An outbreak of pulmonary tuberculosis in young Australians

OBJECTIVE: To characterise a pulmonary tuberculosis (TB) cluster in the Hunter Area of New South Wales using a combination of traditional epidemiological methods and molecular typing. DESIGN, SETTING AND PARTICIPANTS: Review of all notifications of TB in the Hunter Area between January 1994 and June 2005, with a detailed analysis of cases among people born in Australia or New Zealand. MAIN OUTCOME MEASURES: Comparison of genotypes of Mycobacterium tuberculosis isolates; extent of TB cluster. RESULTS: Over the period studied, there were 72 TB notifications among people born in Australia or New Zealand. Genotypic testing was available for 20 of these cases, of which nine were confirmed to be part of a cluster. Two further cases for which genotyping was not available were epidemiologically linked to the cluster and regarded as probable cluster cases. Members of the cluster were relatively young (median age at diagnosis, 35 years; range, 21-57 years), and eight were women. Over the same period, there were 83 TB notifications among people born overseas, the majority being from Asia (47%) or central and eastern Europe (24%) (median age, 54 years; range, 9-63 years). CONCLUSION: Clinicians should maintain a high index of suspicion for pulmonary TB in a person presenting with a productive cough lasting more than 3 weeks, weight loss, haemoptysis, night sweats and chest pain, even if the person is not overseas-born or elderly. A comprehensive tuberculosis genotyping network at regional and national level in Australia could help identify clusters resulting from recent transmission.     

几种常用肺结核病诊断方法临床价值的探讨

为了探讨肺结核病的诊断方法，观察了直接痰涂片查抗酸杆菌、痰结核杆菌聚合酶链反应（ＰＣＲ）检测法、结核菌素试验（ＰＰＤ试验）和血中抗分枝杆菌抗体测定对肺结核病的诊断价值。结果表明：痰涂片法诊断肺结核病的特异性达１００％，但敏感性只有２２．２％。而其他３种方法虽然敏感性稍有提高，但特异性很差。提示：目前诊断肺结核病最可靠的方法仍是痰涂片法     

Childhood tuberculosis in Malawi: caseload,diagnostic practices and treatment outcomes

There were 22,982 cases of TB registered in Malawi in 1998, of which 2739 (11.9%) were children. Children accounted for 11.3% of all case notifications with smear-positive pulmonary TB (PTB), 21.3% with smear-negative PTB and 15.9% with extrapulmonary TB (EPTB). A significantly higher proportion of TB cases were diagnosed in central hospitals. Only 45% of children completed treatment. There were high rates of death (17%), default (13%) and unknown treatment outcomes (21%). Treatment outcomes were worse in younger children and in children with smear-negative PTB. In 2001, all 44 non-private hospitals in Malawi that register and treat children with tuberculosis (TB) were surveyed to determine actual diagnostic practice. This cross sectional study identified 150 children aged 14 years or below in hospital receiving anti-TB treatment, 98 with pulmonary TB (PTB) and 52 with extrapulmonary TB (EPTB). Median duration of illness was 8 weeks. Most patients had fever, no response to anti-malarial treatment and antibiotics, and 40% had a positive family history of TB. Nearly 45% had weight for age < 60%. Diagnosis was mainly based on clinical features and radiography, with less than 10% having tuberculin skin tests or HIV serology, and very few having other sophisticated investigations. Diagnostic difficulties make it difficult to accurately define the actual burden of childhood TB in Malawi. Diagnostic practices are poor and treatment outcomes unsatisfactory.     

