苏州市2011—2020年学生肺结核患者发现延迟状况

  目的  分析苏州市学生肺结核患者发现延迟情况，为学校结核病疫情防控工作提供参考依据。  方法  以2011—2020年苏州市登记管理的1 148例学生肺结核患者为研究对象，采用Kruskal-Wallis H检验、χ2检验和Cochran-Armitage趋势检验分析学生肺结核患者发现延迟的时间趋势，采用χ2检验和Logistic回归分析学生肺结核患者入院特征与发现延迟的关系。  结果  调查的学生肺结核患者中，共有569例发现延迟，发现延迟率为49.6%，发现时长中位数为26(11~49)d。2011—2020年学生肺结核患者发现时长差异有统计学意义(Hc=54.62，P < 0.05)，发现延迟率(51.2%，44.2%，33.9%，26.2%，65.8%，51.0%，43.2%，61.5%，55.0%，53.5%)差异有统计学意义(χ2=53.69，P < 0.05)。发现延迟率随时间变化而波动，总体呈上升趋势(Z=-3.67，P < 0.05)。发现方式为因症就诊(OR=5.57，95%CI=1.91~16.27)、病原学检查结果为阳性(OR=1.46，95%CI=1.14~1.86)均与发现延迟呈正相关(P值均 < 0.05)。  结论  苏州市学生肺结核患者发现延迟情况不容乐观，因症就诊、病原学检查阳性是发现延迟的影响因素。针对日常学校结核病防控中的突出问题，多部门应联动合作落实相关防控措施，减少发现延迟的发生。

Delay in student pulmonary tuberculosis case-finding and associated factors in Suzhou during 2011 to 2020

  Objective  To analyze delay in student pulmonary tuberculosis(PTB) case-finding and associated factors in Suzhou, and to provide a reference for tuberculosis outbreak prevention and control in schools.  Methods  A total of 1 148 students with PTB who registered and were treated in Suzhou from 2011 to 2020 were included. Kruskal-Wallis H test, 2 test and Cochran-Armitage trend test were used to analyze the time trend of case-finding delay. Logistic regression was used to analyze the correlation between admission characteristics and case-finding delay.  Results  Among the students with PTB, a total of 569 cases were found to be delayed. The rate of delay was 49.6%, and the median delay time was 26(11-49) days. From 2011 to 2020, the difference in case-finding interval of students with PTB was statistically significant(Hc=54.62, P < 0.05), and the difference in case-finding rate was also statistically significant(χ2=53.69, P < 0.05). The rate of delay fluctuated, with an overall upward trend over time(Z=-3.67, P < 0.05). Clinical consultation(OR=5.57, 95%CI=1.91-16.27), positive etiology (OR=1.46, 95%CI=1.14-1.86) were positively correlated with case-finding delay(all P < 0.05).  Conclusion  There are significant delays in case-finding among students with PTB in Suzhou. Clinical consultation and positive etiology are associated with case-finding delay. In response to the growing problems in daily school tuberculosis prevention and control, multiple departments should cooperate to implement relevant measures and to reduce the occurrence of case-finding delay.