结核病患者关爱项目实施质量及其对患者治疗效果的影响

doi:10.19983/j.issn.2096-8493.20260051

摘要/Abstract

摘要：

目的: 评估福建省龙岩市永定区2015—2025年肺结核患者管理质量,分析治疗成功的影响因素,为结核病患者关爱行动试点工作提供循证依据。方法: 采用回顾性分析方法,收集“中国疾病预防控制信息系统”子系统“结核病管理信息系统”中2015年1月1日至2025年12月31日登记的现住址为福建省龙岩市永定区的肺结核患者病案相关信息,共计1382例。针对患者资料从诊断质量、治疗管理质量、随访监测质量及数据质量等4个维度,以及治疗结局进行评价。结果: 2015—2025年永定区肺结核患者管理质量整体尚可,但存在明显短板,各维度管理水平不均衡。诊断质量方面,患者就诊延迟问题突出,就诊延迟率达82.1%(1135/1382);病原学检测质量逐年提升,10年间病原学阳性率由58.0%(94/162)上升至71.7%(71/99)(r=0.773,P=0.009)。治疗与随访管理落实较好,1324例有效结局患者的总体治疗成功率为87.0%(1152/1324),结核病患者关爱行动试点实施后的2024年治疗成功率提升至90.9%(90/99)。影响因素分析显示,高服药依从性(OR=20.26,95%CI:6.86~59.85)、开展首次入户访视(OR=2.96,95%CI:1.84~4.76)是提高治疗成功率的独立保护因素;接尘人群治疗成功率为75.7%(28/37),低于普通人群的87.3%(1124/1287),差异无统计学意义(χ²=3.363,P=0.067)。数据管理质量薄弱,患者症状记录完整率仅63.7%(880/1382),且存在数据负值等逻辑错误,制约了肺结核精细化管理质量提升。结论: 福建省龙岩市永定区2015—2025年肺结核患者整体管理与治疗效果良好,试点推进后治疗质量进一步提升,基层管理覆盖好,但存在就诊延迟严重、数据质量较薄弱的现象;服药依从性与首次入户访视是影响患者治疗成功的关键可控因素,可为当地结核病患者关爱行动试点优化管理模式、精准施策提供科学依据。

关键词: 结核,肺, 治疗结果, 病例管理, 因素分析,统计学

Abstract:

Objective: To evaluate the management quality of pulmonary tuberculosis patients in Yongding District, Longyan City, Fujian Province from 2015 to 2025, analyze the influencing factors of treatment success, and provide evidence-based basis for the pilot work of Tuberculosis Patient Care Program. Methods: A retrospective analysis was conducted to collect medical record information of 1382 pulmonary tuberculosis patients registered in the Tuberculosis Management Information System (a subsystem of the China Information System for Disease Control and Prevention) from January 1, 2015 to December 31, 2025, whose current residence was Yongding District, Longyan City, Fujian Province. The patient data were evaluated from four dimensions:diagnostic quality, treatment management quality, follow-up monitoring quality and data quality, as well as treatment outcomes. Results: The overall management quality of pulmonary tuberculosis patients in Yongding District from 2015 to 2025 was acceptable but had obvious shortcomings, with unbalanced management levels across dimensions. In terms of diagnostic quality, the problem of delayed medical consultation was prominent, with a delayed consultation rate of 82.1% (1135/1382). The quality of etiological detection improved year by year, and the etiological positive rate increased from 58.0% (94/162) to 71.7% (71/99) over the decade (r=0.773, P=0.009). Treatment and follow-up management were well implemented. The overall treatment success rate of 1324 patients with valid outcomes was 87.0% (1152/1324), and it increased to 90.9% (90/99) in 2024 after the implementation of the Tuberculosis Patient Care Program pilot. Influencing factor analysis showed that high medication adherence (OR=20.26, 95%CI:6.86-59.85, P<0.001) and first home visit (OR=2.96, 95%CI:1.84-4.76, P<0.001) were independent protective factors for improving treatment success rate. The treatment success rate of dust-exposed population was 75.7% (28/37), lower than 87.3% (1124/1287) of the general population, but the difference was not statistically significant (χ²=3.363, P=0.067). Data management quality was weak, with only 63.7% (880/1382) of patients having complete symptom records, and logical errors such as negative data existed, which restricted the improvement of refined pulmonary tuberculosis management quality. Conclusion: The overall management and treatment effects of pulmonary tuberculosis patients in Yongding District, Longyan City, Fujian Province from 2015 to 2025 were good, and the treatment quality was further improved after the pilot implementation. Grassroots management coverage was extensive, but there were serious delayed medical consultation and weak data quality. Medication adherence and first home visit are key controllable factors affecting patients’ treatment success, which can provide scientific basis for optimizing the management model and implementing precise measures in the local Tuberculosis Patient Care Program pilot.

