青海省2013—2023年学生肺结核治疗不良结局及时空特征

马斌忠; 李永盛; 梁达; 司雅婧

doi:10.16835/j.cnki.1000-9817.2025261

青海省2013—2023年学生肺结核治疗不良结局及时空特征

doi: 10.16835/j.cnki.1000-9817.2025261

1.
青海省疾病预防控制中心免疫规划所，西宁 810021
2.
青海大学医学院公共卫生系，西宁 810021

基金项目:

青海省2022年度“昆仑英才·高原名医”项目青卫健办[2023]95号

详细信息

作者简介:
马斌忠(1979-)，男，青海海东人，硕士，副主任医师，主要从事传染性疾病防控工作

通讯作者:
李永盛，E-mail：505306080@qq.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R181.3⁺² R521
计量
- 文章访问数: 4
- HTML全文浏览量: 2
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2025-05-14
- 修回日期: 2025-06-30
- 网络出版日期: 2025-10-10
- 刊出日期: 2025-09-25

Adverse treatment outcome and spatio-temporal characteristics of pulmonary tuberculosis cases among students in Qinghai Province, 2013-2023

1.
Institute of Immunization Program, Qinghai Provincial Center for Disease Control and Prevention, Xining 810021, Qinghai Province, China

摘要

摘要: 目的分析青海省学生肺结核治疗不良结局状况及时空特征，为学校肺结核防控提供参考依据。方法通过“全国结核病管理信息系统”获得2013—2023年青海省学生肺结核病例资料，回顾性分析其治疗转归情况。运用Joinpoint模型分析不良结局报告率趋势，对青海省学生肺结核不良结局报告率进行全局和局部空间自相关及时空扫描聚集性分析。结果 2013—2023年青海省学生肺结核患者不良结局报告率为7.93%(488/6 155)。2013—2023年学生肺结核不良结局报告率呈下降趋势(APC=-16.20, t=-3.89，P＜0.05)。空间自相关结果显示，青海省学生肺结核不良结局率的Moran's I＞0，其中2020、2021和2022年学生肺结核不良结局率存在空间正相关性(Z值均>1.96，P值均 < 0.05)；局部空间自相关中聚类和异常值分析结果显示，高—高聚集区主要集中在玉树州(治多县、杂多县、囊谦县、玉树市)、黄南州(泽库县、河南县)和海南州(同德县)；低—低聚集区分布在海东市、西宁市、海北州(刚察县、祁连县)、海西州(天峻县、乌兰县)、海南州(共和县、贵德县)和黄南州(同仁市、尖扎县)。时空扫描结果显示，共探测到2个可能聚集区域，其中一级聚集区覆盖青海省的玉树州和果洛州10个县区，聚集半径为658.09 km，RR=10.58，LLR=305.91；二级聚集区覆盖海南州、海西州、黄南州和果洛州16个县区，聚集半径为407.02 km，RR=9.83，LLR=152.48(P值均 < 0.05)。结论青海省学生肺结核治疗不良结局报告率仍较高且在全省范围内分布不均。应强化督导提高病例的依从性，进一步降低学生肺结核的不良结局发生率。
- 结核，肺 /
- 治疗结果 /
- 回顾性研究 /
- 学生
Abstract: Objective To analyze the adverse treatment outcome status and spatio-temporal characteristics of pulmonary tuberculosis cases among students in Qinghai Province, providing a reference basis for pulmonary tuberculosis prevention and control in schools. Methods The data of student pulmonary tuberculosis cases during 2013-2023 in Qinghai Province were obtained through the "National Tuberculosis Management Information System", and the treatment outcome was retrospectively analyzed. The Joinpoint model was applied to analyze the adverse outcome rate trend. Global and local spatial autocorrelation analysis, and spatiotemporal scan cluster analysis were conducted on the adverse outcome rate of pulmonary tuberculosis among students in Qinghai Province. Results During 2013-2023, 488 cases of adverse outcomes were reported among 6 155 students with pulmonary tuberculosis in Qinghai Province, with an adverse outcome rate of 7.93%. The reporting adverse outcome rate of pulmonary tuberculosis among students showed a downward trend from 2013 to 2023 (APC=-16.20, t=-3.89, P < 0.05). The results of spatial autocorrelation showed that the adverse outcome rate of pulmonary tuberculosis was Moran's I >0 among students in Qinghai Province. Among them, there was a spatially positive correlation in the adverse outcome rate of pulmonary tuberculosis among students in 2020, 2021 and 2022(all Z>1.96, all P < 0.05). The results of clustering and outlier analysis in local spatial autocorrelation showed that the areas with high-high aggregation were mainly concentrated in Yushu Prefecture(Zhiduo County, Zaduo County, Nangqian County, Yushu City), Huangnan Prefecture (Zeku County, Henan County) and Hainan Prefecture (Tongde County). The low-low concentration areas were distributed in Haidong City, Xining City, Haibei Prefecture (Gangcha County, Qilian County), Haixi Prefecture (Tianjun County, Ulan County), Hainan Prefecture (Gonghe County, Guide County) and Huangnan Prefecture (Tongren City, Jianzha County). The spatio-temporal scanning showed that a total of two possible aggregation areas had been detected. Among them, the first-level aggregation area composed of 10 counties and districts in Yushu Prefecture and Guoluo Prefecture of Qinghai Province, and the cluster radius was 658.09 km, the RR was 10.58, and the LLR was 305.91; the second-level aggregation area was composed of 16 counties and districts in Hainan Prefecture, Haixi Prefecture, Huangnan Prefecture and Guoluo Prefecture, and the cluster radius was 407.02 km, the RR was 9.83, and the LLR was 152.48 (both P < 0.05). Conclusions The reporting rates of adverse treatment outcome of pulmonary tuberculosis cases among students in Qinghai Province remain relatively high and unevenly distribute throughout the province. Supervision should be strengthened to improve cases compliance, and to reduce student pulmonary tuberculosis adverse treatment outcomes incidence.
- Tuberculosis, pulmonary /
- Treatment outcome /
- Retrospective studies /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 青海省2013—2023年学生肺结核患者治疗转归情况分布

