【摘要】 目的:系统评价中国学生肺结核患者的确诊延迟情况。方法:通过计算机检索Web of Science、PubMed、Embase、The Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普网(VIP)和万方(WanFang)等数据库，搜集与中国(除外港澳台地区)学生肺结核患者确诊延迟相关的横断面研究，检索时限为建库至2025年7月，由2名评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险，采用Stata 15.0软件进行Meta分析。结果:共纳入36篇横断面研究，包括101 473例研究对象，24 906例学生肺结核确诊延迟患者，总确诊延迟率为24.54%。偏倚风险评估14篇为高等质量文献，22篇为中等质量文献。Meta分析结果显示，中国学生肺结核患者确诊延迟率为25.47%(95%CI:21.16%～29.79%),其中，男生、女生患者的确诊延迟率分别为26.41%和27.20%;来自于东、中、西部地区学生患者的确诊延迟率分别为24.50%、23.80%和28.00%;小学及以下、初中、高中和大学及以上学生患者的确诊延迟率分别为23.41%、28.09%、21.90%和27.08%;因症就诊或推荐、转诊、追踪、健康体检和其他方式发现患者的确诊延迟率分别为22.10%、28.91%、24.20%、18.83%和30.09%;汉族和少数民族患者的确诊延迟率分别为21.20%和17.31%;初治和复治患者的确诊延迟率分别为21.90%和28.60%;病原学检查阴性和阳性患者的确诊延迟率分别为25.00%和14.22%;本地和外地患者确诊延迟率分别为19.60%和20.62%。7个确诊延迟影响因素的Meta分析结果显示：女性是中国学生肺结核确诊延迟的保护性因素(OR=0.758,95%CI:0.617～0.931),外地户籍是确诊延迟的危险因素(OR=1.550,95%CI:1.039～2.295)。结论:中国学生肺结核患者确诊延迟率较高，虽自2018年后开始逐年下降，但受性别、地区、学历、发现方式、病原学检查结果和民族等因素的影响，学生肺结核患者确诊延迟率存在较大差异，防控形势依旧严峻。更多还原

【Abstract】 Objective: To systematically evaluate the diagnostic delay of pulmonary tuberculosis(PTB) among Chinese students. Methods: Cross-sectional studies related to diagnostic delay of PTB in students from China(excluding Hong Kong, Macao, and Taiwan) were collected by searching electronic databases including Web of Science, PubMed, Embase, The Cochrane Library, CBM, CNKI, VIP, and WanFang Data from inception of each database to July 2025. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was performed using Stata 15.0 software. Results: A total of 36 cross-sectional studies were included, involving 101 473 subjects and 24 906 student PTB patients with diagnostic delay, the overall diagnostic delay rate was 25.54%. The risk of bias assessment indicated that 14 studies were of high quality and 22 were of moderate quality. Meta-analysis results showed that the pooled rate of diagnostic delay among Chinese student PTB patients was 25.47%(95%CI: 21.16%-29.79%). Specifically, the diagnostic delay rates were 26.41% and 27.20% for male and female patients, respectively; 24.50%, 23.80%, and 28.00% for students from eastern, central, and western regions of China, respectively; and 23.41%, 28.09%, 21.90%, and 27.08% for students with educational levels of primary school and below, junior high school, senior high school, and college and above, respectively. The diagnostic delay rates for patients detected via symptomatic visit/recommendation, referral, tracking, health check-up, and other methods were 22.10%, 28.91%, 24.20%, 18.83%, and 30.09%, respectively. The rates were 21.20% and 17.31% for Han Chinese and ethnic minority patients, 21.90% and 28.60% for new and retreatment patients, 25.00% and 14.22% for patients with negative and positive etiological test results, and 19.60% and 20.62% for local and non-local residents, respectively. Meta-analysis of seven influencing factors revealed that female gender was a protective factor against diagnosis delay(OR=0.758, 95%CI: 0.617-0.931), while non-local household registration was a risk factor for diagnosis delay(OR=1.550, 95%CI: 1.039-2.295). Conclusion: The diagnostic delay rate among Chinese student PTB patients is high. Although it has shown a yearly declining trend since 2018, significant variations in the diagnostic delay persist due to factors such as gender, region, education level, detection method, etiological test results, and ethnicity, indicating that the epidemic prevention and control situation remains severe.更多还原