老年人肺结核主动筛查及影响因素分析  

Active screening and influencing factor analysis of pulmonary tuberculosis among elderly people

作　　者：秦雪玲 陈丽[1] 孙晓英 胡善朋 路震 何乃玲 张继芬 Qin Xueling;Chen Li;Sun Xiaoying;Hu Shanpeng;Lu Zhen;He Nailing;Zhang Jifen(Tuberculosis Prevention and Control Institute of Rizhao People’s Hospital in Shandong Province,Rizhao 276800,China;Department of Statistics,Public Health Clinical Center of Shandong Province,Ji’nan 25000,China;Juxian Tuberculosis Prevention and Control Institute of Shandong Province,Rizhao 276500,China;Wulian Center for Disease Control and Prevention,Rizhao 262300,China)

机构地区：[1]山东省日照市人民医院市结核病防治所,日照276800 [2]山东省公共卫生临床中心统计科,济南250000 [3]山东省莒县结核病防治所,日照276500 [4]山东省五莲县疾病预防控制中心,日照262300

出　　处：《中国防痨杂志》2025年第3期355-361,共7页Chinese Journal of Antituberculosis

基　　金：山东省医药卫生科技发展计划项目(202012071504);济宁医学院教师科研扶持基金项目(JYFC2019FKJ150)。

摘　　要：目的:通过对≥65岁及以上老年人连续主动筛查,研究老年人肺结核主动筛查实施效果及影响因素,为精准制定老年人结核病防控提供数据支持。方法:2020—2023年连续4年对日照市4个县(区)的4个乡(镇、街道)的老年人进行面对面问卷调查和胸部数字影像(digital radiography,DR)检查,并进行人口学特征、既往肺结核病史、肺结核患者密切接触史等单因素分析和多因素logistic回归分析,分析在老年人群中开展主动筛查的效果及影响因素。结果:2020—2023年分别筛查了21876、18575、17389、19883名,共77723名,检出活动性肺结核患者123例,检出率为158.25/10万,男性检出率(240.97/10万,82/34029)明显高于女性(93.83/10万,41/43694),差异有统计学意义(χ2=26.212,P<0.001);活动性肺结核检出率由65~74岁的118.24/10万(51/43133)上升至85~108岁的448.43/10万(5/1115),既往肺结核病史、肺结核患者密切接触史检出率分别为479.70/10万(39/8130)和519.02/10万(103/19845)。2020—2023年连续4年在相同研究现场进行筛查,随着筛查次数的增加,老年人活动性肺结核检出率呈下降趋势(χ2趋势=14.682,P<0.001);病原学阳性率呈降低趋势(χ2趋势=12.749,P<0.001)。多因素logistic回归分析结果显示,高龄(75~84岁和85~108岁)是肺结核患病的危险因素[OR(95%CI)值分别为8.25(1.95~35.83)、12.53(3.03~55.12)]。结论:在老年人中开展主动筛查可以快速发现肺结核患者从而降低结核病疫情,多次筛查后老年人活动性肺结核检出率呈大幅下降趋势,需要根据筛查频率、筛查方法及人群高危因素优化筛查策略。Objective:By conducting continuous active tuberculosis screening among elderly people aged 65 and above,the study aims to evaluate the implementation effect and influencing factors of active screening in the elderly,providing data support for precise formulation of tuberculosis prevention and control measures among the elderly.Methods:From 2020 to 2023,we conducted face-to-face questionnaire survey and digital radiography(DR)examination for the elderly people in four counties/districts and four townships/streets in Rizhao City for four consecutive years.We performed univariable analysis on characteristics,previous tuberculosis history,and close contact history with tuberculosis patients,as well as multivariable logistic regression analysis,to analyze the effectiveness and influencing factors of active screening for tuberculosis among the elderly population.Results:From 2020 to 2023,21876,18575,1789,and 19883 people were screened respectively,totaling 77723 person-times,and 123 cases of pulmonary tuberculosis were detected,with a detection rate of 158.25/100000.The detection rate for male(240.97/100000,82/34029)was significantly higher than that for female(93.83/100000,41/43694,χ2=26.212,P<0.001);The detection rate of active pulmonary tuberculosis increased from 118.24/100000(51/4133)in those aged 65-74 years old to 448.43/100000(5/1115)in people aged 85-108 years old;Detection rates among people with pulmonary tuberculosis history and close contact history with pulmonary tuberculosis patients were 479.70/100000(39/8130)and 519.02/100000(103/19845),respectively.Screening was conducted at the same research site for four consecutive years from 2020 to 2023,and as the times of screening increased,the detection rates of active pulmonary tuberculosis in the elderly people showed a downward trend(χ2 trend=14.682,P<0.001)and the etiological positive rate showed a downward trend(χ2 trend=12.749,P<0.001)too.Logistic multivariable analysis showed that higher age(75-84 years and 85-108 years)was risk factor for pulmonary

关 键 词：结核 肺:老年人 因素分析 统计学 

分 类 号：R52[医药卫生—内科学] R195[医药卫生—临床医学]