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芜湖市肺外结核流行特征及其合并肺结核的影响因素
Epidemiological characteristics of extrapulmonary tuberculosis in Wuhu City and risk factors for concurrent pulmonary tuberculosis
目的 描述2024年芜湖市肺外结核（extrapulmonary tuberculosis, EPTB）的流行特征，并探讨其合并肺结核的影响因素。方法 通过芜湖市突发公共卫生事件多点触发预警系统与中国疾病预防控制信息系统，获取本次研究所需的病例资料。对确诊的EPTB病例进行描述性分析，采用logistic回归分析其合并肺结核的相关因素。结果 共纳入199例EPTB病例，登记发病率为5.30/10万。男性多于女性（52.76% vs. 47.24%），年龄中位数为54（41，70）岁，EPTB类型以淋巴结结核最为常见（占27.14%）。58.29%的病例分布于主城区，85.43%的病例仅在1家医疗机构诊断，主要为省级医院和市级结核病定点医院。多因素logistic回归分析显示，年龄（OR=0.979，95%CI：0.962~0.996）、男性（OR=2.048，95%CI：1.100~3.888）和其他肺外结核（OR=3.753，95%CI：1.428~10.341）与EPTB合并肺结核相关。结论 2024年芜湖市EPTB以淋巴结结核最为常见，发病存在人群和地区差异，诊断机构集中。年龄、性别和疾病类型是EPTB合并肺结核的影响因素。建议提升基层诊断能力并对高危人群开展协同筛查。
Objective To describe the epidemiological characteristics of extrapulmonary tuberculosis (EPTB) in Wuhu City in 2024 and to explore factors associated with concurrent pulmonary tuberculosis (PTB). Methods Case data for this study were obtained from the Multi-Point Trigger Early Warning System for Public Health Emergencies in Wuhu City and the China Information System for Disease Control and Prevention. A descriptive analysis was conducted on the diagnosed cases of EPTB, and the factors associated with concurrent PTB were analyzed using logistic regression. Results A total of 199 cases of EPTB were included, with a registered incidence rate of 5.30 per 100 000. There were more males than females (52.76% vs. 47.24%), and the median age was 54 (41, 70) years. Lymph node tuberculosis was the most common type of EPTB (27.14%). Overall, 58.29% of the cases were distributed in the urban area, and 85.43% of the cases were diagnosed in only one medical institution, mainly provincial hospitals and municipal tuberculosis-designated hospitals. Multivariate logistic regression analysis showed that age (OR=0.979, 95%CI: 0.962-0.996), being male (OR=2.048, 95%CI: 1.100-3.888), and other types of EPTB (OR=3.753, 95%CI: 1.428-10.341) were associated with concurrent PTB in EPTB patients. Conclusion Lymph node tuberculosis is the most common type of EPTB in Wuhu City in 2024, with population and regional differences in incidence, and diagnoses are concentrated in a limited number of institutions. Age, gender, and disease type are relevant factors for concurrent EPTB and PTB. It is recommended to strengthen grassroots diagnostic capabilities and carry out collaborative screening for high-risk populations.
肺外结核 / 流行特征 / 肺结核 / 影响因素 / logistic回归
Extrapulmonary tuberculosis / Epidemiological characteristics / Pulmonary tuberculosis / Risk factors / Logistic regression
| [1] |
国家卫生和计划生育委员会. 结核病分类:WS 196—2017[S/OL]. 北京: 国家卫生和计划生育委员会, 2017. https://www.nhc.gov.cn/wjw/s9491/201712/0d3c52de984b4bc4add047f19ccd51b9.shtml.
|
| [2] |
|
| [3] |
刘二勇, 李玉红, 周林, 等. 统筹兼顾:肺外结核应纳入防治规划[J]. 中国防痨杂志, 2021, 43(5):428-431.
|
| [4] |
唐神结, 高文. 临床结核病学[M]. 北京: 人民卫生出版社, 2011.
|
| [5] |
董景五译. 疾病和有关健康问题的国际统计分类-第一卷-类目表[M]. 2版. 北京协和医院世界卫生组织国际分类家族合作中心编,译. 北京: 人民卫生出版社, 2008.
