629例老年肺结核患者特征及诊断延迟情况分析

doi:10.3969/j.issn.2096-8493.20210068

摘要/Abstract

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),Z_trend=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

徐静, 罗萍, 贺晓新. 629例老年肺结核患者特征及诊断延迟情况分析[J]. 结核与肺部疾病杂志, 2021, 2(3): 216-222. doi: 10.3969/j.issn.2096-8493.20210068

XU Jing, LUO Ping, HE Xiao-xin. Analysis of characteristics and diagnosis delay of 629 elderly tuberculosis patients[J]. Journal of Tuberculosis and Lung Disease, 2021, 2(3): 216-222. doi: 10.3969/j.issn.2096-8493.20210068

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参考文献 19

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患者特征	老年患者(629例)	非老年患者(2275例)	统计检验值	P值
性别[例(构成比,%)]			χ²=0.802	0.371
男	392(62.32)	1373(60.35)
女	237(37.68)	902(39.65)
发现方式[例(构成比,%)]			χ²=32.914	<0.001
健康检查	24(3.82)	262(11.52)
非健康检查	605(96.18)	2013(88.48)
转诊	407(64.71)	1275(56.04)
因症就诊	180(28.62)	670(29.45)
因症推荐	5(0.79)	12(0.53)
追踪	12(1.91)	25(1.10)
接触者检查	1(0.15)	21(0.92)
其他方式	0(0.00)	10(0.44)
治疗分类[例(构成比,%)]			χ²=70.247	<0.001
初治	505(80.29)	2091(91.91)
复治	124(19.71)	184(8.09)
病原学检测结果[例(构成比,%)]			χ²=94.324	<0.001
病原学阳性	320(50.87)	684(30.07)
阴性及无结果	309(49.13)	1591(69.93)
0月序痰涂片[例(构成比,%)]			χ²=69.366	<0.001
涂阳	267(42.45)	578(25.41)
非涂阳	362(57.55)	1697(74.59)
就诊延迟[例(构成比,%)]			χ²=53.684	<0.001
是	388(61.69)	1028(45.19)
否	241(38.31)	1247(54.81)
确诊延迟[例(构成比,%)]			χ²=3.096	0.079
是	211(33.55)	680(29.89)
否	418(66.45)	1595(70.11)
就诊时间[d,M(Q₁,Q₃)]	27(5,68)	11(1,38)	U=-7.563	<0.001
确诊时间[d,M(Q₁,Q₃)]	6(0,28)	7(1,18)	U=-0.799	0.425

年份	非老年肺结核患者					老年肺结核患者
年份	病原学阳性	病原学阴性	无病原学结果	涂阳	合计	病原学阳性	病原学阴性	无病原学结果	涂阳	合计
2011	73(27.14)	178(66.17)	18(6.69)	73(27.14)	269	21(48.84)	19(44.19)	3(6.98)	21(48.84)	43
2012	76(25.50)	211(70.81)	11(3.69)	76(25.50)	298	28(39.44)	36(50.70)	7(9.86)	28(39.44)	71
2013	85(29.41)	194(67.13)	10(3.46)	85(29.41)	289	26(49.06)	24(45.28)	3(5.66)	26(49.06)	53
2014	57(19.39)	225(76.53)	12(4.08)	57(19.39)	294	24(36.36)	38(57.58)	4(6.06)	24(36.36)	66
2015	50(25.00)	145(72.50)	5(2.50)	50(25.00)	200	19(34.55)	33(60.00)	3(5.45)	19(34.55)	55
2016	53(25.12)	157(74.41)	1(0.47)	53(25.12)	211	21(36.84)	30(52.63)	6(10.53)	21(36.84)	57
2017	49(27.22)	129(71.67)	2(1.11)	48(26.67)	180	16(53.33)	14(46.67)	0(0.00)	16(53.33)	30
2018	96(46.15)	104(50.00)	8(3.85)	51(24.52)	208	53(63.10)	27(32.14)	4(4.76)	42(50.00)	84
2019	78(45.09)	94(54.33)	1(0.58)	53(30.64)	173	62(68.89)	26(28.89)	2(2.22)	43(47.78)	90
2020	67(43.79)	86(56.21)	0(0.00)	32(20.92)	153	50(62.50)	30(37.50)	0(0.00)	27(33.75)	80
合计	684(30.07)	1523(66.95)	68(2.99)	578(25.41)	2275	320(50.87)	277(44.04)	32(5.09)	267(42.45)	629

临床特征	患者例数	就诊延迟例数	就诊延迟率(%)	χ²值	P值	确诊延迟例数	确诊延迟率(%)	χ²值	P值
性别				3.345	0.067			1.282	0.257
男	392	231	58.93			125	31.89
女	237	157	66.24			86	36.29
年龄组(岁)				12.798	0.025			10.433	0.064
60~64	151	81	53.64			44	29.14
65~69	114	69	60.53			46	40.35
70~74	101	64	63.37			34	33.66
75~79	117	87	74.36			44	37.61
80~84	98	57	58.16			23	23.47
85~100	48	30	62.50			20	41.67
发现方式				5.180	0.023			0.028	0.867
被动方式	604	378	62.58			203	33.61
主动方式	25	10	40.00			8	32.00
治疗分类				0.094	0.759			0.260	0.610
初治	505	313	61.98			167	33.07
复治	124	75	60.48			44	35.48
病原学检测				0.087	0.957			8.812	0.012
阳性	320	196	61.25			92	28.75
阴性	276	171	61.96			110	39.86
无结果	33	21	63.64			9	27.27

组别	就诊延迟		确诊延迟
组别	例数	就诊时间[d,M(Q₁,Q₃)]	例数	确诊时间[d,M(Q₁,Q₃)]
发生延迟患者	388	55(30,108)	211	44(28,86)
未发生延迟患者	241	2(0,8)	418	1(0,6)
合计	629	27(5,68)	629	6(0,28)