2012–2022年成都市肺结核流行特征与治疗转归分析

doi:10.19871/j.cnki.xfcrbzz.2024.05.004

摘要/Abstract

摘要： 目的分析2012–2022年四川省成都市肺结核病患者登记管理变化趋势及治疗转归影响因素,为进一步制订成都市结核病防治策略和措施奠定基础。方法通过“中国疾病预防控制信息系统”子系统“结核病信息管理系统”收集2012–2022年成都市肺结核登记与管理的相关资料,2012–2022年肺结核登记管理率的变化采用Joinpoint回归模型进行趋势分析,采用多因素Logistic回归分析研究肺结核患者治疗转归的影响因素。结果 2012–2022年,成都市累计登记活动性肺结核患者69 421例,以男性、农民、中青年为主。年平均登记管理率为45.49/10万,登记管理率总体呈下降趋势,平均每年下降6.09%（AAPC=-6.09%,t=-9.37,P<0.001）,下降趋势具有统计学意义。Joinpoint回归模型分段结果显示：2012–2016年肺结核登记管理率逐年下降7.75%,且趋势具有统计学意义（APC=-7.75%,t=-11.53,P<0.001）;2017–2022年下降趋势减缓为3.54%（APC=-3.54%,t=-2.76,P=0.03）。2012–2022年病原学阳性患者登记管理率上升趋势无统计学意义（AAPC=0.87%,t=0.79,P=0.43）;2012–2016年病原学阳性患者登记管理率呈下降趋势且具有统计学意义（APC=-9.67%,t=-4.76,P=0.003）;2017–2022年病原学阳性患者登记管理率呈上升趋势且具有统计学意义（APC=8.57%,t=7.20,P<0.001）。男性与女性年均登记管理率分别为62.25/10万和31.03/10万,男女性登记管理率之比为2.01∶1,男性高于女性(χ²=708.084,P<0.001)。多因素回归分析表明：男性、年龄、农民、病原学阳性和复治是患者预后的影响因素。结论 2012—2022年成都市肺结核登记管理率呈稳定下降趋势。应重点加强中青年男性,以及农村中老年人群的宣传教育、结核病筛查工作力度;加强病原学阳性、复治患者的治疗、随访管理工作。

关键词: 肺结核病, 流行特征, 治疗转归, 影响因素

Abstract: Objective To analyze the change trend of pulmonary tuberculosis patient registration and management and the influencing factors of treatment outcome in Chengdu, Sichuan Province, from 2012 to 2022, so as to lay a foundation for further formulating tuberculosis prevention and control strategies and measures in Chengdu. Method The data related to the registration and management of tuberculosis in Chengdu from 2012 to 2022 were collected through the "Tuberculosis Information Management System", a subsystem of the "China Disease Prevention and Control Information System". The change of the registration and management rate of tuberculosis from 2012 to 2022 was analyzed by the trend analysis of the Joinpoint regression model, and the influencing factors of the treatment outcome of tuberculosis patients were analyzed by the multi factor logistic regression analysis. Result From 2012 to 2022, a total of 69421 active tuberculosis patients were registered in Chengdu, with males, farmers, and middle-aged and young people as the main population, and with an average annual registration rate of 45.49/100 000. The overall registration management rate showed a downward trend, with an average annual decrease of 6.09% (AAPC=-6.09%, t=-9.37, P<0.001）. The downward trend has statistical significance. The segmented results of Joinpoint regression model showed that the registration and management rate of pulmonary tuberculosis decreased by 7.75% year by year from 2012 to 2016, and the trend was statistically significant (APC=-7.75%, t=-11.53, P<0.001). The downward trend slowed down to 3.54% from 2017 to 2022 (APC=-3.54%, t=-2.76, P=0.03). There was no statistically significant increase in the registration and management rate of pathogen positive patients from 2012 to 2022 (AAPC=0.87%, t=0.79, P=0.43）. However, from the segmented results, the registration and management rate of pathogen positive patients showed a downward trend from 2012 to 2016 and was statistically significant (APC=-9.67%, t=-4.76, P=0.003）. But from 2017 to 2022, the registration and management rate of pathogen positive patients showed an upward trend and had statistical significance (APC=8.57%, t=7.20,P<0.001）. The average annual registration and management rates for males and females are 62.25/100 000 and 31.03/100 000, respectively. The ratio of male to female registration and management rates is 2.01:1, with males having a higher rate than females (χ²=708.084, P<0.001). The patient composition is relatively high among young people aged 20 to 29 (22.12%) and farmers (44.10%). Univariate and multivariate regression analysis of treatment:Male, age, farmer, pathogen positive, and retreatment are important influencing factors on patient prognosis. Conclusion From 2012 to 2022, the registration and management of pulmonary tuberculosis in Chengdu showed a stable downward trend. Pathogenic positivity and re treatment increased the risk of adverse outcomes. The next step is to focus on strengthening the publicity, education, and screening efforts of males, students, and middle-aged and elderly populations; Strengthen the treatment and follow-up management of patients with positive and recurrent pathogens.

