2016—2023年贵州省合并糖尿病的肺结核患者就诊延迟及不良结局危险因素分析  

Analysis of risk factors for patient delay and adverse treatment outcomes among patients with pulmonary tuberculosis and diabetes mellitus in Guizhou Province,2016—2023

作　　者：王大福 马晓雪 王芸[1] 李福栋 饶文 龚婷婷 李世军[2] 李进岚 Wang Dafu;Ma Xiaoxue;Wang Yun;Li Fudong;Rao Wen;Gong Tingting;Li Shijun;Li Jinlan(Key Laboratory of Environmental Pollution and Disease Control,Ministry of Education,School of Public Health and Health,Guizhou Medical University,Guiyang 561113,China;Guizhou Provincial Center for Disease Control and Prevention,Guiyang 550004,China)

机构地区：[1]贵州医科大学公共卫生与健康学院,环境污染与疾病监控教育部重点实验室,贵阳561113 [2]贵州省疾病预防控制中心,贵阳550004

出　　处：《中国防痨杂志》2025年第2期201-209,共9页Chinese Journal of Antituberculosis

基　　金：贵州省发改委省级基本建设前期工作项目(2020-181-131);国家自然科学基金(82360659,81860591);贵州省科技计划项目[黔科合基础-ZK(2022)386]。

摘　　要：目的:了解贵州省合并糖尿病的肺结核(PTB-DM)患者就诊延迟及不良结局现状并分析其影响因素,为改善共病患者的管理和控制策略提供参考依据。方法:从“中国疾病预防控制信息系统”子系统“结核病管理信息系统”中导出贵州省2016—2023年登记确诊的8123例PTB-DM患者病案信息,采用Joinpoint和二元logistic回归模型分析肺结核就诊延迟率和患者不良结局的变化趋势及其影响因素。结果:2016—2023年,PTB-DM患者肺结核就诊延迟率为65.74%(5340/8123),就诊延迟中位时间为27(10,65) d;其中,不同年份延迟率[65.92%(265/402)~71.52%(457/639)]的差异无统计学意义(AAPC=-1.314,95%CI:-3.489~0.911,P=0.245),但不同地区延迟率[55.89%(318/569)~70.44%(808/1147)]的差异有统计学意义(χ^(2)=51.424,P<0.001),尤其是安顺市[40.00%(4/10)~79.46%(89/112)]呈逐年上升趋势(AAPC=6.302,95%CI:1.216~11.643,P=0.015)。不良结局发生率[10.56%(858/8123)]较高,但不同年份的发生率[8.53%(185/2169)~14.68%(59/402)]呈下降趋势(AAPC=-6.904,95%CI:-9.716~-4.004,P=0.001),同时也存在不同地区发生率[6.97%(80/1147)~13.14%(147/1119)]的差异(χ^(2)=35.262,P<0.001)。多因素分析结果显示,患者来源于追踪、有合并症、病原学阳性、复治和合并其他系统结核病均是发生就诊延迟的危险因素[OR(95%CI)值分别为1.160(1.013~1.327)、1.380(1.193~1.596)、1.183(1.065~1.316)、1.327(1.126~1.563)、1.303(1.133~1.497)],而患者来源于健康体检、主动筛查等途径是就诊延迟的保护因素[OR(95%CI)=0.606(0.448~0.820)];36~64岁、≥65岁、有合并症、复治和病原学阳性均是发生不良结局的危险因素[OR(95%CI)值分别为1.724(1.088~2.734)、2.903(1.816~4.641)、1.324(1.090~1.609)、1.439(1.161~1.784)、1.386(1.159~1.657)],而学生、餐饮业、服务业等其他职业是发生不良结局的保护因素[OR(95%CI)=0.480(0.292~0.788)]。结论:2016—2023年,贵州省PTB-DM患者肺结核总就诊延迟率无明显�Objective:To investigate the prevalence of patient delay and adverse outcomes among individuals with pulmonary tuberculosis coexisting with diabetes mellitus(PTB-DM)in Guizhou Province and to analyze the associated influencing factors.The findings aim to provide evidence-based guidance for optimizing the management and control strategies of comorbid conditions.Methods:Medical records of 8123 PTB-DM patients registered and diagnosed in Guizhou Province between 2016 and 2023 were extracted from the“Tuberculosis Information Management System,”a component of the“National Tuberculosis Information Management System”.Joinpoint regression and binary logistic regression models were employed to assess trends in patient delay rates,adverse treatment outcomes,and their associated influencing factors.Results:From 2016 to 2023,the patient delay rate among PTB-DM patients was 65.74%(5340/8123),with a median delay time of 27 days(interquartile range:10-65 days).No statistically significant differences were observed in delay rates across different years,ranging from 65.92%(265/402)to 71.52%(457/639)(AAPC=-1.314,95%CI:-3.489-0.911,P=0.245).However,delay rates varied significantly across regions,ranging from 55.89%(318/569)to 70.44%(808/1147)(χ^(2)=51.424,P<0.001).Notably,Anshun City exhibited a significant year-on-year increase in delay rates,from 40.00%(4/10)to 79.46%(89/112)(AAPC=6.302,95%CI:1.216-11.643,P=0.015).The incidence of adverse outcomes was relatively high at 10.56%(858/8123),although the yearly rates demonstrated a significant downward trend,ranging from 8.53%(185/2169)to 14.68%(59/402)(AAPC=-6.904,95%CI:-9.716--4.004,P=0.001).Regional variations in incidence rates were also observed,ranging from 6.97%(80/1147)to 13.14%(147/1119)(χ^(2)=35.262,P<0.001).Multivariate analysis identified several risk factors for patient delay,including being traced(OR:1.160,95%CI:1.013-1.327),having comorbidities(OR:1.380,95%CI:1.193-1.596),positive etiological findings(OR:1.183,95%CI:1.065-1.316),undergoing retreatment(OR:1.327

关 键 词：结核 肺 糖尿病 就诊延迟 治疗结果 因素分析 统计学 贵州省 

分 类 号：R183[医药卫生—流行病学] R521[医药卫生—公共卫生与预防医学]