|
| [6] |
|
| [7] |
Pulmonary tuberculosis (PTB) complicated with extrapulmonary tuberculosis (EPTB) infection can aggravate the disease, but there have been few reports.Retrospective analysis was used to collect the clinical data of PTB patients with pathogen positive in a teaching hospital from 2017 to 2021. We describe the incidence, the invasive site of EPTB patients, and analyze the infection risk factors for PTB with EPTB by univariate and multivariate logistic regression models. We also compared the complications, disease burden with chi-square test and rank-sum test.A total of 1806 PTB were included, of which 263 (14.6%) were complicated with EPTB. The common invasive sites for EPTB were neck lymph nodes (16.49%), intestines (16.13%), and meninges (10.75%). Age ≤ 40 (OR = 1.735; 95%CI [1.267-2.376]; P = 0.001), malnutrition (OR = 2.029; 95%CI [1.097-3.753]; P = 0.022), anemia (OR = 1.739; 95%CI[1.127-2.683]; P = 0.012), and osteoporosis (OR = 4.147; 95%CI [1.577-10.905]; P = 0.004) were all independent risk factors for PTB infection with EPTB. The incidence of extrathoracic hydrothorax, intestinal bacterial infection, urinary tract bacterial infection, and abdominal bacterial infection were higher in patients with PTB with EPTB. PTB with EPTB patients also had longer median hospitalization durations (19 vs. 14 days), during which time they incurred higher total costs, laboratory test costs, imaging examination costs, and drug use costs.This study found important risk factors for PTB complicated with EPTB, such as age ≤ 40, malnutrition, anemia, and osteoporosis. PTB with EPTB patients have more extrapulmonary complications and higher hospitalization disease burden.© 2023. The Author(s).
|
| [8] |
王歆尧, 姜美丽, 庞元捷, 等. 中国结核病疾病负担现状[J]. 中华流行病学杂志, 2024, 45(6):857-864.
|
| [9] |
丁芹, 陈薇, 张胜康, 等. 肺外结核患者的营养状况调查及影响因素分析[J]. 中国防痨杂志, 2023, 45(9):839-844.
|
| [10] |
牛佩璇, 阿尔泰, 李媛媛, 等. 2018—2022年新疆维吾尔自治区肺外结核住院患者流行病学特征分析[J]. 结核与肺部疾病杂志, 2024, 5(1):51-57.
|
| [11] |
王陇德. 结核病防治[M]. 北京: 中国协和医科大学出版社, 2004.
|
| [12] |
中国疾病预防控制中心. 中国结核病预防控制工作技术规范(2020 年版)[M]. 北京: 人民卫生出版社, 2020.
|
| [13] |
孟秋月, 荣宁宁, 刘亚东, 等. 肺结核患者治疗依从性干预措施的研究进展[J]. 中国防痨杂志, 2026, 48(3):413-418.
|
| [14] |
|
| [15] |
Extrapulmonary TB (EPTB) is not a notifiable infectious disease in China but brought heavy burden to public health. However, epidemic situation of EPTB nationwide was unclear yet. This study aimed to investigate the magnitude and main subtypes of EPTB in China.A national cross-sectional study with multistage, stratified cluster random sampling was conducted during 2020-2021. Proportions of EPTP in all TB patients by organs were calculated. Logistic regression models were used to estimate odds ratios by characteristics.A total of 6,843 TB patients were included. 24.6% of them were patients with EPTB, and the proportion of EPTB solo was 21.3%. Higher EPTB burden was observed in children, female, clinically diagnosed patients, provincial-level and prefectural-level health facilities, and Central and West China. EPTB occurred most frequently in respiratory (35.5%), musculoskeletal (15.8%) and peripheral lymphatic (15.8%) systems with top three subtypes including tuberculous pleurisy (35.0%), spinal TB (9.8%) and cervical tuberculous lymphadenopathy (7.9%). With the increase of age, proportion of peripheral lymphatic TB decreased, and proportion rank of genitourinary TB rose.It is essential to strengthen diagnosis and treatment capacity of EPTB in primary medical facilities. EPTB should be list into National Tuberculosis Program as a notifiable disease.Copyright © 2022. Published by Elsevier Ltd.
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| [16] |
徐祖辉, 刘礼亲, 王巧智, 等. 病原学阳性住院肺结核患者并发肺外结核的流行特征及其影响因素研究[J]. 中国防痨杂志, 2021, 43(11):1164-1170.
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