北京市大兴区2013-2022年布鲁氏菌病病例就诊延迟、诊断延迟情况及相关影响因素分析  

Analysis of delayed medical care-seeking and delayed diagnosis of brucellosis cases in Daxing District,Beijing City from 2013 to 2022,and related influencing factors

作　　者：李秋玲 王新宇 李梦楠 胡月 李志平 刘琪 唐金凤[1] 甘亚弟[1] 高艳青[1] 张丽杰[2] Li Qiuling;Wang Xinyu;Li Mengnan;Hu Yue;Li Zhiping;Liu Qi;Tang Jinfeng;Gan Yadi;Gao Yanqing;Zhang Lijie(Department for Infectious Diseases and Endemic Diseases Control and Prevention,Beijing Daxing District Center for Disease Control and Prevention,Beijing 102600,China;China Field Epidemiology Training Program,Chinese Center for Disease Control and Prevention,Beijing 100050,China)

机构地区：[1]北京市大兴区疾病预防控制中心传染病地方病防制科,北京102600 [2]中国疾病预防控制中心中国现场流行病学培训项目,北京100050

出　　处：《中华地方病学杂志》2024年第12期986-991,共6页Chinese Journal of Endemiology

基　　金：国家疾病预防控制局-公共卫生人才培养支持项目(01063)

摘　　要：目的了解北京市大兴区人间布鲁氏菌病(简称布病)病例的就诊延迟、诊断延迟情况,并分析相关影响因素。方法采用回顾性分析方法,收集2013年1月1日至2022年12月31日中国疾病预防控制信息系统传染病报告信息管理系统报告的北京市大兴区布病病例信息。并对病例信息进行复核,内容包括人口学信息、临床表现、就诊情况、诊断情况等。采用二元logistic回归分析病例诊断延迟的影响因素。结果共纳入120例布病病例,男性91例、女性29例,男女性别比为3.14∶1.00;年龄以40~79岁为主,占81.7%(98/120);职业以农民和家务待业为主,占67.5%(81/120)。临床表现以发热(85.8%,103/120)、多汗(65.8%,79/120)、乏力(61.7%,74/120)和肌肉酸痛(60.0%,72/120)为主。就诊延迟率为33.3%(40/120);就诊天数[中位数(四分位数间距)]为6(2,22)d,范围为0~727 d。诊断延迟率为50.8%(61/120);诊断天数为10(3,22)d,范围为0~1530 d。二元logistic回归分析结果显示,首诊原因为病情严重或反复(OR=6.76,95%CI:2.40~19.01)、血清学监测或其他疾病(OR=36.00,95%CI:3.57~362.72)以及就诊延迟(OR=4.30,95%CI:1.68~11.01)为布病病例诊断延迟的危险因素,诊断医院位置在本市外区(OR=0.27,95%CI:0.08~0.92)为布病病例诊断延迟的保护因素。结论北京市大兴区布病病例在就诊和诊断阶段均有不同程度的延迟。首诊原因为病情严重或反复、血清学监测或其他疾病以及就诊延迟为布病病例诊断延迟的危险因素,诊断医院位置在本市外区为布病病例诊断延迟的保护因素。Objective To investigate the delay in medical care-seeking and diagnosis of human brucellosis cases in Daxing District,Beijing City,and analyze the relevant influencing factors.Methods Retrospective analysis method was used to collect the information on brucellosis cases reported by the Infectious Disease Reporting Information Management System of the China Disease Prevention and Control Information System in Daxing District,Beijing City from January 1,2013 to December 31,2022.And the case information was reviewed,including demographic information,clinical manifestations,medical care-seeking,diagnosis,etc.Binary logistic regression was used to analyze the influencing factors of delayed diagnosis.Results A total of 120 cases of brucellosis were included,including 91 males and 29 females,with a male-to-female ratio of 3.14∶1.00.The majority were aged 40-79 years,accounting for 81.7%(98/120).Farmers and unemployed household workers were the main occupations,accounting for 67.5%(81/120).The main clinical manifestations were fever(85.8%,103/120),hyperhidrosis(65.8%,79/120),fatigue(61.7%,74/120),and muscle soreness(60.0%,72/120).The delay rate of medical care-seeking was 33.3%(40/120),with a median medical care-seeking time of 6 days(interquartile range:2-22 days,range:0-727 days).The diagnosis delay rate was 50.8%(61/120),with a median diagnosis time of 10 days(interquartile range:3-22 days,range:0-1530 days).The results of binary logistic regression analysis showed that the reasons for initial diagnosis were severe or recurrent symptoms(OR=6.76,95%CI:2.40-19.01),serological monitoring or other diseases(OR=36.00,95%CI:3.57-362.72),and delayed medical care-seeking(OR=4.30,95%CI:1.68-11.01)were risk factors for delayed diagnosis of brucellosis cases.The location of the diagnostic hospitals outside the city(OR=0.27,95%CI:0.08-0.92)was a protective factor for delayed diagnosis of brucellosis cases.Conclusions The medical care-seeking and diagnosis of brucellosis cases in Daxing District,Beijing City have been delayed to

关 键 词：布鲁氏菌病 就诊延迟 诊断延迟 影响因素 

分 类 号：R516.7[医药卫生—内科学]