我国部分地区肺结核可疑症状发生情况及影响因素研究

Study on incidence and influence factors of pulmonary tuberculosis suspected symptoms in some areas of China

目的获得研究地区肺结核可疑症状的发生情况，分析影响发生率的潜在因素。方法从全国东部、中部和西部的10个省（直辖市、自治区）（上海市、江苏省、浙江省、广东省、黑龙江省、河南省、湖北省、四川省、云南省、广西壮族自治区）中选择10个县（区）的27个乡镇（社区）作为研究现场（应调查人口为331583名），对研究对象进行入户面对面问卷调查，获得一般人口学特征、肺结核可疑症状发生情况、吸烟饮酒史等个人生活方式信息。按照国家规划中对肺结核可疑症状的定义（咳嗽、咯痰≥2周，或者有咯血或血痰症状），分析肺结核可疑症状的发生情况，并采用单因素logistic回归和多因素logistic回归的方法分析影响肺结核患者可疑症状发生的因素。结果本研究实际调查人口为307554名，全人群肺结核可疑症状发生率为0．77％（2366／307554）。对肺结核可疑症状发生率的不同影响因素进行单因素logistic回归分析发现：男性、75～岁年龄组、农村、中部和西部、文盲及半文盲、有吸烟史、有饮酒史人群肺结核可疑症状的发生率分别为0．87％（1333／152892）、1．95％（282／14497）、0．93％（1681／181080）、0．91％（827／90437）和0．91％（884／97289）、1．12％（442／39366）、1．51％（797／52762）、1．36％（700／51559），分别高于女性[O．67％（1033／154662）]、15～岁年龄组[0．13％（44／32853）]、城市[0．54％（685／126474）]、东部地区[0．55％（655／119828）]、大专及以上学历[0．39％（114／28892）]、从不吸烟[O．78％（1569／201724）]、从不饮酒[O．82％（1665／202646）]人群的发生率，差异均有统计学意义（x2值分别为41．89、2262．78、145．87、127．54、245．84、243．81、128．13，P值均〈O．001）。多因素logistic回归分析发现，75～岁年龄组、农村、中西部地区、有吸烟史、有饮酒史人群分别是15～岁年龄组、城市、东部地区、从不吸烟、从不饮酒人群发生肺结核可疑症状的15．58（10．36-23．44）倍、1．41（1．25～1．59）倍、1．92（1．6742．20）和1．51（1．32～1．73）倍、1．59（1．38～1．83）倍、1．21（1．05～1．39）倍。结论在老年人、贫困地区人群和具有吸烟饮酒史的人群中进行肺结核可疑症状的筛查，可以获得较好的效果，资源有限地区可以考虑更有针对性地开展肺结核患者发现工作。

Objective To obtain the incidence of suspected symptoms of the whole population in study sites, and to analyze the potential influence factors. pulmonary tuberculosis （PTB） of Methyls In 27 townships/corn- munities of 10 counties selected from 10 provinces located in eastern, middle and western regions in China, which included Shanghai city, Jiangsu province, Zheiiang province, Guangdong province, Heilongiiang province, He＇ nan province, Hubei province, Sichuan province, Yunnan province, and Guangxi Autonomous Region, with 331 583 eli- gible individuals, face-to-face household questionnaire investment was provided to all participants to obtain the infor- mation of demographic characteristics and personal lifestyle, such as PTB suspected symptoms, history of smoking and drinking, etc. According to the definition of TB suspected symptom in the national tuberculosis control pro- gramme （cough or expectoration for more than 2 weeks, or hemoptysis or bloody sputum）, the incidence of PTBsuspected symptoms was analyzed, and related influence factors of PTB patients were analyzed using univariate logistic analysis and multi-variate logistic analysis. Results 307 554 individuals were interviewed. The incidence of presumptive PTB patients in whole population was 0.77G （2366/307 554）. Univariate logistic analysis for incidence of presumptive PTB patients showed that the detection rates of male, age group ＇75-＇, rural areas, central and western region, illiteracy/semi-illiteracy, individuals with smoking history, and individuals with drinking history were0.87% （1333/152 892）, 1.95% （282/14 497）, 0.93% （1681/181 080）, 0.91% （827/90 437）, 0.91% （884/97 289）, 1.12%/00 （442/39 366）, 1.51% （797/52 762）, and 1.36% （700/51 559） respectively, and were higher than that of female （0. 670% （1033/154 662））, age group ＇15- ＇ （0. 13% （44/32 853））, urban areas （0. 540%（685/126 474））, eastern region （0.55% （655/119 828））, junior college and above （0.39% （114/28 892））, never smoked （0. 78% （1569/201 724）） and never drunk （0.82% （1665/202 646）） respectively. All the differences were statistically significant （X2 =41.89, 2262.78, 145.87, 127.54, 245.84, 243.81, 128. 13 respectively, P〈0. 001）. Multi-logistics showed that individuals of age group ＇ 75- ＇, rural areas, central and western region, and individuals with smoking history, drinking history were 15.58 （10. 36-23.44）, 1.41 （1.25-1.59）, 1.92 （1.67-2.20） and 1.51 （1.32- 1.73）, 1.59 （1.38- 1.83） and 1.21 （1.05 - 1.39） times likely to be presumptive PTB patients respectively, compared with individuals of age group‘15 - 7 ’urban areas, eastern region, and individuals never smoked and drunk. Conclusion Among the elderly, people lived in poverty areas, and people with history of smoking and drinking, screening for presumptive PTB patients could get better results, so for resources-limited regions, it could be more effective to conduct targeted TB case-finding.