Table 1. Distribution of treatment outcomes of students with pulmonary tuberculosis in Qinghai Province from 2013 to 2023

年份	例数	成功治疗		不良结局
年份	例数	治愈	完成疗程	死亡	不良反应	丢失	其他	失败
2013	224	88(39.29)	103(45.98)	1(0.45)	2(0.89)	1(0.45)	0	29(12.95)
2014	173	34(19.65)	110(63.58)	0	4(2.31)	0	2(1.16)	23(13.29)
2015	301	60(19.93)	168(55.81)	0	6(1.99)	14(4.65)	2(0.66)	51(16.94)
2016	438	54(12.32)	326(74.43)	0	5(1.14)	10(2.28)	2(0.46)	41(9.36)
2017	646	68(10.53)	482(74.61)	2(0.31)	3(0.46)	8(1.24)	0	83(12.85)
2018	758	109(14.38)	613(80.87)	2(0.26)	3(0.40)	8(1.06)	0	23(3.03)
2019	898	148(16.48)	723(80.51)	1(0.11)	0	1(0.11)	1(0.11)	24(2.67)
2020	815	139(17.06)	645(79.14)	1(0.12)	0	0	2(0.25)	28(3.44)
2021	789	146(18.50)	584(74.02)	1(0.13)	0	0	1(0.13)	57(7.22)
2022	391	120(30.69)	249(63.68)	0	0	0	0	22(5.63)
2023	722	290(40.17)	408(56.51)	0	0	0	0	24(3.32)
合计	6 155	1 256(20.41)	4 411(71.67)	8(0.13)	23(0.37)	42(0.68)	10(0.16)	405(6.58)
注：()内数字为构成比/%。

下载: 导出CSV

表 2 青海省2013—2023年学生肺结核不良结局报告率全局自相关分析

Table 2. Global autocorrelation analysis of adverse outcome reporting rates of pulmonary tuberculosis among students in Qinghai Province from 2013 to 2023

年份	Moran's I值	Z值	P值
2013	-0.15	-1.56	0.12
2014	0.09	1.37	0.17
2015	-0.01	0.18	0.85
2016	-0.04	-0.25	0.80
2017	0.04	0.84	0.40
2018	-0.01	0.25	0.80
2019	0.06	1.30	0.19
2020	0.21	3.22	＜0.01
2021	0.45	6.30	＜0.01
2022	0.21	2.95	＜0.01
2023	-0.04	-0.20	0.84

