合肥市2019—2020年学校肺结核流行特征及诊断延误影响因素分析

Epidemiological characteristics and influencing factors of delayed diagnosis of pulmonary tuberculosis in schools in Hefei during 2019-2020

目的了解合肥市2019—2020年学校肺结核流行特征和病例诊断延误的影响因素,为进一步做好学校肺结核防控工作提供参考。方法对2019年1月至2020年12月合肥市学校肺结核报卡信息、学校肺结核聚集性疫情资料等进行回顾性研究,分析新冠肺炎疫情防控措施影响下合肥市学校肺结核流行特征及病例诊断延误因素的变化。结果2020年合肥市学校肺结核报告发病率为14.04/10万,5—6月和10—11月出现发病高峰。职业为教师的学校肺结核病例占8.00%,较2019年差异有统计学意义(χ^(2)=4.30,P<0.05)。2020年本地医疗机构报告的病例诊断时长中位数为5.14 d、确诊时长中位数为18 d,均较2019年有所缩短,差异有统计学意义(Z值分别为22.45,4.52,P值均<0.05)。学校肺结核多病例散发疫情中密切接触者PPD强阳性率为13.50%、新发病例检出率为0.62%。密切接触者暴露发病时长中位数为132 d,较2019年增加明显,差异有统计学意义(Z=251.50,P<0.05)。2020年病例首次医疗机构放射项目为胸部CT的诊断延误率为12.10%,通过学校或家长对病例进行督促诊断延误率为16.15%。以首次医疗机构放射项目为胸部CT为对照,首次放射项目为胸片的病例诊断延误风险高(OR=4.34,P<0.05);以学校或家长未开展病例就诊督促为对照,有就诊督促的病例诊断延误风险低(OR=0.26,P<0.05)。结论首次医疗机构放射项目选择以及病例就诊督促等因素对病例诊断延误有影响。应在继续加强学校肺结核疫情处置与监测的基础上,采取多病同防措施。

Objective To explore epidemiological characteristics and diagnosis delay among tuberculosis patients,and to provide reference basis for pulmonary tuberculosis prevention and control in schools.Methods Retrospective data of school-based tuberculosis patients information and cluster epidemiological information in Hefei during Jan.2019 to Dec.2020 was collected.Changes of the epidemiological characteristics and diagnosis delay of school tuberculosis epidemic and possible role were explored.Results The reported incidence of Hefei school pulmonary tuberculosis was 14.04/10^(5) in 2020.Two peaks of cases occurred during May to Jun.and Oct.to Nov.Teacher account for 8.00%of pulmonary tuberculosis cases in school,a significant increase was observed compared with 2019(χ^(2)=4.30,P<0.05).In 2020,the median length of treatment for cases reported by local medical institutions was 5.14 days,and the median length of diagnosis was 18 days,both of which were shorter than those in 2019(Z=22.45,4.52,P<0.05).In multiple cases sporadic of school pulmonary tuberculosis,strong positive rate of PPD test was 13.50%among close contacts,and new case detectable rate was 0.62%.The median duration from exposure to symptoms onset among close contacts was 132 days,which significant increased compared to 2019(Z=251.50,P<0.05).The diagnosis delay among tuberculosis patients diagnosed by chest CT was 12.10%,and was 16.15%through supervision by school or parents.Chest radiograph was associated with higher risk of delayed diagnosis(OR=4.34,P<0.05)compared to chest CT as the first medical radiology option.Low delayed diagnosis rate was associated with supervision of tuberculosis by school or parents than control(OR=0.26,P<0.05).Conclusion Factors such as the selection of diagnostic radiology and case supervision are associated with delay diagnosis.It's necessary to strengthen the management and monitoring of the pulmonary tuberculosis epidemic in school.