【作者】 黄俊新； 吴肖冰； 薛浩泽； 黄志明； 陈赵文； 许宗严； 张建霞；

【机构】 深圳市慢性病防治中心； 宝安慢病院； 龙岗慢病院； 福田慢病院； 罗湖慢病院；

【摘要】 目的了解深圳市首诊麻风病患者的就医行为特征及其诊断情况,为进一步提高麻风病患者早期发现提供依据。方法采用结构化问卷通过面对面访谈方式收集首诊麻风病人的就医行为及诊断情况,使用SPSS17.0软件进行数据分析。结果 2016年1月1日至2017年3月31日共新确诊麻风病人16例,其中2016年8例,2017年第1季度8例;男性8例,女性8例;年龄最小16岁,最大62岁,平均36岁;确诊BT5例,BB1例,BL2例和LL8例,出现I级畸残4例,II级畸残3例。5例在来深圳前已出现麻风病相关临床症状,来深后最短1个月最长68个月确诊麻风病;11例病例来深圳后才出现麻风相关症状,从来深到发病最短6个月最长215个月,从发病到确诊最短3个月最长91个月。患者就诊次数最少1次最多10次确诊;确诊前由皮肤科和病理室同时报告为疑似病例的7例,仅皮肤科5例,仅病理室报告4例。比较2016年和2017年的麻风病例就诊情况,非参数秩和检验发现两个年度麻风病例从发病到诊断时间差距(月)及就诊次数(次)的差异均无统计学意义(P>0.05),而提出疑似病例的科室构成则存在差异(Fisher精确检验P=0.001),2017年度确诊病例更多由病理科室单独报告疑似病例。结论无论是来深前发病或是来深后发病的麻风病例普遍存在延迟诊断的情况。病理室可能成为麻风病例发现的重要科室,应进一步加强对病理室医务人员的培训,提高其识别麻风病理的能力。更多还原

【Abstract】 Objective This study aimed to understand the health service utilization characteristics and disease diagnosis among leprosy patients and provide evidence for early detection on leprosy patients.Methods This study used structural questionnaire to collect information on health service utilization behaviors,disease diagnosis,etc,and interviewed patients face-to-face.The data were analyzed using SPSS 17.0 software.Results From January 1 st 2016 to March 31 st 2017,16 leprosy patients werenewly reported in Shenzhen,among whom 8 were reported in 2016 and 8 were reported in 2017,8 were male and 8 were female.The youngest patient was 16 years old and the eldest one 62 years old,with an average age of 36 years old.Among the 16 patients,5 were diagnosed with BT type,1 were BB type,2 were BL type and 8 were LL type;4 patients performed grade I disability and 3 performed grade II disability.Five patients had presented leprosy related syndromes before coming to Shenzhen,and after their arriving in Shenzhen,patients were diagnosed with leprosy with the shortest time of 1 months and the longest time of 68 months.Eleven patients performed leprosy related symptoms during their residence in Shenzhen with the shortest time of 6 months and the longest time of 215 months,and they were diagnosed with leprosy with the shortest time of 3 months and 91 months after symptoms presented.Some patients were diagnosed with leprosy at their first visit in dermatology department,while one case was diagnosed at the 10 th time he visit the clinic.Seven suspected cases reported by dermatology department and pathology department,and 5 by dermatology department only and 4 by pathology department only.The results from non-parametric statistics showed the distances(by months) between syndromes performed and diagnosis and the clinic visit times in 2016 and 2017 were similar with P>0.05.However,pathology department reported more suspected leprosy cases in 2017 when comparing that in 2016(Fisher’ exact test,P=0.001).Conclusions Delay detection is popular among leprosy patients no matter the syndromes performed before coming to Shenzhen or during the residence in Shenzhen.The pathology department may become an important place to detect suspected leprosy cases.Trainings for the medical staffs from the pathology departments to promote their skills in leprosy detection are needed in future.更多还原