衡水市职业性尘肺病合并肺结核患者临床特征及其影响因素研究

Research on the clinical characteristics and influencing factors of occupational pneumoconiosis patients with pulmonary tuberculosis in Hengshui city

目的调查衡水市职业性尘肺病(以下简称尘肺病)合并肺结核患者的临床特征,并分析其影响因素,为本地区尘肺病合并肺结核的防治及制定相关政策提供依据。方法收集衡水市某医院尘肺病报告网络数据库中2010年8月至2020年8月确诊的650例尘肺病患者资料,回顾性分析尘肺病合并肺结核发生的流行特征,比较不同临床特征尘肺病合并肺结核情况,采用多因素logistic回归分析影响尘肺病合并肺结核的相关因素。结果650例确诊尘肺病新报告病例中并发肺结核患者186例,肺结核并发率为28.62%(186/650)。单因素分析结果显示,发生率男性整体高于女性,但随患者年龄增长呈逐渐减低趋势;发病年龄越小、接尘工龄越长、开始接尘年龄越大、尘肺期别越高以及维生素D(Vitamin D,VitD)缺乏者其发生率增加;掘进工、采煤工、煤矿混合工、电焊工合并肺结核发生率高于其他工种;尘肺病患者合并肺结核发生率高于其他类型尘肺病患者;以上差异均有统计学意义(χ^(2)=4.101、22.142、66.458、25.24、66.581、89.362、56.423,P<0.05)。多因素logistic回归分析结果显示,接尘工龄长、开始接尘年龄大、尘肺期别高及血清中VitD含量缺乏,均是影响尘肺病合并肺结核发生的危险因素。结论衡水市尘肺病合并肺结核发生率较高,且发生率与接尘工龄、开始接尘年龄、尘肺期别、血清中VitD含量有关。需加强尘肺病与肺结核的防治工作。

Objective To investigate clinical characteristics of occupational pneumoconiosis(pneumoconiosis)complicated with pulmonary tuberculosis in Hengshui city,and to analyze its influencing factors,providing a basis for the prevention and treatment of pneumoconiosis complicated with pulmonary tuberculosis and formulating related policies in this area.Methods The data of 650 patients diagnosed with pneumoconiosis from August 2010 to August 2020 were analyzed retrospectively.All the relevant data on pneumoconiosis patients were from the hospital pneumoconiosis reporting network database.The epidemiological characteristics of pneumoconiosis combined with tuberculosis were analyzed,and the prevalence of pneumoconiosis patients combined with tuberculosis with different clinical characteristics was compared.Multivariate logistic regression was used to analyze the related factors of pneumoconiosis complicated with pulmonary tuberculosis.Results Among the 650 newly diagnosed cases of pneumoconiosis,186 newly reported cases were complicated with pneumoconiosis tuberculosis,and the complication rate of tuberculosis was 28.62%(186/650).Univariate analysis showed that the prevalence was higher in males than in females as a whole,but showed a gradually decreasing trend with the age of patients;the younger the age of onset,the longer the duration of dust exposure,the older the age of starting dust exposure,the higher the pneumoconiosis stage,and the increased prevalence of(Vitamin D,VitD)deficiency;the prevalence was higher in tunnelers,coal miners,coal mine mixers,and welders than in other types of work;the prevalence was higher in silicosis than in other types of pneumoconiosis,and the above differences were statistically significan(tχ^(2)=4.101,22.142,66.458,25.24,66.581,89.362,56.423,P<0.05),and the multivariate logistic regression analysis showed that the long duration of dust exposure,the older the age of starting dust exposure,the higher pneumoconiosis stage,and the lack of serum VitD content were all risk factors affecting the occurrence of pneumoconiosis with pulmonary tuberculosis.Conclusion The prevalence of pneumoconiosis combined with pulmonary tuberculosis in Hengshui City is relatively high,which is related to the exposure duration of dust,age of starting pneumoconiosis,stage of pneumoconiosis,and VitD level.Therefore,the city needs to strengthen to prevent and treat the pneumoconiosis and pulmonary tuberculosis,not only to improve the knowledge and education of occupational health examination and tuberculosis prevention and control of dust workers,but also to improve the lack of VitD in patients.