丰台区2016—2019年有可疑症状肺结核患者确诊延误及其影响因素分析

Analysis on the diagnosis delay of pulmonary tuberculosis in patients with suspicious symptoms and its influencing factors in Fengtai District from 2016 to 2019

目的了解丰台区肺结核患者确诊延误现状及其影响因素,为制订防控措施提供依据。方法分析2016年1月至2019年12月国家结核病管理信息系统肺结核患者信息,采用频数和构成比(%)进行统计学描述,采用χ;检验进行组间差异的比较,采用Logistic回归进行多因素分析。结果丰台区1984例有可疑症状的肺结核患者中,确诊延误236例,确诊时间中位数为0 d,确诊延误率为11.90%;单因素分析发现,不同首诊医院和诊断分类的肺结核患者确诊延误率比较,差异有统计学意义(P<0.05);不同性别、年龄、民族、户籍、职业、治疗分类、是否有合并症及是否开展分子生物学检查的肺结核患者确诊延误率比较,差异无统计学意义(P>0.05)。多因素研究发现,非定点医院就诊的患者确诊延误的可能性更大(OR:2.128, 95%CI 1.538~2.945);非病原学阳性的患者确诊延误的可能性更大(OR:1.871, 95%CI 1.383~2.531)。是否开展分子生物学检查对确诊时间无影响。结论丰台区有可疑症状的肺结核患者存在确诊延误的现象,分子生物学检测对确诊延误无影响,实际工作中需采取措施提高分子生物学检测工作效率;同时应加强非定点医院就诊的肺结核患者转诊效率。

Objective To understand the current situation of diagnosis delay of pulmonary tuberculosis(PT) of patients and influencing factors in Fengtai District, and to provide basis for formulating prevention and control measures. Methods The information of tuberculosis patients in the Chinese Tuberculosis Information Management System from January 2016 to December 2019 was analyzed. The frequency and composition ratio(%) were used for statistical description, and the difference between groups was compared by χ;test. Logistic regression was used for multivariate analysis. Results Among 1984 PT patients with suspicious symptoms in Fengtai District,236 cases were delayed in diagnosis, with a median time of 0 day and a delay rate of 11.90%. Univariate analysis showed that there were significant differences in the delay rate of diagnosis among PT patients in different first-visit hospitals and diagnostic classifications(P<0.05).There were no significant differences in the delay rate of diagnosis among PT patients with different gender, age, nationality,household registration,occupation, treatment classification,complications and molecular biology examination(P >0.05).Multivariate analysis showed that patients in non-designated hospitals were more likely to be delayed in diagnosis(OR:2.128, 95%CI 1.538-2.945). Patients with non-etiological positive were more likely to be delayed in diagnosis(OR:1.871,95%CI 1.383-2.531). Whether to carry out molecular biology examination had no effect on the time of diagnosis. Conclusion PT patients with suspicious symptoms in Fengtai district have the delayed diagnosis, and molecular biological detection has no effect on delayed diagnosis.Measures should be taken to improve the efficiency of molecular biological detection in practical work. At the same time, the referral efficiency of PT patients in non-designated hospitals should be strengthened.