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Article(id=1202979640869610072, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1202979639087030850, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.0943.2022.1017, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1650988800000, receivedDateStr=2022-04-27, revisedDate=null, revisedDateStr=null, acceptedDate=1660579200000, acceptedDateStr=2022-08-16, onlineDate=1764742296664, onlineDateStr=2025-12-03, pubDate=1690473600000, pubDateStr=2023-07-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1764742296664, onlineIssueDateStr=2025-12-03, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1764742296664, creator=13701087609, updateTime=1764742296664, updator=13701087609, issue=Issue{id=1202979639087030850, tenantId=1146029695717560320, journalId=1189873630562394117, year='2023', volume='48', issue='7', pageStart='749', pageEnd='870', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1764742296239, creator=13701087609, updateTime=1764742346610, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1202979850442203282, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1202979639087030850, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1202979850442203283, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1202979639087030850, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=749, endPage=755, ext={EN=ArticleExt(id=1202979641255486051, articleId=1202979640869610072, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Epidemiological characteristics of tuberculosis in Zigong city, Sichuan province, 2018-2021, columnId=1202979639976223301, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Special Issue Ⅱ on Prevention, Diagnosis and Treatment of Tuberculosis, runingTitle=null, highlight=null, articleAbstract=

Objective To identify the epidemiological characteristics of tuberculosis in Zigong from 2018 to 2021, and to compare the epidemic situation of tuberculosis before and during the COVID-19 pandemic, so as to provide guidance for further prevention and control. Methods The data of tuberculosis cases reported in Zigong from January 1, 2018 to December 31, 2021 were derived from the "Tuberculosis Information Management System". And further descriptive epidemiological analysis was carried out based on the collected data. Results A total of 5289 tuberculosis cases were reported in Zigong from 2018 to 2021 with the range of reported incidence from 49.29/100 000 to 55.19/100 000, and the average incidence reported was 52.54/100 000. The incidence showed two peaks every year from 2018 to 2021, except for 2020 with only one peak in September. The ratio of male to female patients was 3.14:1 (4010:1279) and farmers were the main occupation of patients (56.06%). Tuberculous pleurisy was the main type of extrapulmonary tuberculosis (69.17%), and diabetes was the main type of comorbidities (74.32%), respectively. Ziliujing district showed the lowest incidence among these districts in Zigong. Newly treated patients have been the main treatment type of tuberculosis patients in Zigong in the past four years with the ratio of newly patients to retreatment patients of 14.60:1(4950:339). There were four types of patients showing high rates of consultation delays, including officers (74.29%), retreatment patients (73.75%), diagnosed (74.95%) and recommended (78.57%) due to symptoms. During the COVID-19 pandemic, while the reported incidence of tuberculosis in Zigong city has decreased, the rate of laboratory positive detection has also decreased. Conclusions Middle-aged male and farmers are still the focus of tuberculosis prevention and treatment in Zigong. The COVID-19 pandemic has little effect on the gender structure of patients. However, the COVID-19 pandemic might cause a slight increase in the number of hidden tuberculosis patients in Zigong. It is suggested to strengthen publicity, education and screening for the target population.

, correspAuthors=Jian-Ping Deng, authorNote=null, correspAuthorsNote=
* E-mail:
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目的 了解2018－2021年四川省自贡市结核病的流行特征，比较新冠疫情前后结核病的流行情况，为结核病防控提供依据。方法 从结核病管理信息系统收集2018年1月1日－2021年12月31日自贡市报告的结核病患者资料，对资料进行描述性流行病学分析。结果 2018－2021年自贡市累计报告结核病5289例，4年报告发病率49.29/10万～55.19/10万，平均52.54/10万。2018、2019及2021年，每年均有2个报告发病高峰，而2020年报告发病高峰集中在9月。所有登记报告患者中，男女患者比例为3.14:1(4010:1279)，农民为患者的主要职业(占56.06%)，结核性胸膜炎(占肺外结核的69.17%)和糖尿病(占合并症的74.32%)分别是患者最主要的肺外结核和合并症类型。自流井区是自贡市发病率最低的区县，初治患者是自贡市结核病患者的主要治疗类型，初治患者与复治患者之比为14.60:1(4950:339)，就诊延迟率较高的是干部职员(74.29%)、复治(73.75%)、因症就诊(74.95%)/因症推荐(78.57%)人群。新冠疫情后，自贡市结核病报告发病率降低，实验室阳性检出率也降低。结论 中老年男性及农民是自贡市结核病防治的重点人群。新冠疫情对结核病患者的性别构成影响不大，但新冠疫情可能使结核病隐匿患者增加，因此新冠疫情期间应有针对性地加大对结核病的宣传、教育及筛查力度。