Epidemiology of extra pulmonary tuberculosis in Eastern Sudan

Objective: To investigate the epidemiological factors associated with extra pulmonary tuberculosis(EPTB) in Kassala, Eastern Sudan.Methods: Patients infected with TB(pulmonary and extra-pulmonary) documented at the hospital were interviewed with a structured questionnaire used to gather socio-demographic information. The diagnosis of EPTB cases was based on presence of tuberculous granulomas in the histological samples, positive PCR to DNA of mycobacterium tuberculosis, radiological i ndings and l uid analysis suggestive of EPTB and clinical diagnosis with adequate response to anti-tuberculous therapy.Results: A total of 985 patients with TB were enrolled in the study, including 761(77.3%) with PTB and 224(22.7%) with EPTB. The mean age(SD) of patients with PTB and EPTB was 33.2(15.4) and 34.7(14.6) years respectively. The prevalence of EPTB was at(22.7%), with TB lymphadenitis 79(35.3%), marking the frequent form of EPTB followed by peritoneal TB 27(12.05%). While residence and occupation were not associated with EPTB, those with lower level of education(OR = 0.3; coni dence intervals(CI) = 0.2-0.5; P 0.001), female(OR = 8.7, CI = 4.9-15.1, P 0.001), non vaccination(OR=70.3, CI = 34.2-144.3, P 0.001), and non smoker(OR = 0.1; CI = 0.06-0.20; P 0.001), were associated with high prevalence of EPTB. Conclusions: Around one quarter of patients with TB in this study were more likely to have EPTB. Therefore, ef ective strategic plans regarding diagnostic procedures and control measures are needed to reduce the burden of the disease in Sudan.     

贵州省盘州市肺结核病患者就诊延迟影响因素

目的 分析贵州省盘州市肺结核病患者就诊延迟的影响因素,为该市肺结核病的有效防控提供参考依据。方法 从中国疾病预防控制信息系统的结核病管理信息系统中导出盘州市2014年1月1日—2018年12月31日肺结核病患者的病案信息,采用非条件多因素Logistic回归分析肺结核病患者就诊延迟的危险因素。结果 盘州市2014年1月1日—2018年12月31共报告活动性肺结核病患者5 342例,有2 776例患者就诊延迟,就诊延迟率为51.97%,就诊中位天数为13 d （2~42 d）。单因素分析结果显示,年龄、居住地、户籍、职业、文化程度、患者来源和病原学检查结果为盘州市肺结核病患者就诊延迟的影响因素。多因素分析结果显示,>60岁（OR=2.61,95%CI：1.30~7.01）、郊区或农村（OR=1.67,95%CI：1.10~6.27）、农业和运输业（OR=2.35,95%CI：1.86~4.19）、转诊（OR=1.71,95%CI：1.22~4.21）及因症推荐（OR=1.70,95%CI：1.15~4.61）的患者发生就诊延迟的比例更高。结论 居住在郊区或农村、农业和运输业是盘州市肺结核患者就诊延迟的危险因素。盘州市肺结核患者就诊延迟率较高,应根据就诊延迟患者的特征,制定有效的干预措施。     

"Discovery to treatment" window in patients with smear-positive pulmonary tuberculosis

Delay in commencing treatment in patients diagnosed with smear-positive pulmonary tuberculosis (PTB) may promote the spread of PTB in the community. Socio-demographic and clinical data from 169 patients (119 retrospectively and 50 prospectively collected) treated for smear-positive PTB in our hospital Chest Clinic from June 2002 to February 2003 were analysed. One hundred and fifty eight (93.5%) patients were started on treatment in less than 7 days from the time when the report first became available while 11 (6.5%) patients had their treatment started > or = 7 days. The median 'discovery to treatment' window was 1 day (range, 0 to 24 days). Of the factors studied, longevity of symptoms, absence of fever or night sweats and having sought traditional medicine were associated with delay in treatment commencement. The urgency and importance of anti-TB treatment should be emphasized especially to patients who are inclined towards treatment with traditional medicine.     

山东省部分设立乡镇查痰点地区农民疑似肺结核患者的就诊延误情况

目的 探讨山东省设立乡镇卫生院查痰点地区农民疑似肺结核患者的就诊延误情况及影响因素。方法 按地理特点、乡镇查痰点查痰情况多阶段分层抽样，抽取8个县作为调查现场，对抽取到的疑似肺结核患者进行问卷调查。结果 共调查245例疑似患者，其中农民患者204例（83.3%），平均就诊延误时间为38.54d（中位数为5d）；28.4%的农民患者就诊延误天数超过14d。在乡镇卫生院、县结核病防治所登记查痰的农民疑似患者，就诊延误天数差异无统计学意义（P>0.10）。距乡镇卫生院越远的患者越易发生就诊延误，低收入者发生就诊延误的危险性高，家庭成员因病住院治疗者发生就诊延误的危险性高，未获得过结核病知识宣传的患者更易发生就诊延误。结论 影响农民患者就诊延误的影响因素有距乡镇卫生院的距离、经济状况、是否有家庭成员住院治疗以及是否获得过结核病知识的宣传。     

