2014—2019年上海市静安区老年与非老年肺结核流行特征对比分析

目的 通过分析上海市静安区老年(≥60岁)与非老年(<60岁)肺结核患者的流行特征,为老年结核病的防治提供参考依据。方法 从《中国疾病预防控制信息系统》的子系统《结核病管理信息系统》导出静安区2014年4月1日至2019年3月31日登记为首次管理、病种为“肺结核”的患者病案信息、诊疗情况、0月序时的实验室及影像学检查、治疗效果及转归等。再将患者病案信息按照年龄≥60岁(≥60岁组)和<60岁(<60岁组)分别整理统计,对比分析两组肺结核患者的特征。结果 2014年4月1日至2019年3月31日,全人群共登记肺结核患者1563例,其中≥60岁组患者555例(35.51%),5年来构成比由27.62%(95/344)上升至41.30%(114/276),呈上升趋势(χ²=7.501,P=0.006)。≥60岁组患者中,本市户籍95.86%(532/555)]、男性74.59%(414/555)]明显高于<60岁组患者分别为61.71%(622/1008)、68.35%(689/1008)](χ²=2.160、6.713;P=0.000、0.010)。静安区≥60岁组与<60岁组肺结核患者的主要来源均以因症就诊分别为67.21%(373/555)和69.35%(699/1008)]及转诊30.27%(168/555)和28.37%(286/1008)]等被动发现方式为主。≥60岁组患者在并发其他疾病26.13%(145/555)]、病原学检测阳性46.67%(259/555)]、复治14.59%(81/555)]、0月序痰涂片阳性41.62%(231/555)]和胸部X线摄影(简称“胸片”)检查异常99.10%(550/555)]等方面均高于<60岁组分别为14.19%(143/1008)、35.32%(356/1008)、9.23%(93/1008)、25.69%(259/1008)、96.73%(975/1008)](χ²值分别为33.946、19.318、10.427、42.189、8.496;P值分别为0.000、0.000、0.001、0.000、0.004)。≥60岁组患者在2个月末痰涂片阴转率73.59%(170/231)]、治愈或完成疗程率80.18%(445/555)]等方面均低于<60岁组分别为85.33%(221/259)、92.86%(936/1008)](χ²值分别为10.430、57.199;P值分别为0.001、0.000)。结论 静安区全人群登记肺结核患者逐年下降,而老年登记肺结核患者占比高且逐年上升,应重点关注本市户籍、男性、并发基础疾病的老年人群,并结合该类人群的痰菌检测及胸片检查阳性率高、治疗效果差等特点积极开展主动筛查和规范治疗。

A comparative analysis of the epidemic characteristics of tuberculosis in elderly and non-elderly in Jing’an District,Shanghai from 2014 to 2019

Objective To explore the epidemic characteristics of elderly (≥60 years old) and non-elderly (<60 years old) pulmonary tuberculosis patients in Jing’an District, Shanghai, providing reference for the prevention and treatment of tuberculosis in the elderly. Methods Data of the tuberculosis patients first managed and registered in Jing’an District from April 1, 2014 to March 31, 2019 were collected from China Information System for Disease Control and Prevention (subsystem “TB Management Information System”), including the medical records, diagnosis and treatment information, 0-month laboratory and imaging examination results, treatment effect and prognosis.These data were divided into ≥60 years old group and <60 years old group, and the characteristics of pulmonary tuberculosis patients in the two groups were compared and analyzed. Results From April 1, 2014 to March 31, 2019, a total of 1563 pulmonary tuberculosis patients in the whole population were registered, of whom 555 patients (35.51%) were ≥60 years old, and the composition ratio increased from 27.62% (95/344) to 41.30% (114/276) in the past five years, showing an increasing trend (χ²=7.501, P=0.006). Of the patients ≥60 years old, the local household registration (95.86% (532/555)) and male (74.59% (414/555)) of the patients were significantly higher than those in the <60 years old group (61.71% (622/1008), 68.35% (689/1008)) (χ ²=2.160, 6.713; P=0.000, 0.010). Most pulmonary tuberculosis patients of the two groups in Jing’an District were passively screened through symptom visits (67.21% (373/555) vs. 69.35% (699/1008)) and referrals (30.27% (168/555) vs. 28.37% (286/1008)). The complication rate of other diseases, positive etiological test, re-treatment, positive rate of 0-month sequence sputum smear and abnormal rate of chest film in the ≥60 years old group were all higher than those in the <60 years old group (26.13% (145/555) vs. 14.19% (143/1008), χ ²=33.946, P=0.000; 46.67% (259/555) vs. 35.32% (356/1008), χ ²=19.318, P=0.000; 14.59% (81/555) vs. 9.23% (93/1008), χ ²=10.427, P=0.001; 41.62% (231/555) vs. 25.69% (259/1008), χ ²=42.189, P=0.000; 99.10% (550/555) vs. 96.73% (975/1008), χ ²=8.496, P=0.004; respectively). The negative conversion rate of sputum smear at the end of the 2nd month and the cure or completion of treatment of patients aged ≥60 years were both lower than those of patients aged <60 years (73.59% (170/231) vs. 85.33% (221/259), χ ²=10.430, P=0.001; 80.18% (445/555) vs. 92.86% (936/1008), χ ²=57.199, P=0.000; respectively). Conclusion The registered tuberculosis patients in the whole population decreased year by year in Jing’an District, however, the proportion of the elderly patients increased year by year. The male elderly population with local household registration and complicated diseases should be paid more attention. Considering the high positive rates of sputum bacteria test and chest X-ray, and poor treatment effect of the elderly population, active screening and standard treatment should be carried out.