Key words: Tuberculosis, Epidemic characteristics, Treatment outcome, Influencing factors

中图分类号:

R521

段晓菲, 吴桂辉, 杨洁, 蒋良双. 2012–2022年成都市肺结核流行特征与治疗转归分析[J]. 新发传染病电子杂志, 2024, 9(5): 19-24.

Duan Xiaofei, Wu Guihui, Yang Jie, Jiang Liangshuang. Analysis on epidemic characteristics and treatment effect of pulmonary tuberculosis in Chengdu from 2012 to 2022[J]. Electronic Journal of Emerging Infectious Diseases, 2024, 9(5): 19-24.

参考文献

[1] WORLD HEALTH ORGANIZATION.Global tuberculosis report 2023[EB/OL].[2023-11-07]. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/globaltuberculosis-report-2023.
[2] 卢春容, 谭卫国, 陆普选, 等. 2023年WHO全球结核病报告:全球与中国关键数据分析[J/CD]. 新发传染病电子杂志, 2023, 8(6):73-78.
[3] 王黎霞, 成诗明, 陈明亭, 等. 2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志, 2012, 34(8):485-508.
[4] 鲁周琴, 张正斌, 王晓君, 等. 2016—2020年武汉市老年肺结核疫情特征分析[J].公共卫生与预防医学, 2023, 34(1):35-38.
[5] 周文洁, 钟立, 罗兴能. 2008—2017年重庆市沙坪坝区老年结核病流行特征分析[J].结核病与肺部健康杂志, 2018, 7(3):171-175.
[6] 王前, 李涛, 杜昕, 等. 2015—2019年全国肺结核报告发病情况分析[J].中国防痨杂志, 2021, 43(2):107-112.
[7] 滕冲, 王玉兰, 刘柳, 等. 2013—2022年北京市东城区肺结核报告发病流行特征及发病预测分析[J].中国防痨杂志, 2024, 46(4):397-402.
[8] 孙海燕, 代晓琦, 宋颂, 等. 2008—2022年青岛市肺结核流行特征分析[J]. 结核与肺部疾病杂志, 2024, 5(2):164-167.
[9] OSPINA JE, OREAU A, MILLET JP, et al.Epidemiology of tuberculosis in immigrants in a large city with large-scale immigration (1991-2013)[J]. PLos One, 2016, 11(10):E0164736.
[10] 滕人聪, 李涛, 李玉红, 等. 2015—2021年全国65岁及以上老年肺结核患者登记情况分析[J]. 中国防痨杂志, 2023, 45(4):367-371.
[11] MEALER M, JONES J, NEWMAN J, et al.The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses; results of a national survery[J]. Int J Nurs Stud, 2012, 49(3):292-299.
[12] 严菁敏, 陈莹, 于洁, 等. 基于LASSO-LOGISTIC回归的TB/HIV患者抗结核治疗结局影响因素研究[J].现代预防医学, 2023, 50(22):4039-4045, 4051.
[13] FETENSA G, WIRTU D, ETANA B, et al.Magnitude and determinants of delay in diagnosis of tuberculosis patients in ethiopia:a systematic review and meta-analysis:2020[J]. Arch Public Health, 2022, 80(1):78.
[14] 蒋泽顺, 杨正贵, 李江平, 等. 宁夏结核病治疗转归影响因素分析及预测模型的建立[J]. 现代预防医学, 2021, 48(16):2905-2910.
[15] 周锦仪, 郭婉如, 陈其琛, 等. 2013—2015年广州市番禺区肺结核登记及治疗转归分析[J]. 现代医院, 2017, 17(5):703-706.
[16] 张梦娴, 杨成凤, 叶建君, 等. 1447例耐多药肺结核患者治疗转归队列分析[J].公共卫生与预防医学, 2020, 31(3):68-72.
[17] 中国防痨协会.流动人口肺结核患者管理指南[J/CD]. 新发传染病电子杂志,2021,6(1):7-12.