苏州市2011—2020年学生肺结核患者发现延迟状况

傅颖; 蒋骏; 张晓龙; 李云; 王斐娴

doi:10.16835/j.cnki.1000-9817.2021.12.006

苏州市2011—2020年学生肺结核患者发现延迟状况

doi: 10.16835/j.cnki.1000-9817.2021.12.006

江苏省苏州市疾病预防控制中心结核病防治所，215004

基金项目:

苏州市“科教兴卫”青年科技项目 KJXW2019050

详细信息

作者简介:
傅颖(1989-)，女，安徽六安人，硕士，主管医师，主要从事结核病防制工作

通讯作者:
蒋骏，E-mail：junjiang.jj@163.com

中图分类号: R521 G478 R179
计量
- 文章访问数: 892
- HTML全文浏览量: 371
- PDF下载量: 52
- 被引次数: 0
出版历程
- 收稿日期: 2021-06-28
- 修回日期: 2021-10-18
- 网络出版日期: 2021-12-23
- 刊出日期: 2021-12-25

Delay in student pulmonary tuberculosis case-finding and associated factors in Suzhou during 2011 to 2020

Department of Tuberculosis Prevention and Control, Suzhou Center for Disease Control and Prevention, Suzhou(215004), Jiangsu Province, China

摘要

摘要: 目的分析苏州市学生肺结核患者发现延迟情况，为学校结核病疫情防控工作提供参考依据。方法以2011—2020年苏州市登记管理的1 148例学生肺结核患者为研究对象，采用Kruskal-Wallis H检验、χ²检验和Cochran-Armitage趋势检验分析学生肺结核患者发现延迟的时间趋势，采用χ²检验和Logistic回归分析学生肺结核患者入院特征与发现延迟的关系。结果调查的学生肺结核患者中，共有569例发现延迟，发现延迟率为49.6%，发现时长中位数为26(11~49)d。2011—2020年学生肺结核患者发现时长差异有统计学意义(Hc=54.62，P < 0.05)，发现延迟率(51.2%，44.2%，33.9%，26.2%，65.8%，51.0%，43.2%，61.5%，55.0%，53.5%)差异有统计学意义(χ²=53.69，P < 0.05)。发现延迟率随时间变化而波动，总体呈上升趋势(Z=-3.67，P < 0.05)。发现方式为因症就诊(OR=5.57，95%CI=1.91~16.27)、病原学检查结果为阳性(OR=1.46，95%CI=1.14~1.86)均与发现延迟呈正相关(P值均 < 0.05)。结论苏州市学生肺结核患者发现延迟情况不容乐观，因症就诊、病原学检查阳性是发现延迟的影响因素。针对日常学校结核病防控中的突出问题，多部门应联动合作落实相关防控措施，减少发现延迟的发生。
- 结核，肺 /
- 回归分析 /
- 学生 /
- 回顾性研究
Abstract: Objective To analyze delay in student pulmonary tuberculosis(PTB) case-finding and associated factors in Suzhou, and to provide a reference for tuberculosis outbreak prevention and control in schools. Methods A total of 1 148 students with PTB who registered and were treated in Suzhou from 2011 to 2020 were included. Kruskal-Wallis H test, 2 test and Cochran-Armitage trend test were used to analyze the time trend of case-finding delay. Logistic regression was used to analyze the correlation between admission characteristics and case-finding delay. Results Among the students with PTB, a total of 569 cases were found to be delayed. The rate of delay was 49.6%, and the median delay time was 26(11-49) days. From 2011 to 2020, the difference in case-finding interval of students with PTB was statistically significant(Hc=54.62, P < 0.05), and the difference in case-finding rate was also statistically significant(χ²=53.69, P < 0.05). The rate of delay fluctuated, with an overall upward trend over time(Z=-3.67, P < 0.05). Clinical consultation(OR=5.57, 95%CI=1.91-16.27), positive etiology (OR=1.46, 95%CI=1.14-1.86) were positively correlated with case-finding delay(all P < 0.05). Conclusion There are significant delays in case-finding among students with PTB in Suzhou. Clinical consultation and positive etiology are associated with case-finding delay. In response to the growing problems in daily school tuberculosis prevention and control, multiple departments should cooperate to implement relevant measures and to reduce the occurrence of case-finding delay.
- Tuberculosis, pulmonary /
- Regression analysis /
- Students /
- Retrospective studies