下载: 导出CSV

参考文献(32)

[1]	BAO H, LIU K, WU Z, et al. Tuberculosis outbreaks among students in mainland China: a systematic review and Meta-analysis[J]. BMC Infect Dis, 2019, 19(1): 972. doi: 10.1186/s12879-019-4573-3
[2]	陈卉, 张灿有, 张慧, 等. 2004—2021年全国学校肺结核疫情分析[J]. 中国防痨杂志, 2022, 44(8): 768-776. CHEN H, ZHANG C Y, ZHANG H, et al. Analysis on the epidemic situation of pulmonary tuberculosis in schools in China from 2004 to 2021[J]. Chin J Antituberc, 2022, 44(8): 768-776. (in Chinese)
[3]	MACNEIL A, GLAZIOU P, SISMANIDIS C, et al. Global epidemiology of tuberculosis and progress toward meeting global targets-worldwide, 2018[J]. MMWR, 2020, 69(11): 281-285.
[4]	BURKE R M, NLIWASA M, FEASEY H R A, et al. Community-based active case-finding interventions for tuberculosis: a systematic review[J]. Lancet Public Health, 2021, 6(5): e283-e299. doi: 10.1016/S2468-2667(21)00033-5
[5]	CHENCINER L, ANNERSTEDT K S, PESCARINI J M, et al. Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a National Retrospective Cohort Study[J]. Lancet Glob Health, 2021, 9(10): e1380-e1390. doi: 10.1016/S2214-109X(21)00300-4
[6]	梁达, 商越, 王兆芬, 等. 青海省肺结核发病与气象因素的时间序列分析[J]. 中华疾病控制杂志, 2021, 25(10): 1186-1193. LIANG D, SHANG Y, WANG Z F, et al. The relationship between incidence of pulmonary tuberculosis and meteorological factors in Qinghai Province and multivariate time series analysis[J]. Chin J Dis Control Prev, 2021, 25(10): 1186-1193. (in Chinese)
[7]	马斌忠, 李永盛, 王蓉, 等. 青海省2009—2012年活动性肺结核流行病学分析[J]. 医学动物防制, 2014, 30(3): 249-251, 255. MA B Z, LI Y S, WANG R, et al. Epidemiological analysis on the characteristic of active pulmonary tuberculosis cases in Qinghai Province during 2009-2012[J]. J Med Pest Control, 2014, 30(3): 249-251, 255. (in Chinese)
[8]	青海省统计局. 青海统计年鉴[EB/OL]. (2023-01-10)[2025-05-06]. http://tjj.qinghai.gov.cn/nj/2023/indexch.htm.
[9]	国家基础地理信息中心. 全国1∶100万地形图数据库使用指南[EB/OL]. (2023-12-01)[2025-06-01]. https://www.ngcc.cn/services/data_guide.html.
[10]	中华人民共和国卫生部疾病预防控制局, 中华人民共和国卫生部医政司, 中国疾病预防控制中心. 中国结核病防治规划实施工作指南(2008版)[M]. 北京: 中国协和医科大学出版社, 2009. Bureau for Disease Control and Prevention, Ministry of Health of the PRC, Department of Medical Administration, Ministry of Health of the PRC, Chinese Center for Disease Control and Prevention. Guidelines for the implementation of tuberculosis prevention and control program in China (2008 version)[M]. Beijing: Peking Union Medical College Press, 2009. (in Chinese)
[11]	中华人民共和国国家卫生健康委员会办公厅关于印发中国结核病预防控制工作技术规范(2020年版)的通知[EB/OL]. (2020-04-02)[2025-01-29]. http://zyscdc.com/article/36/41.html.
[12]	周海兵. 2005—2020年中国大陆肺结核发病率时空演变及影响因素研究[D]. 南昌: 江西师范大学, 2022. ZHOU H B. Research on the spatial-temporal evolution of pulmonary tuberculosis incidence and its influencing factors in China's mainland from 2005 to 2020[D]. Nanchang: Jiangxi Normal University, 2022. (in Chinese)
