划项目(SBGJ202002013)。

摘　　要：目的分析2016-2020年河南省学生肺结核患者发现、就诊、确诊延迟变化趋势和影响因素,为有效控制学生肺结核疫情提供理论依据。方法收集整理2016-2020年《结核病管理信息系统》中学生肺结核病案数据,描述学生肺结核发现、就诊、确诊延迟现状和变化趋势,采用非条件logistic回归模型分析学生肺结核发现、就诊、确诊延迟的影响因素。结果2016-2020年河南省学生肺结核患者发现、就诊、确诊延迟时间[M(P25,P25)]分别为17(6,36),7(1,22),2(0,10)d,呈现逐年增长趋势(P均<0.05)。发现、就诊、确诊延迟率分别为49.32%,35.83%,20.97%,总体呈现上升趋势(P均<0.05)。不同学段学生发现、就诊、确诊延迟率变化趋势存在波动,但总体均呈现上升趋势(P均<0.05)。多因素logistic回归模型显示,被动发现方式(OR=2.081,95%CI:1.859~2.33;OR=2.671,95%CI:2.335~3.056;OR=1.262,95%CI:1.097~1.452)、病原学阳性(OR=2.059,95%CI:1.899~2.233;OR=1.388,95%CI:1.279~1.508;OR=2.274,95%CI:2.070~2.497)和结核性胸膜炎(OR=1.624,95%CI:1.458~1.810;OR=1.316,95%CI:1.179~1.470;OR=1.711,95%CI:1.507~1.942)是发生发现、就诊、确诊延迟的共同危险因素,首诊单位为综合医院(OR=0.603,95%CI:0.525~0.692;OR=0.623,95%CI:0.526~0.738;OR=0.722,95%CI:0.589~0.885)是发生发现、就诊、确诊延迟的共同保护因素。学段、户籍地址类别、治疗分类、首诊单位级别、合并肺外结核和发病时间等也是发生发现、就诊、确诊延迟的影响因素。结论2016-2020年河南省学生肺结核发现、就诊、确诊延迟时间中位数和延迟率均呈现上升趋势。发现方式、诊断结果和首诊单位性质是学生肺结核发现、就诊、确诊延迟共同的影响因素,应对相关高风险学生患者进行重点关注,减少延迟发生。Objective To analyze the change trends and influencing factors of pulmonary tuberculosis(PTB)case finding,health-seeking,and confirmed diagnosis among students in Henan province from 2016 to 2020,and provide a theoretical evidence for effectively controlling the epidemic of PTB among students.Methods The data of PTB cases among middle school students in the"Tuberculosis Management Information System"from 2016 to 2020 were collected and sorted,and the current status and trend of delay in case-finding,medical treatment,and confirmed diagnosis of PTB were described.Results From 2016 to 2020,the delay time of M(P25,P25)for case-finding,health-seeking and confirmed diagnosis of PTB among students in Henan was 17(6,36),7(1,22),and 2(0,10)d,respectively,showing an increasing trend year by year(all P<0.05).The delayed rates of case-finding,health-seeking and confirmed diagnosis of PTB were 49.32%,35.83%,and 20.97%,respectively,with an upward trend(all P<0.05).Multivariate logistic regression model showed passive detection(OR=2.081,95%CI:1.859-2.33;OR=2.671,95%CI:2.335-3.056;OR=1.262,95%CI:1.097-1.452),positive etiology(OR=2.059,95%CI:1.899-2.233;OR=1.388,95%CI:1.279-1.508;OR=2.274,95%CI:2.070-2.497)and tuberculous pleurisy(OR=1.624,95%CI:1.458-1.810;OR=1.316,95%CI:1.179-1.470;OR=1.711,95%CI:1.507-1.942)were common risk factors for case-finding,health-seeking and confirmed-diagnosis delay;having general hospital factor as the first health-seeking institution(OR=0.603,95%CI:0.525-0.692;OR=0.623,95%CI:0.5260-0.738;OR=0.722,95%CI:0.589-0.885)was the common protective factor for case-finding,health-seeking and confirmed-diagnosis delay.The school phase,the type of household registration address,the classification of treatment,the level of the first diagnosis institution,having complication of ex-PTB and the date of onset were also the influencing factors of case-finding,health-seeking and confirmed-diagnosis delay.Conclusions From 2016 to 2020,the medians and rates of PTB case-finding,health-seeking and confirmed-diagnosis de

关 键 词：学生 肺结核 发现延迟 就诊延迟 确诊延迟 

分 类 号：R521[医药卫生—内科学] R181.3[医药卫生—临床医学]