【作者】 闵婕；

【导师】 沈孝兵； 谭文文；

【作者基本信息】 东南大学 ， 公共卫生（专业学位）， 2019， 硕士

【摘要】 目的1.分析宜兴市2008-2015年间肺结核病的流行特征,探讨登记肺结核病的流行趋势2.了解宜兴市肺结核病的管理现状和存在的问题,提出相应的防控策略方法从结核病信息管理系统收集宜兴市2008年1月1日至2015年12月31日登记在册的肺结核患者的资料,对资料内信息进行回顾性描述分析。采用Epidata3.1软件建库,运用SPSS18.0进行统计学分析,采用卡方检验与单因素logistic回归分析分布差异,P值<0.05存在统计学差异。结果1.2008-2015年宜兴市肺结核患者共登记在册肺结核患者3317例,肺结核患者登记率分别为27.69/10万-39.74/10万,平均登记率为33.12/10万;新发肺结核患者登记率分别为25.13/10万-37.60/10万,平均登记率为31.01/10万;新发涂阳肺结核患者登记率分别为7.66/10万-28.46/10万,平均登记率为16.44/10万,上述登记率同呈逐年下降趋势。2.8年间登记的肺结核患者中,其中男性2480例,占比74.77%,男女性别比值为2.96:1,性别构成无统计学差异(χ2=13.87,P=0.053);户籍人口中的男性登记率为33.01/10万-45.97/10万,平均登记率为39.37/10万,女性登记率为11.39/10万-15.84/10万,平均登记率为13.76/10万,分性别比登记率比较男性高于女性,二者登记率的性别分布有统计学差异(χ2=533.42,P<0.001);15-44岁年龄段所占比例最高,达50.02%,0-14岁年龄段所占比例最少(0.90%),各年龄组分布无统计学差异(χ2=30.52,P=0.082);农民1571例,占比最高(47.36%),职业分布无统计学差异(χ2=6.642,P=0.467);本地人口登记数2222例,占比66.99%;本地人口登记率25.81/10万,流动人口为77.91/10万,二者分布有统计学差异(χ2=990.43,P<0.001);2009-2015年登记的肺结核患者的流动人口中,贵州户籍的为217例,占比最高(23.69%);春夏季登记数略高于秋冬季。3.8年的初复治比在9.84-50.13之间,平均初复治比为14.65;初复治患者分布有统计学差异(χ2=30.43,P<0.001);8年的涂阳与涂阴之比为0.50-4.38之间,平均涂阳涂阴比为1.16,诊断结果分布有统计学差异(χ2=519.88,P<0.001);2012-2015年间,系统推送的耐药可疑者中新涂阳患者208例,占比最高(67.75%),所有可疑者中确诊耐多药患者11例,广泛耐药1例,单耐药1例;49.08%的患者来源于转诊,其次为因症就诊,8年的肺结核患者来源分布有统计学差异(χ2=635.18,P<0.001);空洞患者占比19.05%,空洞分布有统计学差异(χ2=55.02,P<0.001)。4.8年治疗成功率为89.40%-95.76%,平均治疗成功率为92.34%,成功治疗率有统计学差异(χ2=510.60,P<0.001);耐多药病人最近几年有上升趋势,而“丢失”和“其他”两类的率有下降趋势;初治、复治患者平均治疗成功率分别为92.66%、83.49%,初治患者各年治疗成功率有统计学差异(χ2=27.66,P=0.000),复治患者各年治疗成功率无统计学差异(χ2=9.47,P=0.22);涂阳患者平均治疗成功率为89.17%,涂阳患者各年治疗成功率有统计学差异(χ2=16.67,P=0.022),但涂阳患者治疗成功率呈下降趋势;涂阴肺结核患者8年平均治疗成功率为95.50%,各年治疗成功率无统计学差异(χ2=9.73,P=0.204)。5.就诊延迟中位数为13天,确诊延迟中位数为3天;肺结核患者的性别、年龄、户籍患者来源、患者分类等因素与其就诊延迟差异无统计学意义(P>0.05),肺结核患者的职业因素与其就诊延迟差异有统计学意义(P<0.05);肺结核患者的职业、患者来源、患者分类等因素与其确诊延迟差异无统计学意义(P>0.05),肺结核患者的性别、年龄、户籍等因素与其确诊延迟差异有统计学意义(P<0.05)结论1.宜兴市肺结核病患者总体登记率、新发患者登记率、涂阳患者登记率同处于逐年下降趋势,说明目前肺结核病“三位一体”防治模式和DOTS策略取得了较好的效果2.当前宜兴市肺结核病防治工作仍存在医防合作机制不完善、工作保障经费不足耐多药工作进展缓慢、耐多药肺结核患者未纳入单病种定额付费保障政策等问题,下一步要继续完善“三位一体”防治服务体系,落实经费保障,贯彻实施耐药高危人群的筛查,高度重视耐多药患者的纳入治疗与随访管理,提高肺结核患者的发现率,加大肺结核病防治知识宣传力度3.病人的发现和管理方面应高度重视青壮年和以体力劳动为主的人群4.提高涂阳患者的成功治疗率,是肺结核病控制工作的重点,也是难点5.减少肺结核患者的发现延迟和提高患者的依从性是提高治疗成功率的关键因素。更多还原