[13]	崔彩岩, 蒋骏, 王斐娴, 等. 2015—2023年苏州市学生肺结核时空分布特征[J]. 预防医学, 2025, 37(1): 77-81. CUI C Y, JIANG J, WANG F X, et al. Spatio-temporal distribution of pulmonary tuberculosis among students in Suzhou City from 2015 to 2023[J]. China Prev Med J, 2025, 37(1): 77-81. (in Chinese)
[14]	孙付胜, 刘增法, 付刚, 等. 山东省菏泽市2018—2022年60岁以上老年肺结核流行特征及空间聚集性分析[J]. 现代医学, 2023, 51(11): 1565-1572. SUN F S, LIU Z F, FU G, et al. Epidemiological characteristics and spatial clustering of pulmonary tuberculosis in people aged over 60 years from 2018 to 2022 in Heze City, Shandong Province[J]. Mod Med J, 2023, 51(11): 1565-1572. (in Chinese)
[15]	冉海良, 杨庆欢, 陈莹, 等. 2015年西双版纳州肺结核登记病例流行特征与空间聚集性[J]. 昆明医科大学学报, 2020, 41(6): 46-50. RAN H L, YANG Q H, CHEN Y, et al. Analysis on epidemiological characteristics and spatial clustering of registered pulmonary tuberculosis cases in Xishuangbanna Prefecture in 2015[J]. J Kunming Med Univ, 2020, 41(6): 46-50. (in Chinese)
[16]	刘家起, 姜婧, 王亮, 等. 2008—2017年全国肺结核发病的时空分布特征分析[J]. 现代预防医学, 2020, 47(19): 3461-3464. LIU J Q, JIANG J, WANG L, et al. Spatial and temporal distribution of pulmonary tuberculosis in China, 2008-2017[J]. Mod Prev Med, 2020, 47(19): 3461-3464. (in Chinese)
[17]	黎舒, 邱媛, 何波, 等. 基于SaTScan的2017—2021年南宁市耐多药肺结核疫情时空分析[J]. 公共卫生与预防医学, 2024, 35(2): 17-20. LI S, QIU Y, HE B, et al. Spatial and temporal analysis of MDR-TB epidemic based on SaTScan in Nanning during 2017-2021[J]. J Public Health Prev Med, 2024, 35(2): 17-20. (in Chinese)
[18]	廖龙, 陈慧娟, 李进岚, 等. 2022—2023年贵州省学校肺结核流行及接触者筛查结果的时空关联性分析[J]. 中国防痨杂志, 2024, 46(10): 1227-1235. LIAO L, CHEN H J, LI J L, et al. Spatial and temporal correlation analysis of school pulmonary tuberculosis prevalence and contact screening results in Guizhou Province from 2022 to 2023[J]. Chin J Antituberc, 2024, 46(10): 1227-1235. (in Chinese)
[19]	HUO X N, ZHANG W W, SUN D F, et al. Spatial pattern analysis of heavy metals in Beijing agricultural soils based on spatial autocorrelation statistics[J]. Int J Environ Res Public Health, 2011, 8(6): 2074-2089. doi: 10.3390/ijerph8062074
[20]	YU Y, WU B, WU C, et al. Spatial-temporal analysis of tuberculosis in Chongqing, China 2011-2018[J]. BMC Infect Dis, 2020, 20(1): 531. doi: 10.1186/s12879-020-05249-3
[21]	文祎, 李洁, 徐永梅, 等. 2016—2022年荆门市学生肺结核流行特征及治疗转归分析[J]. 华南预防医学, 2024, 50(9): 837-840. WEN Y, LI J, XU Y M, et al. Epidemiological characteristics and treatment outcome of pulmonary tuberculosis among students in Jingmen City from 2016 to 2022[J]. South China J Prev Med, 2024, 50(9): 837-840. (in Chinese)
[22]	段晓菲, 吴桂辉, 杨洁, 等. 2012—2022年成都市肺结核流行特征与治疗转归分析[J]. 新发传染病电子杂志, 2024, 9(5): 19-24. DUAN X F, WU G H, YANG J, et al. Analysis on epidemic characteristics and treatment effect of pulmonary tuberculosis in Chengdu from 2012 to 2022[J]. Electron J Emerg Infect Dis, 2024, 9(5): 19-24. (in Chinese)