Key words: Tuberculosis, pulmonary, Treatment outcome, Case management, Factor analysis, statistical

中图分类号:

张爱珍, 苏绍荣. 结核病患者关爱项目实施质量及其对患者治疗效果的影响[J]. 结核与肺部疾病杂志, 2026, 7(4): 474-479. doi: 10.19983/j.issn.2096-8493.20260051

Zhang Aizhen, Su Shaorong. Implementation quality of Tuberculosis Patient Care Program and its impact on patients’ treatment outcomes[J]. Journal of Tuberculosis and Lung Disease, 2026, 7(4): 474-479. doi: 10.19983/j.issn.2096-8493.20260051

图/表 2

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表2

参考文献 16

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因素	例数	治疗成功[例 (成功率,%)]	统计检验值	单因素分析		多因素分析
因素	例数	治疗成功[例 (成功率,%)]	统计检验值	OR(95%CI)值	P值	OR(95%CI)值	P值
督导模式
强化期督导	358	314(87.7)	参考水平	1.00		1.00
全程督导	497	423(85.1)	χ²=1.230	0.80(0.54~1.20)	0.324	0.72(0.44~1.17)	0.187
全程管理	33	28(84.9)		0.78(0.29~2.14)	0.841	0.56(0.18~1.77)	0.326
首次入户访视
无	480	394(82.3)	参考水平	1.00		1.00
有	902	758(89.7)	χ²=14.357	1.88(1.36~2.60)	0.001	2.96(1.84~4.76)	<0.01
服药依从性
低依从性(服药依从率<80%)	19	1(5.3)	参考水平	1.00		1.00
中等依从性(服药依从率80%~94%)	1	0(0.0)		-		-
高依从性(服药依从率≥95%)	703	652(92.7)	χ²=171.250	230.12 (30.11~1758.76)	<0.01	20.26 (6.86~59.85)	<0.01
抗结核固定剂量复合制剂
未使用	335	324(96.0)	参考水平	1.00		1.00
使用	388	388(100.0)	χ²=21.660	50.49 (3.04~838.06)	<0.01	0.90 (0.55~1.48)	0.690
接尘人员
否	1287	1124(87.3)	参考水平	1.00		1.00
是	37	28(75.7)	χ²=3.363	0.51(0.24~1.08)	0.067	0.39(0.11~1.34)	0.133
糖尿病
否	1053	917(87.1)	参考水平	1.00		1.00
是	271	235(86.7)	χ²=0.003	0.96(0.63~1.47)	0.952	1.39(0.73~2.64)	0.312
学校及托幼机构人员
否	1312	1140(86.9)	参考水平	1.00		1.00
是	12	12(100.0)	χ²=2.730	校正后0.26 (0.02~3.89)	0.361
流动人口
否(本地人口)	1311	1141(87.0)	参考水平	1.00		1.00
是	13	11(84.6)	χ²=0.190	1.22(0.26~5.71)	0.661	1.74(0.09~35.47)	0.717

年份	例数	治疗成功		病原学诊断阳性		基层管理		平均发现时间 (d)	发现时间中位数 (d)
年份	例数	例数	成功率 (%)	例数	阳性率 (%)	例数	管理率 (%)	平均发现时间 (d)	发现时间中位数 (d)
2015	162	148	91.4	94	58.0	0	0.0	54.9	37.0
2016	156	124	79.5	57	36.5	0	0.0	60.1	38.0
2017	141	106	75.2	48	34.0	0	0.0	158.2	49.0
2018	134	118	88.1	64	47.8	0	0.0	99.3	51.0
2019	130	117	90.0	70	53.8	128	98.5	136.1	44.5
2020	138	127	92.7	68	49.3	129	93.5	92.5	47.0
2021	123	116	94.3	82	66.7	120	97.6	98.7	46.0
2022	103	87	84.5	65	63.1	103	100.0	103.8	46.0
2023	95	84	88.4	69	72.6	95	100.0	112.7	52.0
2024	99	90	90.9	71	71.7	98	99.0	132.5	44.0
r值			0.380		0.773			0.426	0.328
P值			0.279		0.009			0.220	0.354