2015—2020年广州市番禺区学生肺结核患者就诊延迟影响因素分析

Analysis of influencing factors of delayed medical treatment of students with pulmonary tuberculosis in Panyu District of Guangzhou City from 2015 to 2020

目的探索番禺区学生结核病临床特征,为制定干预措施提供理论依据。方法以2015—2020年番禺区学校的479例初治肺结核患者为研究对象,采用回顾性研究方法从中国结核病管理信息系统收集病案数据,采用单因素χ^(2)检验及多因素logistic回归分析方法,分析学校肺结核患者的就诊延误的影响因素。结果2015—2020年番禺区学生肺结核患者病原学阳性率为45.93%,从出现症状到就诊的中位数(四分位数)为8.0(1.0,28.0)d,就诊延迟率为39.67%,多因素logistic回归分析结果显示,以病原学阴性为对照,病原学阳性学生肺结核患者就诊延误的风险低[OR(95%CI)=0.679(0.468~0.986)];以接触者检查为对照,被动发现学生肺结核患者的就诊延误的风险低[OR(95%CI)=0.334(0.134~0.832)];以高中/中专为对照,大学学生肺结核患者的就诊延误的风险高[OR(95%CI)=2.705(1.098~6.665)]。结论番禺区学生肺结核患者的就诊延迟较为普遍,对就诊延迟的影响因素要加强干预,重点关注学校定期健康体检制度等学校相关因素的干预,减少延误的发生。

Objective To explore the characteristics of tuberculosis among students in Panyu District,Guangzhou City,so as to provide theoretical evidence for the formulation of interventions.MethodsA retrospective study was used to collect the case data from the China Tuberculosis Management Information System,and there were 479 newly treated tuberculosis patients in schools in Panyu District from 2015 to 2020.Univariateχ^(2) test and multivariate logistic regression analysis were used to analyze the influencing factors of delayed treatment of tuberculosis patients in schools(the interval between the onset of symptoms and the first visit to a medical institution was more than 14 days).ResultsFrom 2015 to 2020,the etiological positive rate of pulmonary tuberculosis patients in Panyu District was 45.93%.The median number of days from symptom onset to consultation(quartile)was 8.0(1.0,28.0)d.The delay rate of seeing a doctor was 39.67%.The results of multivariate logistic regression analysis showed that the etiological negative was used as a control,etiologically positive students had a low risk of delayed treatment in patients with pulmonary tuberculosis[OR (95%CI)0.6790.468-0.986].Taking contact examination as a control,the risk of delayed visits for patients with pulmonary tuberculosis was low[OR(95%CI)=0.334(0.134-0.832)].Taking high school/middle school students as a control,the university students had a high risk of delayed treatment for tuberculosis patients[OR(95%CI)=2.705(1.098-6.665)].ConclusionsThe delay in medical treatment of students with pulmonary tuberculosis in Panyu District is relatively common.It is necessary to strengthen the intervention of the influencing factors of delayed medical treatment,focusing on the intervention of school-related factors such as the regular health examination system of the school to reduce the occurrence of delay.