南阳地区肺结核流行病学特征及患者就诊延迟率分析

Epidemiological characteristics of pulmonary tuberculosis in Nanyang region and analysis of patient visit delay rate

目的探析南阳地区肺结核患者流行病学特征、就诊延迟情况及相关影响因素。方法收集2019-2022年752例肺结核患者为研究对象,对比初诊和复诊组患者病原学检查结果。按照报告的年份分组,对比不同年份男女患者构成情况,对比不同年份患者的就诊延迟率及不同年份男女患者的就诊延迟率,同时分析可能导致患者就诊延迟的相关影响因素。结果752例肺结核患者中,313例通过健康体检方式检出,190例通过转诊方式检出,113例通过因症就诊方式检出,70例通过因症推荐方式检出,65例通过追踪方式检出,1例通过接触者检查方式检出。602例为初诊患者,150例为复诊患者。初诊组患者中80.56%病原学检测阴性,复诊组患者中68.67%病原学检测阴性,初诊组患者中4.32%痰培养阳性,复诊组患者中10.67%痰培养阳性,两组差异有统计学意义(P<0.05)。初诊组患者中15.12%痰涂片阳性,复诊组患者中20.67%痰涂片阳性,两组差异无统计学意义(P>0.05)。发病例数呈逐年减少趋势,2019年发病277例,2020年209例,2021年158例,2022年108例。每年各月均有肺结核病例报告,发病曲线变化相似,发病高峰期为每年3月份,发病次高峰为每年11月份,病例数最少为每年8月。2019年报告的肺结核病例中,男性193例,女性84例,2020年病例中,男性142例,女性67例,2021年病例中,男性103例,女性55例,2022年病例中,男性72例,女性36例,每年的男女比例稳定,差异无统计学意义(P>0.05)。752例肺结核患者中,405例出现就诊延迟,就诊延迟率为53.86%。2019年就诊延迟率为60.65%,2020年为55.02%,2021年为49.37%,2022年为40.74%,就诊延迟率总体呈逐年下降趋势,差异有统计学意义(P<0.05)。510例男性患者就诊延迟率为57.45%,242例女性为46.28%,差异有统计学意义(P<0.05)。2020年不同性别患者就诊延迟率差异有统计学意义(P<0.05),2019年、2021年、2022年差异无统计学意义(P>0.05)。对肺结核患者就诊延迟可能的影响因素进行分析,年龄、职业、病原学检查、治疗分类是肺结核患者就诊延迟的相关影响因素(P<0.05)。结论本地区肺结核患者主要通过健康体检方式发现,病原学检测结果以阴性为主。发病例数呈逐年减少趋势,发病高峰期为每年3月份,病例数最少为每年8月。患者就诊延迟率总体呈逐年下降趋势,不同年份、不同性别的肺结核患者就诊延迟率对比差异具有统计学意义,年龄、职业、病原学检查、治疗分类是肺结核患者就诊延迟的相关影响因素。

Objective To explore the epidemiological characteristics,delayed visits,and related influencing factors of pulmonary tuberculosis patients in Nanyang region.Methods 752 cases of pulmonary tuberculosis patients and related clinical data from 2019 to 2022 were collected as the research subjects,and the pathogen test results of patients in the initial and follow-up groups were compared.According to the reported years,they were grouped to compare the composition of male and female patients in different years,the delay rate of patients in different years,and the relevant influencing factors that may cause patient delay were analyzed.Results Among 752 patients with pulmonary tuberculosis,313 were detected by health examinations,190 were detected by referral,113 were detected by symptomatic treatment,70 were detected by symptomatic recommendation,65 were detected by follow-up,and 1 were detected by contact examination.602 patients were initially diagnosed,and 150 patients were re diagnosed.80.56%of patients in the initial diagnosis group had a negative pathogen test,68.67%in the follow-up group had a negative pathogen test.4.32%in the initial diagnosis group had a positive sputum culture,and 10.67%in the follow-up group had a positive sputum culture.The difference between the two groups was statistically significant(P<0.05).15.12%of patients in the initial diagnosis group showed positive sputum smear,while 20.67%in the follow-up group showed positive sputum smear.The difference between the two groups was not statistically significant(P>0.05).The number of cases has been decreasing year by year,with 277 cases in 2019,209 cases in 2020,158 cases in 2021,and 108 cases in 2022.There were reports of pulmonary tuberculosis cases in each month every year,and the incidence curve changes similarly.The peak of incidence was in March every year,the second peak of incidence was in November every year,and the number of cases was at least in August every year.Among the tuberculosis cases reported in 2019,there were 193 male patients and 84 female patients.Among the cases reported in 2020,there were 142 male patients and 67 female patients.Among the cases reported in 2021,there were 103 male patients and 55 female patients.Among the cases reported in 2022,there were 72 male patients and 36 female patients.The annual ratio of male to female was stable,and the difference was not statistically significant(P>0.05).Among 752 patients with pulmonary tuberculosis,405 experienced delayed visits,with a delay rate of 53.86%.The delay rate of visits in 2019 was 60.65%,in 2020 it was 55.02%,in 2021 it was 49.37%,and in 2022 it was 40.74%.The overall delay rate of visits had been decreasing year by year,and there was a statistically significant difference in the delay rate of visits among tuberculosis patients in different years(P<0.05).The delayed visit rate of 510 male patients was 57.45%,and the delayed visit rate of 242 female patients was 46.28%,with a statistically significant difference(P<0.05).There was a statistically significant difference in the delay rate of visits between patients of different genders in 2020(P<0.05),while there was no statistically significant difference in the delay rate of visits between patients of different genders in 2019,2021,and 2022(P>0.05).The possible influencing factors of delayed medical treatment for pulmonary tuberculosis patients were analyzed,and age,occupation,pathogen examination,and treatment classification were the relevant influencing factors of delayed medical treatment for pulmonary tuberculosis patients(P<0.05).Conclusion Pulmonary tuberculosis patients in this region were mainly detected through health examinations,and the pathogen test results were mainly negative.The number of cases was decreasing year by year,with a peak in March and the minimum number of cases in August each year.The overall trend of delayed patient visits was decreasing year by year,and there was a statistically significant difference in delayed patient visits among tuberculosis patients of different years and genders.Age,occupation,pathogen examination,and treatment classification were related influencing factors for delayed patient visits in tuberculosis.