2010年我国城乡肺结核患者就诊报告过程及其相关因素分析

目的分析2010年中国结核病流行病学抽样调查（简称“流调”）发现患者在调查前出现症状、就诊、确诊、报告至开始治疗的全过程并比较城乡差异。方法以2010年在全国77个城镇调查点、99个乡村调查点进行结核病调查发现的≥15岁的肺结核患者作为研究对象，采用统一结构化的问卷，以面对面询问的形式进行社会经济情况及发病、就诊、治疗过程中相关因素的问卷调查，按照1301例患者（其中城乡患者分别为373例、928例）自然就诊报告过程进行分析，采用y。检验（显著性水平设为0．05）比较城乡差异并探讨其原因。结果城镇患者中49．3％（184／373）在流调前出现了肺结核相关症状，低于乡村患者（59．9％，556／928），差异有统计学意义（x2=12．15，P〈O．01）。城乡有症状者中就诊者分别占47．3％（87／184）、46．6％（259／556），城乡有症状就诊者中确诊肺结核者分别占41．4％（36／87）、34．0％（88／259），确诊结核病后进行了传染病报告者分别占69．4%（25／36）、70．5％（62／88），开始了抗结核治疗者分别占91．7％（33／36）、88．6G（78／88），以上差异均无统计学意义（x2=1．52、0．01、0．03，P值均〉0．05）。总结患者在流调前发病、就诊、诊断、治疗全过程，可见患者分流的最主要环节是无症状不就诊、有症状未就诊、有症状就诊诊断为其他疾病，分别占所有患者的42．1％（548／1301）、30．3％（394／1301）、17．1％（222／1301），最终仅有8．5％（111／1301）的患者出现了症状后确诊并开始了抗结核治疗，另有1.0％（13／1301）的患者虽未出现症状但因为其他原因确诊患了肺结核。结论患者有症状不就诊、就诊未确诊、确诊未治疗应被视为防控策略需重点注意的薄弱环节，城乡患者主要在出现症状的比例上存在差异，乡村患者无症状比例较低，其有症状就诊、就诊者确诊、确诊者治疗比例与城镇患者差异无统计学意义。

Analysis on process of seeking health care and case-reporting in patients with pulmonary tuberculosis in China in 2010and its relevant factors

Objective To analyze the process of pulmonary tuberculosis （TB） patients, who were detected during the 5th National TB Prevalence Survey in 2010, from onset of symptoms and health care seeking to diagnosis with TB, reporting and treatment; to compare the difference of those in urban and rural areas in China. Methods A face-to-face interview with structured questionnaire was conducted among pulmonary TB patients who were detected during the TB prevalence survey, which was conducted in 77 urban sites and 99 rural sites in China in 2010. Information and data related to soeio-economic, onset of symptoms, health care seeking behaviors, process of diagnosis, reporting and treatment were collected; information and data from 1301 patients who completed the inter- view （373 patients were from urban and 928 patients were from rural） were analyzed and x2 test was used to com- pare the difference between urban and rural areas （the level of statistical significance was P〈0.05）; reasons for the difference were explored. Results 49.3% （184/373） of urban patients had TB-related symptoms before the preva- lence survey and this proportion was lower than that of rural patients （59.9%, 556/928） ; the difference had statis- tical significance （x2=12.15, P〈0.01）. Among urban and rural TB patients, the proportions of symptomatic pa tients who sought health care were 47.3% （87/184） and 46.6% （259/556） respectively, the proportions of patients diagnosed with TB after sought health care were 41.4% （36/87） and 34.0%（88/259） respectively, the proportions of patients who were reported in the National Infectious Diseases Surveillance System after diagnosis with TB were 69. 4% （25/36） and 70. 5% （62/88） respectively, the proportions of patients who received anti-TB treatment afterdiagnosis with TB were 91.7% （33/36） and 88.6% （78/88） respectively; those differences between urban and ru- ral patients had no statistical significance （x2=0. 03, 1.52, 0.01, 0.03; P〈0. 05）. Throughout the whole journey of the TB patients from onset of symptoms to treatment, we could understand the most important reasons to lead patients to remain undetected and untreated, including patients were asymptomatic （42.1%, 548/1301）; patients had symptoms but did not seek health care （30.3%, 394/1301） ; patients had symptoms and sought health care but were diagnosed with other diseases （17.1%, 222/1301）. Only 8.5% （111/1301） of TB patients, who sought health care for symptoms and were diagnosed with TB, got anti-TB treatment before the prevalence survey; another 1.0% （13/1301） of TB patients, who did not have symptoms but visited health facilities due to other reasons, were also diagnosed with TB. Conclusion The following issues should be regarded as the weak points in TB control and need to be addressed, such as the symptomatic patients do not seek health care and TB patients are not timely diag nosed and treated. Compared with TB patients in urban area, the proportion of asyrnptomatic patients in rural area was significantly lower; however, the proportions of patients had no statistically significant differences in health care seeking, TB diagnosis and anti-TB treatment.