, correspAuthors=邓建平, authorNote=null, correspAuthorsNote=
邓建平，E-mail：
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龙莹，硕士研究生，主要从事结核分枝杆菌方面的研究

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龙莹，硕士研究生，主要从事结核分枝杆菌方面的研究

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龙莹，硕士研究生，主要从事结核分枝杆菌方面的研究

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Incidence of tuberculosis in Zigong city, Sichuan province in different months from 2018 to 2021

, figureFileSmall=4jecIA/nrYP96qQ13FJoiA==, figureFileBig=cHOohVd6bbz073ANtUauhw==, tableContent=null), ArticleFig(id=1203005084947935369, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=CN, label=图1, caption=四川省自贡市2018－2021年不同月份结核病发病情况, figureFileSmall=4jecIA/nrYP96qQ13FJoiA==, figureFileBig=cHOohVd6bbz073ANtUauhw==, tableContent=null), ArticleFig(id=1203005085082153110, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=EN, label=Fig. 2, caption=

Gender distribution of all age groups in Zigong city, Sichuan province from 2018 to 2021

, figureFileSmall=IBAtZ1jeNxYfACeees5WKg==, figureFileBig=qHr9CcHJ7v7eCmgZ5YzPqg==, tableContent=null), ArticleFig(id=1203005085178622106, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=CN, label=图2, caption=四川省自贡市2018－2021年各年龄段性别分布情况, figureFileSmall=IBAtZ1jeNxYfACeees5WKg==, figureFileBig=qHr9CcHJ7v7eCmgZ5YzPqg==, tableContent=null), ArticleFig(id=1203005085283479709, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=EN, label=Fig. 3, caption=

Composition of extrapulmonary tuberculosis and tuberculosis comorbidities in Zigong city, Sichuan province from 2018 to 2021

, figureFileSmall=Xsn78QCYaujyNeqki3Byvw==, figureFileBig=pZrevzeC0x5NLoTGeamF+w==, tableContent=null), ArticleFig(id=1203005085384143010, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=CN, label=图3, caption=四川省自贡市2018－2021年肺外结核(A)及结核合并症(B)总体构成情况, figureFileSmall=Xsn78QCYaujyNeqki3Byvw==, figureFileBig=pZrevzeC0x5NLoTGeamF+w==, tableContent=null), ArticleFig(id=1203005085505777833, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=EN, label=Fig. 4, caption=

The incidence of tuberculosis in all districts and counties of Zigong city, Sichuan province from 2018 to 2021

, figureFileSmall=KRHcatr2mvDwkAHvR3XaDg==, figureFileBig=W2A/RffvsFLqOjK/w5GfIg==, tableContent=null), ArticleFig(id=1203005085610635438, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=CN, label=图4, caption=2018－2021年四川省自贡市各区县结核病的发病情况, figureFileSmall=KRHcatr2mvDwkAHvR3XaDg==, figureFileBig=W2A/RffvsFLqOjK/w5GfIg==, tableContent=null), ArticleFig(id=1203005085736464567, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=EN, label=Tab. 1, caption=