HTML全文

表 1 苏州市学生肺结核患者发现延迟的单因素分析

Table 1. Univariate analysis of the case-finding delay among students with PTB in Suzhou City

入院特征	选项	人数	发现延迟人数	χ²值	P值
性别	男	745	362(48.6)	0.81	0.37
	女	403	207(51.4)
年龄/岁	6~ < 12	20	12(60.0)	1.60	0.45
	12~ < 18	549	264(48.1)
	18~30	579	293(50.6)
户籍	本地	888	450(50.7)	1.94	0.16
	流动	260	119(45.8)
户籍地区	西部	77	33(42.9)	9.32	< 0.01
	中部	132	51(38.6)
	东部	939	485(51.7)
学段	小学	29	18(62.1)	2.80	0.25
	中学	581	278(47.9)
	大学	538	273(50.7)
发病时间	一季度	268	133(49.6)	2.80	0.42
	二季度	319	161(50.5)
	三季度	297	136(45.8)
	四季度	264	139(52.7)
发现方式	健康体检	29	4(13.8)	27.75	< 0.01
	主动筛查	34	7(20.6)
	因症就诊	1 085	558(51.4)
首诊单位	县级	1 074	534(49.7)	0.16	0.69
	市级	74	35(47.3)
既往治疗史	初治	1 136	562(49.5)	0.37	0.54
	复治	12	7(58.3)
病原学结果	阴性	698	319(45.7)	17.87	< 0.01
	阳性	441	249(56.5)
	无结果	9	1(11.1)
肺部空洞	有	203	91(44.8)	2.21	0.14
	无	945	478(50.6)
是否重症	是	59	31(52.5)	0.22	0.64
	否	1 089	538(49.4)
是否耐药	是	15	5(33.3)	1.60	0.21
	否	1 133	564(49.8)
注： ()内数字为延迟率/%。

下载: 导出CSV

表 2 苏州市学生肺结核患者发现延迟的多因素Logistic回归分析(n=1 148)

Table 2. Multivariate Logistic analysis of case-finding delay among students with PTB in Suzhou City(n=1 148)

自变量	β值	标准误	Wald χ²值	P值	OR值(OR值95%CI)
性别
男					1.00
女	0.12	0.13	0.87	0.35	1.13(0.89~1.44)
年龄/岁
6~ < 12					1.00
12~ < 18	-0.53	0.47	1.25	0.26	0.59(0.23~1.49)
18~30	-0.38	0.47	0.65	0.42	0.68(0.27~1.72)
户籍地区
西部					1.00
中部	-0.17	0.30	0.31	0.58	0.85(0.47~1.52)
东部	0.30	0.25	1.48	0.22	1.35(0.83~2.21)
发现方式
健康体检					1.00
主动筛查	0.40	0.69	0.34	0.56	1.49(0.39~5.79)
因症就诊	1.72	0.54	9.87	< 0.01	5.57(1.91~16.27)
病原学结果
阴性					1.00
阳性	0.38	0.12	9.10	< 0.01	1.46(1.14~1.86)
无结果	-1.87	1.07	3.05	0.08	0.16(0.02~1.26)

下载: 导出CSV

参考文献(21)

