南宁市贫困县初治涂阳肺结核患者诊断延误及其影响因素

目的了解南宁市贫困县初治涂阳肺结核患者诊断延误情况并分析其影响因素。方法整群采用logistic回归分析法对南宁市隆安和上林县的140例初治涂阳肺结核患者就诊延误的影响因素进行回顾性分析。结果初治涂阳肺结核患者就诊及确诊延误率分别为51.6%和23.7%,延误时间中位数分别为74d和37d。单因素分析结果显示,婚姻状况（P〈0.05）以及首诊医院（P〈0.05）是患者就诊延误的影响因素;首诊医院亦是患者确诊延误的影响因素（P〈0.05）。多因素分析结果显示,已婚状态（OR=0.62,P〈0.05）、首诊医院选择乡镇卫生院（OR=0.19,P〈0.05）是就诊延误的保护因素;高龄是确诊延误的危险因素（OR=1.09,P〈0.05）,首诊医院选择乡镇卫生院的患者发生确诊延误的风险是县级以上综合医院的12.1倍（OR=12.12,P〈0.05）。结论采取综合性干预措施,加强结核病的健康教育工作。未婚青年和高龄人群属于结核病防治知识宣传和教育的重点对象。同时,应鼓励乡镇卫生院、村卫生室及时推荐和转诊肺结核可疑症状者到专业医疗机构进行确诊。

Survey of delayed diagnosis of new smear-positive pulmonary tuberculosis patients and its influencing factors in poverty-stricken counties

Objective To survey the delayed diagnosis of new smear-positive pulmonary tuberculosis patients in two poverty-stricken counties of Nanning,and identify the risk factors for delayed diagnosis.Methods Longan and Shanglin counties were selected as study sites using cluster sampling methods and 140 new smear-positive pulmonary tuberculosis patients were randomly chosen from the two counties.Multiple logistic regression model was used to analyse the risk factors for diagnosis delay.Results The rates of patient delay and diagnosis delay were 51.6% and 23.7%,respectively with the median delay of 74 and 37 days,respectively.The marrital status（P=0.04） and the level（P〈0.01） of the medical bodies the patient firstly seeking treatment after the TB symptom appeared were significantly associated with the patient’s delay.the latter also related to the diagnosis delay.marrital status（OR=0.62,P=0.03） and firstly seeking treatment in a township health center（OR=0.19,P〈0.01） were protective factors for patient’s delay,and age（OR=1.09,P=0.01） was a risk factor for diagnosis delay.The risk of diagnosis delay of the patients firstly seeking medical treatment in the township health centers was 12.1 times higher than that firstly seeking treatment in a county hospital（OR=12.12,P〈0.01）.Conclusion The marrital status and referral of the patients to designated tuberculosis iinstitutions are associated with the patient’s delay,while the level of medical institution influences both patient’s and doctor’s delay.