结核与肺部疾病杂志 ›› 2021, Vol. 2 ›› Issue (3): 216-222.doi: 10.3969/j.issn.2096-8493.20210068

• 论著 • 上一篇    下一篇

629例老年肺结核患者特征及诊断延迟情况分析

徐静, 罗萍, 贺晓新()   

  1. 100035 北京结核病控制研究所门诊部
  • 收稿日期:2021-07-14 出版日期:2021-09-30 发布日期:2021-09-24
  • 通信作者: 贺晓新 E-mail:hexiaoxinbj@126.com

Analysis of characteristics and diagnosis delay of 629 elderly tuberculosis patients

XU Jing, LUO Ping, HE Xiao-xin()   

  1. Department of Outpatient, Beijing Research Institute for Tuberculosis Control, Beijing 100035, China
  • Received:2021-07-14 Online:2021-09-30 Published:2021-09-24
  • Contact: HE Xiao-xin E-mail:hexiaoxinbj@126.com

摘要:

目的 分析北京结核病控制研究所收治的老年肺结核患者特征,为北京地区老年人群肺结核防治提供依据。方法 采用描述性方法对2011—2020年北京结核病控制研究所收治的629例年龄≥60岁的老年肺结核患者的资料进行统计分析,并与同期2275例非老年患者进行对比。 结果 2011—2020年,北京结核病控制研究所登记管理的老年肺结核患者占同期全人群肺结核患者的21.66%(629/2904),各年老年患者构成比分别为13.78%(43/312)、19.24%(71/369)、15.50%(53/342)、18.33%(66/360)、21.57%(55/255)、21.27%(57/268)、14.29%(30/210)、28.77%(84/292)、34.22%(90/263)、34.33%(80/233),呈逐年上升趋势(Z趋势=5.046,P<0.001)。629例患者中,男性392例,女性237例,男∶女=1.65∶1,60~64岁组占比最高,达24.01%(151/629)。初治患者占80.29%(505/629),复治患者占19.71%(124/629);老年复治患者占比明显高于同期非老年复治患者占比(8.09%,184/2275),差异有统计学意义(χ2=70.247,P<0.001)。老年患者病原学阳性率和涂阳率分别为50.87%(320/629)和42.45%(267/629),均明显高于同期非老年患者[30.07%(684/2275)和25.41%(578/2275)],差异均有统计学意义(χ2=94.324,P<0.001;χ2=69.366,P<0.001)。老年患者就诊延迟率(61.69%,388/629)明显高于同期非老年患者(45.19%,1028/2275),差异有统计学意义(χ2=53.684,P<0.001);但确诊延迟率(33.55%,211/629)与同期非老年患者(29.89%,680/2275)比较,差异无统计学意义(χ2=3.096,P=0.079)。老年患者发病至就诊时间 [27(5,68)d]明显高于同期非老年患者[11(1,38)d],差异有统计学意义(U=-7.563,P<0.001);但就诊至确诊时间 [6(0,28)d]与同期非老年患者[7(1,18)d]比较,差异无统计学意义(U=-0.799,P=0.425)。 结论 老年肺结核患者存在病原学阳性率高、涂阳率高、复治比例高、就诊延迟率高、就诊时间间隔长的特点。应加强老年肺结核患者的主动发现工作,特别是定期健康检查,减少老年患者的发现和诊断延迟。

关键词: 结核,肺, 老年人, 流行病学研究特征(主题), 对比研究

Abstract:

Objective To analyze the characteristics of elderly patients with tuberculosis (TB) admitted to a municipal-level designated medical institution in Beijing, and to provide basis for TB prevention and control in elderly population of Beijing. Methods We descriptively analyzed data of 629 elderly TB patients (≥60 years old) admitted to Beijing Research Institute for Tuberculosis Control from 2011 to 2020,and compared them with the data of 2275 non-elderly patients of the same period. Results From 2011 to 2020, the elderly TB patients registered in Beijing Research Institute for Tuberculosis Control accounted for 21.66% (629/2904) of all TB patients in the same period. In recent 10 years, the proportion of elderly patients increased year by year (13.78% (43/312), 19.24% (71/369), 15.50% (53/342), 18.33% (66/360), 21.57% (55/255), 21.27% (57/268), 14.29% (30/210), 28.77% (84/292), 34.22% (90/263), 34.33% (80/233),Ztrend=5.046,P<0.001).There were 392 males and 237 females, and the ratio of male to female was 1.65∶1. 60-64 age group was the main age group, which was 24.01% (151/629) of all elderly patients. Primary patients accounted for 80.29% (505/629) and retreatment patients accounted for 19.71% (124/629);The proportion of retreatment among elderly patients was significantly higher than that of non-elderly patients (8.09%, 184/2275,χ2=70.247,P<0.001).The etiologically positive rate and smear positive rate of elderly patients were 50.87% (320/629) and 42.45% (267/629), respectively, which were significantly higher than those of non-elderly patients (30.07% (684/2275) and 25.41% (578/2275),χ2=94.324,P<0.001; χ2=69.366,P<0.001).The patient delay rate of elderly patients (61.69%, 388/629) was significantly higher than that of non-elderly patients (45.19%, 1028/2275; χ2=53.684,P<0.001). The diagnosis delay rate of elderly patients was 33.55% (211/629), no significant difference was found compared with that of non-elderly patients (29.89%, 680/2275; χ2=3.096, P=0.079).The median time from disease onset to medical visit for elderly patients (27 (5,68) d) was significantly higher than that for non-elderly patients (11 (1,38) d, U=-7.563,P<0.001). The median time from medical visit to TB diagnosis was 6 (0,28) d, no significant difference was found compared with non-elderly patients in the same period (7 (1,18) d, U=-0.799, P=0.425). Conclusion Compared with non-elderly patients, elderly pulmonary TB patients were characterized with high etiologically positive rate, high smear positive rate, high retreatment rate, high patient delay rate, long time of patient delay. We should strengthen active detection of elderly TB patients, especially by organizing regular health examinations and further reducing the detection and diagnosis delay.

Key words: Tuberculosis,pulmonary, Aged, Epidemiologic study characteristics as topic, Comparative study