[1]	成君, 刘剑君. 我国学校结核病疫情监测和预警的现状与进展[J]. 中国防痨杂志, 2020, 42(5): 436. doi: 10.3969/j.issn.1000-6621.2020.05.005 CHENG J, LIU J J. Current status and progress of surveillance and automated-alert for tuberculosis in school[J]. Chin J Antituberc, 2020, 42(5): 436. doi: 10.3969/j.issn.1000-6621.2020.05.005
[2]	XU J, WANG G, ZHANG Y, et al. An outbreak of tuberculosis in a middle school in Henan, China: epidemiology and risk factors[J]. PLoS One, 2019, 14(11): e0225042. doi: 10.1371/journal.pone.0225042
[3]	YOU N N, ZHU L M, LI G L, et al. A tuberculosis school outbreak in China, 2018: reaching an often overlooked adolescent population[J]. Epidemiol Infect, 2019, 147: e303. doi: 10.1017/S0950268819001882
[4]	HOU J L, PANG Y, YANG X, et al. Outbreak of mycobacterium tuberculosis Beijing strain in a high school in Yunnan, China[J]. Am J Trop Med Hyg, 2020, 102(4): 728-730. doi: 10.4269/ajtmh.19-0533
[5]	覃江纯, 陈立凌. 2013—2017年苏州市学校传染病流行病学特征分析[J]. 中国校医, 2020, 34(4): 241-243. https://www.cnki.com.cn/Article/CJFDTOTAL-XIYI202004002.htm QIN J C, CHEN L L. Epidemiologic characteristics of infectious diseases in schools in Suzhou City from 2013 to 2017[J]. Chin J School Doctor, 2020, 34(4): 241-243. https://www.cnki.com.cn/Article/CJFDTOTAL-XIYI202004002.htm
[6]	张晓龙, 王斐娴, 傅颖, 等. 2015—2017年苏州市学校结核病聚集性疫情调查[J]. 现代预防医学, 2019, 46(14): 2634-2637. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201914036.htm ZHANG X L, WANG F X, FU Y, et al. Epidemic analysis of school tuberculosis outbreak in Suzhou city between 2015 and 2017[J]. Mod Prev Med, 2019, 46(14): 2634-2637. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201914036.htm
[7]	BAO H D, KUI L, WU Z K, 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
[8]	卫生部疾病预防控制局, 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[M]. 北京: 中国协和医科大学出版社, 2009: 52. Department of Health Diseases Control and Prevention, Department of Medical Administration, MOH, China CDC. Guidelines for implementation of tuberculosis prevention and control program in China[M]. Beijing: Peking Union Medical College Press, 2009: 52.
[9]	羊海涛, 陆伟, 竺丽梅. 耐药结核病的治疗与控制[M]. 北京: 军事医学科学出版社, 2014: 7. YANG H T, LU W, ZHU L M. Treatment and control of drug-resistant tuberculosis[M]. Beijing: Military Medical Science Press, 2014: 7.
[10]	杨俊超. 农村老年肺结核病人发现延误的影响因素研究[D]. 杭州: 浙江大学, 2010. YANG J C. Factors in diagnostic delay for old patients with pulmonary tuberculosis in rural areas[D]. Hangzhou: Zhejiang University, 2010.
[11]	BELAY M, BJUNE G, AMENI G, et al. Diagnostic and treatment delay among tuberculosis patients in afar region, Ethiopia: a cross-sectional study[J]. BMC Public Health, 2012, 12: 369. doi: 10.1186/1471-2458-12-369
[12]	BOJOVIC O, MEDENICA M, ZIVKOVIC D, et al. Factors associated with patient and health system delays in diagnosis and treatment of tuberculosis in Montenegro, 2015-2016[J]. PLoS One, 2018, 13(3): e0193997. doi: 10.1371/journal.pone.0193997
