广州市越秀区442例学生肺结核患者诊断延误情况分析

Analysis on Delayed Diagnosis of 442 Students with Pulmonary Tuberculosis in Yuexiu District

目的了解广州老城区学生肺结核患者诊断延误情况,为该地区学校结核病防治的科学决策提供参考依据。方法应用"中国疾病预防控制信息系统"之"结核病信息管理系统(新)"中报告的2010-2016年广州市越秀区大、中、小学生肺结核患者相关资料,对就诊延误时间(结核病可疑症状开始至患者就医的时间天数)、诊疗延误时间(患者就医至肺结核诊断确立的时间天数)进行分类分析与比较。结果 (1)在442例患者中,就诊延误、诊疗延误、总延误中位数时间(用"XX-XX-XX天"形式表示,下同)为9-9-22天,其中:男性为9-9-22天,女性为8-8-22天。(2)与小学、初中、高中、大学阶段相对应的7-12、13-15、16-18、≥19岁各年龄组3种延误中位数时间分别为29-2-34天、15-5-22天、5-8-20天、10-10-24天;健康体检、接触者检查、因症就诊、因症推荐、转诊、追踪等不同发现方式的病例分别为2-13-16天、46-15-61天、11-6-22天、20-10-29天、6-12-22天和12-11-35天。(3)涂片染色镜检阳性与阴性病例则分别为15-5-26天和6-13-21天。结论通过加强学校结核病健康教育、定期进行结核病相关健康体检等措施以减少就诊延误时间是及时发现和尽早治疗学生结核、阻断学校结核病流行的关键。

Objective To understand the delayed diagnosis of pulmonary tuberculosis（ TB） in students in Yuexiu district,Guangzhou and provide a reference for schools in the district to make scientific decision in the control and prevention of pulmonary tuberculosis. Methods Information of TB students in primary schools,secondary schools,senior high schools and universities and colleges in Yuexiu district,Guangzhou from 2010 to 2016 from ＂Tuberculosis Information Management System（ New Version） ＂of＂China Information System for Diseases Control and Prevention＂was referred to. Time for delayed consultation（ time interval from the onsets of patient presenting PTB symptoms to patient＇s first consultation to the doctor）and time for delayed diagnosis and treatment（ time interval from the patient＇s first consultation to a doctor to the confirmation of diagnosis of PTB） were classified,analyzed and compared. Results（ 1） The 442 patients＇ median time of delayed consultation,delayed diagnosis and treatment and total delay（ written in ＂XX-XX-XX days＂; the same below） was 9-9-22 days,among which 9-9-22 days for male and 8-8-22 days for female.（ 2） The median time of these three delays for students in primary school（ aged 7-12 years）,middle school（ aged 13-15 years）,senior high school（ aged 16-18 years） and university（ aged ≥19 years） were 29-2-34 days,15-5-22 days,5-8-20 days and 10-10-24 days respectively,while in various cases discovered by physical examination,contact examination,symptomatic clients,symptomatic recommendation,referrals and tracking）,the median time was 2-13-16 days,46-15-61 days,11-6-22 days,20-10-29 days,6-12-22 days and 12-11-35 days,respectively.（ 3） The median time of cases positive or negative after stained smears and microscopic examination was 15-5-26 days and 6-13-21 respectively. Conclusion Taking some measures such as strengthening health education for tuberculosis and implementing tuberculosis-related health examination regularly to help reduce patient＇s delayed consultation is the key to timely identification of tuberculosis,its cure as early as possible and block its epidemic in schools.