重庆市复治涂阳肺结核患者耐药分析

目的 通过了解重庆市复治涂阳肺结核患者对抗结核药物的耐药情况,为改进重庆市肺结核病的防治措施提供参考和建议。方法 收集重庆市39个区县2016年5月至2017年10月期间复治涂阳患者培养阳性的菌株,并采用对硝基苯甲酸培养法鉴定结核分枝杆菌复合群。共收集428例复治涂阳肺结核患者菌株,采用传统的比例法进行8种抗结核药物的药敏试验,并对复治涂阳肺结核患者菌株耐（多）药情况进行分析。8种抗结核药物包括：异烟肼（INH）、利福平（RFP）、链霉素（Sm）、乙胺丁醇（EMB）、氧氟沙星（Ofx）、卡那霉素（Km）,阿米卡星（Am）和卷曲霉素（Cm）。结果 纳入的428例复治肺结核患者总耐药率为45.09%,以青年组耐药率最高,达57.14%,显著高于老年组（36.59%,P=0.002<0.017),但与中年组比较差异无统计学意义（43.52% P=0.022(>)0.017）;复治肺结核患者耐多药率为27.10%,其中青年组耐多药率（41.96%）显著高于中年组（24.35%）和老年组（17.89%, P<0.05);复治肺结核患者广泛耐药率达3.74%,耐Ofx及耐任一种二线注射类抗结核药物（包括Km、Am和Cm）的比例分别为16.12%和6.31%;复治肺结核患者对4种一线抗结核药物的耐药率顺位为：利福平（33.18%）、异烟肼（32.94%）、链霉素（28.74%）、乙胺丁醇（9.11%）。复治涂阳肺结核患者耐一种抗结核药物的耐药率为10.28%,对8种抗结核药物全部耐药的比例为1.17%。复治涂阳肺结核患者耐药状况不同性别之间差异无统计学意义。结论 重庆市复治涂阳肺结核患者的耐药形势严峻,其中青年是耐多药结核病发生的危险人群,应根据本市情况制定科学合理的结核病防治方案,减少耐药结核病的产生和传播。     

Diagnosis of pulmonary tuberculosis among asymptomatic HIV+ patients in Guangxi, China

Background Pulmonary tuberculosis （PTB） among asymptomatic Chinese patients with HIV infection has not been investigated despite high tuberculosis burden in China. This study was aimed to evaluate the prevalence, risk factors and clinical outcomes of PTB among asymptomatic patients with HIV/AIDS in Guangxi to facilitate the development of diagnostic and treatment strategies.Methods All asymptomatic adult HIV-infected patients with CD4 ＜350 cells/μl who attended four HIV clinics in Guangxi between August 2006 and March 2008 were evaluated for active PTB with physical examination, chest X-ray （CXR）,sputum smear and/or sputum liquid culture. Data were described using median （interquartile range, IQR） and frequencies.Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with PTB.Results Among 340 asymptomatic subjects, 15 （4%） were diagnosed with PTB, with 4 （27%） sputum smear positive and 8 （53%） sputum culture positive. CXR has higher diagnostic sensitivity （87%） than sputum smear （25%） and sputum culture （67%）, but lower specificity （56%） compared with sputum smear （99%） and culture （100%）. In univariate analysis,injection drug user, body mass index （BMI） ＜18 kg/m2, CD4 ＜50 cells/μl and presence of peripheral lymphadenopathy were associated with an increased risk of asymptomatic PTB, while in multivariate analysis only peripheral lymphadenopathy maintained statistical significance （OR=7.6, 95% CI 1.4-40）. Patients with negative smear and minor or no abnormalities on CXR had longer interval between screening and TB treatment.Conclusions PTB was relatively common in this group of HIV＋ asymptomatic Chinese patients. Diagnosis is challenging especially where sputum culture is unavailable. These findings suggest that an enhanced evaluation for PTB needs to be integrated with HIV care in China and transmission prevention in China to control at both households and health care facilities, especially for patients with factors associated with a higher risk of PTB.     