[13]	潘冬香, 林玫, 梁大斌, 等. 2010—2015年广西青少年新发涂阳肺结核发现延误及对预后的影响[J]. 中华疾病控制杂志, 2018, 22(5): 462. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ201805007.htm PAN D X, LIN M, LIANG D B, et al. Diagnostic delay and therapy outcomes of new smear-positive pulmonary tuberculosis among adolescents in Guangxi, China from 2010 to 2015[J]. Chin J Dis Control Prev, 2018, 22(5): 462. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ201805007.htm
[14]	陈彬, 王晓萌, 顾华, 等. 浙江省学生肺结核患者发现延误影响因素分析[J]. 中国学校卫生, 2013, 34(11): 1339. http://www.cjsh.org.cn/article/id/zgxxws201311020 CHEN B, WANG X M, GU H, et al. Influencing factors of case-finding delay among student pulmonary TB patients in Zhejiang Province[J]. Chin J Sch Health, 2013, 34(11): 1339. http://www.cjsh.org.cn/article/id/zgxxws201311020
[15]	刘魁, 吴婷, 王伟, 等. 2009—2018年浙江省 <15岁结核病患儿发现延误分析[J]. 结核病与肺部健康杂志, 2019, 8(2): 115. doi: 10.3969/j.issn.2095-3755.2019.02.009 LIU K, WU T, WANG W, et al. Delay in detection of tuberculosis in children under 15 years of age in Zhejiang Province from 2009 to 2018[J]. J Tuberc Lung Health, 2019, 8(2): 115. doi: 10.3969/j.issn.2095-3755.2019.02.009
[16]	李文辉, 冯汉阳, 钟明浩, 等. 东莞市青少年2009—2018年结核病患者就诊延迟及影响因素分析[J]. 中国学校卫生, 2021, 42(2): 264-268. doi: 10.16835/j.cnki.1000-9817.2021.02.026 LI W H, FENG H Y, ZHONG M H, et al. Delay on care-seeking and influencing factors among adolescent tuberculosis patients in Dongguan City from 2009 to 2018[J]. Chin J Sch Health, 2021, 42(2): 264-268. doi: 10.16835/j.cnki.1000-9817.2021.02.026
[17]	马煜, 杜昕, 邓亚丽, 等. 陕西省2015—2019年学生肺结核患者就诊延迟影响因素分析[J]. 中国学校卫生, 2021, 42(4): 615-621. doi: 10.16835/j.cnki.1000-9817.2021.04.031 MA Y, DU X, DENG Y L, et al. Factors influencing the delay of seeking medical treatment among students with tuberculosis in Shanxi Province from 2015 to 2019[J]. Chin J Sch Health, 2021, 42(4): 615-621. doi: 10.16835/j.cnki.1000-9817.2021.04.031
[18]	沈鸿程, 杜雨华, 张广川, 等. 2008—2018年广州市结核病患者就诊延误影响因素分析[J]. 中国防痨杂志, 2020, 42(5): 510-517. doi: 10.3969/j.issn.1000-6621.2020.05.017 SHEN H C, DU Y H, ZHANG G C, et al. Influencing factors of pulmonary tuberculosis patient delay in Guangzhou, 2008-2018[J]. Chin J Antituberc, 2020, 42(5): 510-517. doi: 10.3969/j.issn.1000-6621.2020.05.017
[19]	杨妮, 饶正远, 夏岚, 等. 2016—2018年四川省学生活动性肺结核患者发现延迟影响因素分析[J]. 疾病监测, 2019, 34(12): 1113-1116. doi: 10.3784/j.issn.1003-9961.2019.12.017 YANG N, RAO Z Y, XIA L, et al. Influencing factors for delay in case-finding of active pulmonary tuberculosis in students in Sichuan, 2016-2018[J]. Dis Surveill, 2019, 34(12): 1113-1116. doi: 10.3784/j.issn.1003-9961.2019.12.017
[20]	陈松华, 王晓萌, 钟节鸣, 等. 肺结核病新患者发现延误及影响因素分析[J]. 中国公共卫生, 2013, 29(4): 481-484. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201304006.htm CHEN S H, WANG X M, ZHONG J M, et al. Factors associated with diagnostic delay for primary pulmonary tuberculosis patients in Zhejiang province[J]. Chin J Public Health, 2013, 29(4): 481-484. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201304006.htm
[21]	马希鹏. 济宁市初治活动性肺结核患者发现延迟情况及影响因素分析[D]. 济南: 山东大学, 2018. MA X P. Study on the delay in detection and influencing factors among patients with new active pulmonary tuberculosis in Jining[D]. Jinan: Shandong University, 2018.