肺结核患者就诊临床表现及变化特点调查分析

Investigation and analysis of clinical features and changes in pulmonary tuberculosis patients

目的探讨肺结核(pulmonary tuberculosis,PTB)患者就诊临床表现及变化,为提高对PTB的认识和制定有效控制措施提供科学依据。方法收集山东省7县市2007-2010年PTB患者的有效病历资料共14 623份,对数据进行统计分析。结果 PTB患者年龄中位数为51岁,男女比例为2.46∶1。职业分布以农民最多(91.3%)。PTB患者就诊的临床症状中咳嗽比例最高(97.2%)。年度变化特点分析显示,患者咳痰、咯血和无症状比率呈明显升高趋势(均有P<0.05);相反,咳嗽、发热、乏力、食欲减退等比率则有明显降低趋势(均有P<0.05)。咳嗽、咯血、胸痛、咳痰出现率男性均高于女性(均有P<0.05)。对2个及以上的临床表现排列组合的发生率进行比较,发现共同出现咳嗽、咳痰、发热、乏力、食欲减退和盗汗的发生率最高(10.4%)。结论男性易患PTB,就诊多有咳嗽,应重视咳嗽、咳痰等临床特征及变化,避免误诊漏诊以早期发现患者。

Objective To investigate the clinical features of pulmonary tuberculosis（PTB） patients in this study in order to provide a scientific basis to deepen the understanding of PTB and to improve the prevention and control of PTB.Methods 14 623 medical records of PTB patients from 2007 to 2010 in seven counties of Shandong Province were collected,and analyzed the statistics.Results The age median of the PTB patients was 51.The ratio of male to female patients was 2.46∶1.As to the occupational distribution,peasant was the highest（91.3%）.Cough was the most popular symptom in PTB patients（97.2%）.Annual changes of clinical analysis showed that the incidence rates of expectoration,hemoptysis and symptomless were gradually increased（all P〈0.05）.However,incidence rates of cough,fever,fatigue and loss of appetite significantly decreased annually（all P〈0.05）.The incidence rates of cough,hemoptysis,chest pain and expectoration in female were significantly lower than those in male（all P〈0.05）.The combinations of 2 or more clinical manifestations showed that the incidence of co-occurence of cough,sputum,fever,fatigue,loss of appetite and night sweats was the highest（10.4%）.Conclusions The constituent ratio of male was higher than that of female in PTB,and cough was the most popular symptom.More attention should be paid on the features and changes of cough,sputum and other symptoms to avoid misdiagnosing in early stage.