【Abstract】 Objective1.To analyze the epidemiological characteristics of pulmonary tuberculosis in Yixing City from 2008 to 2015,and to explore the prevalence of registered pulmonary tuberculosis2.Understand the management status and existing problems of pulmonary tuberculosis in Yixing City,corresponding prevention and control strategies is proposedMethodThis was retrospective,descriptive study based on the PTB surveillance data in Yixing city from January 2008 to December 2015,which were extaacted from the TB Information Management System.The data was entered into Epidata3.1 database,and statistical analysis was performed using SPSS18.0.The distribution difference was analyzed by chi-square test and single factor logistic regression.There was statistical difference in P value less than 0.05.Results1.Overall,there were 3317 cases of registered pulmonary tuberculosis patients in Yixing City during 2008 to 2015,with 27.69 per 100000-39.74 per 100000 of incidence of registration rate,and the average was 33.12 per 100000;with 25.13 per 100000 to 37.60 per 100000 of incidence of r smear-positive recently newly registered rate,and the average was 31.01 per 100000;with 7.66 per 100000-28.46 per 100000 of incidence of recently newly smear-positive registered rate,and the average was 16.44 per 100000.and showed a declining trend as the years.2.There were 2480 males cases,which accounting for 74.77%,the ratio between male and female was 2.96,which had a significant difference(χ2=13.87,P=0.053);the male registration rate in the household registration population was 33.01 per 100000 to 45.97 per 100000,and the average was 39.37 per 100,000,the female registration rate was 11.39 per 100000-15.84 per 100,000,and the average was 13.76 per 100,000.Compared with the sex ratio registration rate,men are higher than women,which had a significant difference(χ2=533.42,P<0.001);Registered PTB patients aged 15 to 44 took the highest proportion,reaching 50.02%,and the 0 to 14 age group accounted for the least(0.90%),there was no statistical difference in the distribution of all age groups(χ2=30.52,P=0.082);there were 1571 farmers,accounting for the highest proportion(47.36%),and there was no statistical difference in occupational distribution(χ2=6.642,P=0.467);there were local 2,222 local patients,accounting for 66.99%;the local of registration rate was 25.81 per 100,000,and the floating was 77.91 per 100,000,which had a significant difference(χ2=990.43,P<0.001);among the floating population of pulmonary tuberculosis patients registered in 2009-2015,217 cases of household registration in Guizhou,accounting for the highest proportion(23.69%);Spring and summer registration is slightly higher than autumn and winter.3.The ratio of initial treatment and retreatment was 9.84-50.13,and the average ratio was 14.65,which had a significant difference(χ2=30.43,P<0.001);the ratio of smear positive to smear negative was 0.50-4.38,and the average ratio was 1.16,which had a significant difference(χ =519.88,P<0.001).there were 208 new smear-positive cases of drug-susceptible suspicious recruited during 2012 to 2015,accounted for the highest proportion(67.75%),Among the suspicious individuals,including 11 cases of multidrug-resistant patients,1 case of extensive drug resistance,and 1 case of single drug resistance;49.08%of patients were from referral,followed by symptomatic treatment,there was a statistically significant difference in the source distribution of patients(χ2=635.18,P<0.001);19.05%of patients had cavitations,and there was statistical difference in the cavitations distribution(χ=55.02,P<0.001).4.A total treatment success rate was 89.40%-95.76%,the average was 92.34%,which had a significant difference(χ2=510.60,P<0.001);Multidrug-resistant patients had an upward trend in recent years,while the rate of defaulters and others showed downward trend as the years;the 8-year average treatment success rate of new cases and retreatment cases were 92.66%and 83.49%,respectively,and the former had a significant difference(χ2=27.66,P=0.000),while the latter had no significant difference(χ2=9.47,P=0.22);the average treatment success rate of smear-positive patients was 89.17%,which had had a significant difference(χ2=16.67,P=0.022),but it showed a downward trend;the average treatment success rate of smear-negative pulmonary tuberculosis patients was 95.50%,which had no significant difference(χ2=9.73,P=0.204).5.The median delay was 13 days in hospital visit,and the median delayed diagnosis time was 3 days.There were no significant difference about gender,age,household registration,patient source,patient classification in hospital visit delay(P>0.05),and there were significant differences about occupational factors in hospital visit delay(P<0.05);There were no significant difference about occupational factors,patient source,patient classification in diagnosis delay(P>0.05).and there were significant differences about gender,age,household registration in diagnosis delay(P<0.05).Conclusions1.The registration rate of PTB,new patients and smear patient all decreased year by year in Yixing City indicating that the current prevention mode and DOTS strategy of pulmonary tuberculosis have achieved good results.2.The current problems of Yixing city were such as imperfect medical cooperation mechanism was not perfect,insufficient work guarantee funds,and the progress of the multi-drug resistance was slow,and MDR patients are not included in the single-species fixed-rate payment guarantee policy.The next step is to continue to improve the service system,implement funding guarantees,Screening of high-risk groups for multi-drug resistance should be implemented,attache great importance to the inclusion of treatment and follow-up management for MDR,improve the incidence rate of pulmonary tuberculosis patients,increase the awareness of prevention and treatment of them.3.The discovery and management of patients should pay great attention to young adults and physical labor people.4.It is important and difficult for PTB control to improve the treatment success rate for smear patients.5.Discovery delay of pulmonary tuberculosis patients and compliance with treatment could improve the success rate of PTB treatment.更多还原