Occupational distribution of tuberculosis patients in Zigong city, Sichuan province from 2018 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
职业2018年(n=1401)2019年(n=1398)2020年(n=1274)2021年(n=1216)
例数构成比(%)例数构成比(%)例数构成比(%)例数构成比(%)
农民88463.1083159.4468153.4556946.79
家政、家务及待业17712.6326518.9633226.0642534.95
离退休人员956.78745.29755.89685.59
民工392.78352.50251.96171.40
学生352.50523.72493.85494.03
干部职员201.43181.29201.57120.99
工人181.28201.43201.57201.64
商业服务171.21412.93231.81141.15
教师110.7980.5780.6360.49
医务人员100.71100.72120.94151.23
餐饮食品业30.2150.3640.3130.25
散居儿童10.0700.0000.0010.08
公共场所服务员10.0720.1410.0860.49
海员、长途驾驶员10.0710.0730.2410.08
幼托儿童00.0020.1400.0010.08
牧民00.0020.1410.0800.00
其他896.35322.29201.5790.74
), ArticleFig(id=1203005085811962044, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=CN, label=表1, caption=

四川省自贡市2018－2021年结核病患者职业分布情况

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职业2018年(n=1401)2019年(n=1398)2020年(n=1274)2021年(n=1216)
例数构成比(%)例数构成比(%)例数构成比(%)例数构成比(%)
农民88463.1083159.4468153.4556946.79
家政、家务及待业17712.6326518.9633226.0642534.95
离退休人员956.78745.29755.89685.59
民工392.78352.50251.96171.40
学生352.50523.72493.85494.03
干部职员201.43181.29201.57120.99
工人181.28201.43201.57201.64
商业服务171.21412.93231.81141.15
教师110.7980.5780.6360.49
医务人员100.71100.72120.94151.23
餐饮食品业30.2150.3640.3130.25
散居儿童10.0700.0000.0010.08
公共场所服务员10.0720.1410.0860.49
海员、长途驾驶员10.0710.0730.2410.08
幼托儿童00.0020.1400.0010.08
牧民00.0020.1410.0800.00
其他896.35322.29201.5790.74
), ArticleFig(id=1203005085921013955, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=EN, label=Tab. 2, caption=

The composition of treatment classification of tuberculosis patients in Zigong city, Sichuan province from 2018 to 2021

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年份例数初治患者(例)复治患者(例)复治患者占比(%)χ2P
201814011326755.356.1890.013
201913981313856.08
202012741188866.75
202112161123937.65
), ArticleFig(id=1203005086017482951, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=CN, label=表2, caption=

四川省自贡市2018－2021年结核病患者治疗分类构成情况

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年份例数初治患者(例)复治患者(例)复治患者占比(%)χ2P
201814011326755.356.1890.013
201913981313856.08
202012741188866.75
202112161123937.65
), ArticleFig(id=1203005086181060812, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=EN, label=Tab. 3, caption=

Influencing factors of delayed visit of tuberculosis patients in Zigong city, Sichuan province from 2018 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
因素例数就诊延迟[例(%)]χ2P
性别  1.3000.254
 男40102681(66.86)
 女1279833(65.13)
职业  16.4270.012
 农民/民工/工人31592099(66.45)
 学生185100(54.05)
 医务人员4727(57.45)
 离退休人员312206(66.03)
 干部职员7052(74.29)
 教师3320(60.61)
 家政、家务及待业1199800(66.72)
患者来源  79.317<0.001
 健康检查73(42.86)
 因症就诊930697(74.95)
 因症推荐2822(78.57)
 转诊30351922(63.33)
 追踪802510(63.59)
 其他487380(78.03)
治疗分类  8.6720.003
 初治49503264(65.94)
 复治339250(73.75)
年龄(岁)  5.4440.364
 0～152916(55.17)
 15～30689443(64.30)
 30～45689456(66.18)
 45～6016251099(67.63)
 60～7516911135(67.12)
 ≥75566365(64.49)  
), ArticleFig(id=1203005086290112721, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=CN, label=表3, caption=