[23]	曹碧瑶, 杨浩, 古贞, 等. 2018—2021年海口地区青少年肺结核报告及转归影响因素分析[J]. 公共卫生与预防医学, 2024, 35(6): 97-100. CAO B Y, YANG H, GU Z, et al. Adolescent tuberculosis reported in Haikou Region and factors influencing the outcome in 2018-2021[J]. J Public Health Prev Med, 2024, 35(6): 97-100. (in Chinese)
[24]	王朝才, 刘燕, 李尔琛, 等. 2013—2022年青海省学生肺结核的流行病学特征分析[J]. 现代预防医学, 2023, 50(21): 4004-4008. WANG C C, LIU Y, LI E C, et al. Analysis of epidemiological characteristics of pulmonary tuberculosis among students in Qinghai Province from 2013 to 2022[J]. Mod Prev Med, 2023, 50(21): 4004-4008. (in Chinese)
[25]	李佳琛, 赵剑喜, 白玉娥, 等. 2016—2020年甘肃省肺结核患者流行特征分析[J]. 疾病预防控制通报, 2023, 38(4): 44-48. LI J C, ZHAO J X, BAI Y E, et al. Epidemiological characteristics of pulmonary tuberculosis in Gansu Province from 2016 to 2020[J]. Bull Dis Control Prev, 2023, 38(4): 44-48. (in Chinese)
[26]	中华人民共和国国务院办公厅. 关于印发"十三五"全国结核病防治规划的通知[EB/OL]. (2017-02-16)[2025-05-24]. https://www.gov.cn/zhengce/content/2017-02/16/content_5168491.htm.
[27]	中华人民共和国国家卫生和计划生育委员会办公厅, 中华人民共和国教育部办公厅. 关于印发学校结核病防控工作规范(2017版)的通知[J]. 中华人民共和国国家卫生和计划生育委员会公报, 2017(6): 45-50. Office of the National Health and Family Planning Commission of the PRC, Office of the Ministry of Education of the PRC. Notice on issuing the work specifications for tuberculosis prevention and control in schools (2017 edition)[J]. Gaz Natl Health Fam Plan Comm PRC, 2017(6): 45-50. (in Chinese)
[28]	LIAO W B, JU K, GAO Y M, et al. The association between internal migration and pulmonary tuberculosis in China, 2005-2015: a spatial analysis[J]. Infect Dis Poverty, 2020, 9(1): 5. doi: 10.1186/s40249-020-0621-x
[29]	楚男, 高倩倩, 周成超. 2004—2018年中国肺结核病时间及空间变动趋势分析[J]. 中国公共卫生, 2022, 38(7): 887-890. CHU N, GAO Q Q, ZHOU C C. Trends in spatiotemporal distribution of pulmonary tuberculosis morbidity and mortality in China: 2004-2018[J]. Chin J Public Health, 2022, 38(7): 887-890. (in Chinese)
[30]	杨丽娟. 2004—2015年我国乙类传染病发病趋势的动态因子模型分析[D]. 合肥: 安徽医科大学, 2019. YANG L J. Analyses of the incidence trend of class B infectious diseases in China based on dynamic factor model during 2004-2015[D]. Hefei: Anhui Medical University, 2019. (in Chinese)
[31]	王铂, 何爱伟, 赵剑喜, 等. 甘肃省2018—2022年高中生肺结核时空流行状况[J]. 中国学校卫生, 2023, 44(12): 1889-1893. doi: 10.16835/j.cnki.1000-9817.2023.12.027 WANG B, HE A W, ZHAO J X, et al. Spatial-temporal feature of tuberculosis among high school students in Gansu Province from 2018 to 2022[J]. Chin J Sch Health, 2023, 44(12): 1889-1893. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2023.12.027
[32]	陈卉, 宋雅婷, 李涛, 等. 2016—2020年全国学生耐药肺结核流行特征与治疗转归分析[J]. 热带病与寄生虫学, 2023, 21(2): 65-71. CHEN H, SONG Y T, LI T, et al. Epidemiological characteristics and medication outcomes in students with drug-resistant pulmonary tuberculosis in China from 2016 to 2020[J]. J Trop Dis Parasitol, 2023, 21(2): 65-71. (in Chinese)