重庆市医疗机构对肺结核患者发现的贡献作用

目的 通过分析重庆市医疗机构网络报告肺结核疫情及转诊和到位确诊患者情况,评价医疗机构在提高患者发现中的贡献作用.方法 通过重庆市各县区的结核病控制工作月报表和结核病管理信息系统获得重庆市2006-2015年医疗机构网络直报的肺结核疫情数和确诊的肺结核患者数,采用x2检验对不同年份、不同类别医疗机构的报告水平和确诊患者进行分析.结果 2006-2015年全市医疗机构累计网络直报实际肺结核疫情323 603例,报告数逐年上升.转诊到位率低于全国平均水平,且近年来呈下降趋势.通过医疗机构网络报告总体到位率逐年提高,活动性肺结核患者贡献率由2006年的10.14％上升至2015年的52.09％(x2=25 610.75,P＜0.01),涂片阳性肺结核患者贡献率由2006的6.42％上升至2015年的52.46％(x2=10 520.65,P＜0.01),耐多药肺结核患者贡献率为44.9％.市级综合医院、县区级综合医院等发现的患者逐年增加(P＜0.01).医疗机构来源的患者发现延误中位数为56 d,延误率为79.62％.结论 医疗机构对肺结核患者的发现贡献逐渐增大,但该部分患者的发现延误情况严重.     

重庆市流动人口肺结核患者服药依从性影响因素调查

目的 探讨重庆市流动人口肺结核患者服药依从性的影响因素,为制定完善相关管理模式和防控策略提供科学依据。方法 搜集2018年1月1日—12月31日重庆市9个区县初治结案的流动人口肺结核患者156例病案信息。通过问卷调查患者相关情况,单因素和多因素Logistic回归分析,以了解患者服药依从性的影响因素。结果 单因素分析显示不同性别、职业对服药依从性差异无统计学意义（P>0.05）;不同文化程度、结核病灾难性支出、结核病防治知识的知晓情况以及定点医院可及性对服药依从性差异有统计学意义（P<0.05）。多因素分析显示年龄在35~59岁、结核病灾难性支出、结核病防治知识知晓情况是影响患者服药依从性的重要因素,OR(95%CI):分别为0.17（0.450~0.646）、19.13（6.902~53.028）、3.38（1.166~9.818）。结论 根据年龄采取有针对性的结防知识宣教,提高患者对疾病的认识;重点关注经济状况差的患者,并加强督导随访;通过完善流动人口结核病保障体系,提高患者服药依从性。     

上海市嘉定区初治阳性肺结核诊断延误及其影响因素

目的了解上海市嘉定区初治阳性肺结核诊断延误情况,分析诊断延误发生的影响因素。方法采用调查表对2008年2月20日~2010年12月31日在嘉定区中心医院结核病专科门诊确诊的244例初治阳性肺结核患者的社会状况、临床症状和就诊经历进行调查。问卷调查64名内科医生,了解其肺结核相关知识及肺结核病例处理情况。结果 244例患者中107人（43.9%）发生就诊延误,有咳嗽症状的人相对于没有出现咳嗽症状的人更容易发生就诊延误。44人（20.8%）确诊延误,其中29人被误诊,首次就医选择不同医疗机构确诊延误发生率差异有统计学意义（P〈0.05）。64名内科医生11人（17.2%）认为咳嗽、咳痰超过1个月可能感染肺结核。结论初治阳性肺结核诊断延误率高,其中就诊延误是诊断延误发生的主要环节,应加大对公众肺结核相关知识宣传力度,降低就诊延误率。同时,要加强医务人员肺结核相关知识培训,减少误诊、诊断延误的发生。     

枣庄市肺结核病误诊误治资料调查分析

目的探寻枣庄市5区1市近10年肺结核病误诊误治情况,从而为结核病的诊治提供客观依据。方法对1999年10月至2009年10月期间枣庄市各结核病防治机构以及综合医院门诊、住院的呼吸科5689例肺结核患者的临床资料进行回顾性调查分析。结果近10年来我市5689例肺结核病误诊率为3．66％,误诊男女性别比较差异无统计学意义（P〈0．05）,误诊年龄以40岁以上的患者居多占70％,误诊疾病以肺炎、肺癌最多见,分别占28％和23,9％,平均误诊天数（10．0±0．8）d。结论结核病临床表现复杂,工作人员对之重视不够,缺乏深入了解,要提高对肺结核病的认识,特别对症状不典型的肺结核患者更要提高正确诊断。     

Delayed inpatient diagnosis and isolation of active pulmonary tuberculosis patients,a large tertiary care academic hospital experience in Riyadh,Saudi Arabia: What are we missing?

