苏州市初治菌阴肺结核患者就诊延迟现况及临床特征

Health seeking delay and clinical features of patients with primary smear and culture negative pulmonary tuberculosis in Suzhou

目的分析初治菌阴肺结核患者就诊延迟现况及临床特征,为制定有效措施提供科学依据。方法应用横断面研究,收集苏州市5家结核病定点医院初治菌阴肺结核患者人口学、经济来源、生活方式、结核病知识、主要病史及进入结核病定点医院前发病和就诊等临床资料,采用Logistic回归方法进行统计分析。结果379例初治菌阴肺结核患者就诊延迟186例,就诊延迟率为49.08%。老年人(OR=1.898,95%CI=1.157~3.112,P=0.011)、日工作时间大于8 h(OR=1.774,95%CI=1.014~3.102,P=0.044)、流动人口(OR=3.252;95%CI=1.807~5.855,P<0.001)和发热(OR=2.061,95%CI=1.021~4.160,P=0.043)是初治菌阴肺结核患者发生就诊延迟的危险特征,而咯血(OR=0.356,95%CI=0.164~0.773,P=0.009)是就诊延迟的保护特征。结论初治菌阴肺结核患者就诊延迟现象较严重,需对不同临床特征的患者采取综合干预措施,减少就诊延迟发生。

Objective To investigate the status of delay in seeking health care among patients with primary smear andculture negative pulmonary tuberculosis,and we explore the relative clinical features in order to provide scientific evidence fordeveloping effective measures.Methods The patients with primary smear and culture negative pulmonary tuberculosis wereincluded in the cross-sectional study.Data on demographic characteristics,source of income,life style,knowledge of tuberculosis,history of disease,morbidity and treatment were collected for all participants.The association between clinicalfeatures and health-seeking delay were analyzed by using non-conditional Logistic regression method.ResultsFor the 379 cases of patients with primary smear and culture negative pulmonary tuberculosis,there were 186 patients with delay in seekinghealth care(49.08%).Health-seeking delay was positively associated with the aged(OR=1.898,95%CI=1.157-3.112,P=0.011),working more than 8 hours a day(OR=1.774,95%CI=1.014-3.102,P=0.044),migrating population(OR=3.252;95%CI=1.807-5.855,P<0.001)and low fever(OR=2.061,95%CI=1.021-4.160,P=0.043),but was negatively associated withhemoptysis(OR=0.356,95%CI=0.164-0.773,P=0.009).ConclusionThere is quite serious in seeking health care amongprimary smear and culture negative pulmonary tuberculosis patients,a combination of interventions should be needed fordifferent clinical features to reduce the proportion of patient delay.