Objectives:To identify pulmonary tuberculosis (PTB) delayed inpatient diagnosis duration and contributing factors in an academic center in Saudi Arabia (SA).Methods:Retrospective review of all culture-confirmed PTB cases between May 2015 and April 2019. The outcomes were the timing between admission and suspicion of PTB or isolation to either early group (within 24 hours of admission) and late group (24 hours after admission).Results:Forty-nine cases were included with a median age of 49 years; a third of them were above 65 years of age. Most patients were of Saudi nationality and male. Approximately 38% of the cases were in the delayed group, half of them were smear-positive, with an average delay of 5.5 days. This was significant with age above 65 years (odds ratio [OR]=8.93, 95% confidence interval [CI]=2.22-35.95) presence of non-respiratory symptoms (OR=5.6, 95% CI=1.56-19.98), malignancy (OR=13.38, 95% CI=1.46-122.71), chronic medical problems (OR=4.90, 95% CI=1.31-18.32), missed chest x-ray findings (OR= 48, 95% CI=8.63-266.88) or procalcitonin level above 0.5 ng/mL (OR=12, 95% CI=1.58-91.08).Conclusion:Physicians in SA need to have a low threshold for PTB consideration in elderly patients or those with a history of malignancy. A careful review of the initial chest x-ray might help to overcome missing cases of PTB.     

老年与青年肺结核患者就诊延迟影响因素的对比分析

目的 探讨老年肺结核患者与青年肺结核患者就诊延迟及影响因素,并进行对比分析,为促进结核病的预防和控制提供更有效的依据.方法 采取现况调查方法,以2004年8月至2007年9月间在我院结核科住院治疗的老年肺结核及青年肺结核患者作为研究对象,应用自制调查表收集相关资料,应用logistic回归分析就诊延迟及确诊延迟的影响因素.结果 青年组就诊延迟率55.3%,就诊延迟时间中位数为16天;老年组就诊延迟率70.2%,就诊延迟时间中位数为27.5天.两组差异有统计学意义(P＜0.05).青年组就诊延迟的主要影响因素是:出现不适后的决定及知道结核病防治医疗机构.老年组就诊延迟的主要影响因素是:出现不适后的决定、知道结核病防治医疗机构、咯血及经济困难.结论 老年肺结核患者就诊延迟情况较青年肺结核患者严重.为提高肺结核患者早期发现率,应加强结核病防治知识宣传工作,把知道结核病防治机构作为老年和青年人群的重点宣传内容之一,对老年人群同时还应加强结核病免费政策的宣传.老年人群重点宣传对象为60~64岁群体,而青年人群重点宣传对象是在校初中学生.     

Spread of Mycobacterium tuberculosis in a community implementing recommended elements of tuberculosis control

CONTEXT: Despite improvements in tuberculosis (TB) control during the past decade, Mycobacterium tuberculosis transmission and resulting disease continue to occur in the United States. OBJECTIVE: To determine the primary reasons for disease development from a particular strain of M tuberculosis. DESIGN: Population-based, molecular epidemiological study. SETTING: Urban community in the San Francisco Bay area of California with recommended elements of TB control in place. PATIENTS: Seventy-three TB cases were reported in 1996-1997 that resulted from 1 strain of M tuberculosis as identified by TB genotyping and epidemiological linkage. MAIN OUTCOME MEASURES: Transmission patterns involving source and secondary case-patients; primary reasons for disease development. RESULTS: Seventy-three (33%) of 221 TB case-patients in this community resulted from this strain of M tuberculosis. Thirty-nine (53%) of the 73 case-patients developed TB because they were not identified as contacts of source case-patients; 20 case-patients (27%) developed TB because of delayed diagnosis of their sources; and 13 case-patients (18%) developed TB because of problems associated with the evaluation or treatment of contacts; and 1 case-patient (1%) developed TB because of delay in being elicited as a contact. Of the 51 TB cases identified with sources, 49 (96%) were infected within the 2 years prior to diagnosis. CONCLUSIONS: Our results indicate that in a community that has implemented the essential elements of TB control, TB from ongoing transmission of M tuberculosis will continue to develop unless patients are diagnosed earlier and contacts are more completely identified. JAMA. 2000.     

涂阳肺结核患者诊断延误及影响因素分析

目的对2009年10~12月武汉市结核病防治所住院的痰标本直接涂片抗酸杆菌镜检阳性(涂阳)肺结核患者诊断延误及其影响因素进行研究。方法采用自行设计的问卷,对224例涂阳肺结核患者进行面访式调查。采用Wilcoxon符号秩和检验对首诊延误、卫生系统延误及诊断延误分别进行单因素分析,用逐步logistic回归法对3种延误分别进行多因素分析。结果首诊延误、卫生系统延误及诊断延误中位数分别为8、12及35 d;首诊延误的危险因素为:男性(OR=2.134,95%可信区间1.115~4.083),初中及以下文化(OR=1.879,95%可信区间1.048~3.368),无咯血(OR=2.194,95%可信区间1.056~4.559)及结核知识得分低(OR=4.060,95%可信区间2.232~7.385);卫生系统延误危险因素为:首诊为区以下医疗单位(OR=2.938,95%可信区间1.339~6.446),保护因素为:就诊次数≤1次(OR=0.056,95%可信区间0.025~0.126);诊断延误危险因素为结核知识得分低(OR=3.036,95%可信区间1.654~5.572),自卑及自我羞耻感水平高(OR=2.012,95%可信区间1.103~3.676),保护因素为:就诊次数≤1次(OR=0.216,95%可信区间0.117~0.396)。结论武汉市住院涂阳肺结核患者存在一定的诊断延误,但延误水平不高。应加强对人群特别是文化程度低的人群的结核相关知识宣教;加强基层医务人员对结核病的警觉性并提高诊断能力;应避免患者反复多次就诊于同一水平医疗机构,从而缩短诊断延误时间。     

结核感染T细胞斑点试验在肺结核合并糖尿病患者中的诊断价值

目的 探讨结核感染T细胞斑点试验（T-SPOT.TB）在肺结核（PTB）合并糖尿病（DM）患者中的诊断价值。方法 选取2017年2月—2018年12月河北省胸科医院结核内科收治的106例DM并发可疑PTB患者,其中确诊为PTB合并DM患者62例,设为观察组;单纯DM患者44例,设为对照组。对所有受试者进行T-SPOT.TB、结核菌素（PPD）试验及痰抗酸杆菌（AFB）涂片检测,同时对比不同血糖控制情况下T-SPOT.TB检测诊断PTB合并DM的结果。结果 痰涂片AFB诊断PTB合并DM的灵敏度、特异度、阳性预测值、阴性预测值及诊断准确度分别为27.42%（17/62）、95.45%（42/44）、89.47%（17/19）、48.28%（42/87）、55.66%（59/106）,而PPD试验的诊断结果依次为56.45%（35/62）、84.09%（37/44）、83.33%（35/42）、57.81%（37/64）、67.92%（72/106）,T-SPOT.TB诊断结果则分别为95.16%（59/62）、93.18%（41/44）、95.16%（59/62）、93.18%（41/44）、94.34%（100/106）。其中T-SPOT.TB诊断的灵敏度、阴性预测值及准确度均显著高于痰涂片AFB和PPD试验（P<0.05）。血糖控制良好与控制不良者T-SPOT.TB检测诊断的灵敏度、特异度、阳性预测值、阴性预测值和准确度相比差异均无统计学意义（P>0.05）。结论 T-SPOT.TB检测在PTB合并DM的临床诊断上具有更高的灵敏度和临床应用价值。     

陕西省2015年肺结核患者就诊延迟及其相关因素分析

目的 了解陕西省肺结核患者就诊延迟现况,探索与就诊延迟相关的主要因素.方法 从结核病信息管理系统导出陕西省2015年登记的结核病患者个案资料19 319例.采用描述性统计方法,计算就诊延迟率;采用卡方检验分析不同地域、性别、年龄、民族、职业、治疗分类、患者来源、户籍类型的就诊延迟是否有差异,以P＜0.05为差异有统计学意义;采用logistic回归模型进行多因素分析,以P＜0.05为差异有统计学意义.结果 陕西省肺结核患者就诊延迟率为57.7％(11 152/19 319),就诊延迟中位数为19d.多因素Logistic回归分析结果表明:地域、性别、年龄、治疗分类和患者来源是就诊延迟的影响因素(P＜0.05).女性就诊延迟率是男性患者的1.095倍(OR=1.095,95％CI=1.030～1.164).复治患者就诊延迟率是初治患者的1.221倍(OR=1.221, 95％CI=1.051～1.420).结论 陕西省肺结核患者就诊延迟情况比较严重.应根据就诊延迟的高危人群制定相应措施,积极有效的开展预防干预工作.