四川省自贡市2018－2021年结核病患者就诊延迟影响因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
因素例数就诊延迟[例(%)]χ2P
性别  1.3000.254
 男40102681(66.86)
 女1279833(65.13)
职业  16.4270.012
 农民/民工/工人31592099(66.45)
 学生185100(54.05)
 医务人员4727(57.45)
 离退休人员312206(66.03)
 干部职员7052(74.29)
 教师3320(60.61)
 家政、家务及待业1199800(66.72)
患者来源  79.317<0.001
 健康检查73(42.86)
 因症就诊930697(74.95)
 因症推荐2822(78.57)
 转诊30351922(63.33)
 追踪802510(63.59)
 其他487380(78.03)
治疗分类  8.6720.003
 初治49503264(65.94)
 复治339250(73.75)
年龄(岁)  5.4440.364
 0～152916(55.17)
 15～30689443(64.30)
 30～45689456(66.18)
 45～6016251099(67.63)
 60～7516911135(67.12)
 ≥75566365(64.49)  
), ArticleFig(id=1203005086382387413, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=EN, label=Tab. 4, caption=

Comparison of registered incidence of tuberculosis in Zigong city, Sichuan province before and after the COVID-19 pandemic

, figureFileSmall=null, figureFileBig=null, tableContent=
时间报告病例(例)总人口数(万)报告发病率(/10万)χ2P
新冠疫情前2799510.954.799.9340.002
新冠疫情后2490495.750.23  
), ArticleFig(id=1203005086462079195, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=CN, label=表4, caption=

四川省自贡市新冠疫情前后结核病登记发病率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
时间报告病例(例)总人口数(万)报告发病率(/10万)χ2P
新冠疫情前2799510.954.799.9340.002
新冠疫情后2490495.750.23  
), ArticleFig(id=1203005086587908320, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=EN, label=Tab. 5, caption=

Comparison of the positive rate of tuberculosis etiological detection in laboratory samples before and after the COVID-19 pandemic

, figureFileSmall=null, figureFileBig=null, tableContent=
项目新冠疫情前新冠疫情后χ2P
痰培养[例(%)]  14.106<0.001
 阳性710(22.10)643(18.42)
 阴性2502(77.90)2848(81.58)
Gene-Xpert*[例(%)]  17.225<0.001
 阳性118(33.52)569(23.33)
 阴性234(66.48)1870(76.67)  
), ArticleFig(id=1203005086696960230, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979640869610072, language=CN, label=表5, caption=

四川省自贡市新冠疫情前后实验室样本结核病原学检出阳性率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目新冠疫情前新冠疫情后χ2P
痰培养[例(%)]  14.106<0.001
 阳性710(22.10)643(18.42)
 阴性2502(77.90)2848(81.58)
Gene-Xpert*[例(%)]  17.225<0.001
 阳性118(33.52)569(23.33)
 阴性234(66.48)1870(76.67)  
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2018－2021年四川省自贡市结核病流行病学特征分析
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龙莹 1 , 宁柱 2 , 汪川 1 , 王斌 2 , 邓建平 2, *
解放军医学杂志 | 结核病的预防、诊断与治疗专题研究Ⅱ 2023,48(7): 749-755
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解放军医学杂志 | 结核病的预防、诊断与治疗专题研究Ⅱ 2023, 48(7): 749-755
2018－2021年四川省自贡市结核病流行病学特征分析
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龙莹1, 宁柱2, 汪川1, 王斌2, 邓建平2, *
作者信息
  • 1四川大学华西公共卫生学院/四川大学华西第四医院卫生检验与检疫系，四川成都 610041
  • 2自贡市疾病预防控制中心，四川自贡 643000

    • 龙莹，硕士研究生，主要从事结核分枝杆菌方面的研究

通讯作者:

邓建平，E-mail：
Epidemiological characteristics of tuberculosis in Zigong city, Sichuan province, 2018-2021
Ying Long1, Zhu Ning2, Chuan Wang1, Bin Wang2, Jian-Ping Deng2, *
Affiliations
  • 1Department of Health Inspection and Quarantine, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
  • 2Zigong Center for Disease Control and Prevention, Zigong, Sichuan 643000, China
出版时间: 2023-07-28 doi: 10.11855/j.issn.0577-7402.0943.2022.1017
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摘要
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目的 了解2018－2021年四川省自贡市结核病的流行特征，比较新冠疫情前后结核病的流行情况，为结核病防控提供依据。方法 从结核病管理信息系统收集2018年1月1日－2021年12月31日自贡市报告的结核病患者资料，对资料进行描述性流行病学分析。结果 2018－2021年自贡市累计报告结核病5289例，4年报告发病率49.29/10万～55.19/10万，平均52.54/10万。2018、2019及2021年，每年均有2个报告发病高峰，而2020年报告发病高峰集中在9月。所有登记报告患者中，男女患者比例为3.14:1(4010:1279)，农民为患者的主要职业(占56.06%)，结核性胸膜炎(占肺外结核的69.17%)和糖尿病(占合并症的74.32%)分别是患者最主要的肺外结核和合并症类型。自流井区是自贡市发病率最低的区县，初治患者是自贡市结核病患者的主要治疗类型，初治患者与复治患者之比为14.60:1(4950:339)，就诊延迟率较高的是干部职员(74.29%)、复治(73.75%)、因症就诊(74.95%)/因症推荐(78.57%)人群。新冠疫情后，自贡市结核病报告发病率降低，实验室阳性检出率也降低。结论 中老年男性及农民是自贡市结核病防治的重点人群。新冠疫情对结核病患者的性别构成影响不大，但新冠疫情可能使结核病隐匿患者增加，因此新冠疫情期间应有针对性地加大对结核病的宣传、教育及筛查力度。

自贡市  /  结核病  /  流行病学特征

Objective To identify the epidemiological characteristics of tuberculosis in Zigong from 2018 to 2021, and to compare the epidemic situation of tuberculosis before and during the COVID-19 pandemic, so as to provide guidance for further prevention and control. Methods The data of tuberculosis cases reported in Zigong from January 1, 2018 to December 31, 2021 were derived from the "Tuberculosis Information Management System". And further descriptive epidemiological analysis was carried out based on the collected data. Results A total of 5289 tuberculosis cases were reported in Zigong from 2018 to 2021 with the range of reported incidence from 49.29/100 000 to 55.19/100 000, and the average incidence reported was 52.54/100 000. The incidence showed two peaks every year from 2018 to 2021, except for 2020 with only one peak in September. The ratio of male to female patients was 3.14:1 (4010:1279) and farmers were the main occupation of patients (56.06%). Tuberculous pleurisy was the main type of extrapulmonary tuberculosis (69.17%), and diabetes was the main type of comorbidities (74.32%), respectively. Ziliujing district showed the lowest incidence among these districts in Zigong. Newly treated patients have been the main treatment type of tuberculosis patients in Zigong in the past four years with the ratio of newly patients to retreatment patients of 14.60:1(4950:339). There were four types of patients showing high rates of consultation delays, including officers (74.29%), retreatment patients (73.75%), diagnosed (74.95%) and recommended (78.57%) due to symptoms. During the COVID-19 pandemic, while the reported incidence of tuberculosis in Zigong city has decreased, the rate of laboratory positive detection has also decreased. Conclusions Middle-aged male and farmers are still the focus of tuberculosis prevention and treatment in Zigong. The COVID-19 pandemic has little effect on the gender structure of patients. However, the COVID-19 pandemic might cause a slight increase in the number of hidden tuberculosis patients in Zigong. It is suggested to strengthen publicity, education and screening for the target population.

Zigong city  /  tuberculosis  /  epidemiological characteristics
龙莹, 宁柱, 汪川, 王斌, 邓建平. 2018－2021年四川省自贡市结核病流行病学特征分析. 解放军医学杂志, 2023 , 48 (7) : 749 -755 . DOI: 10.11855/j.issn.0577-7402.0943.2022.1017
Ying Long, Zhu Ning, Chuan Wang, Bin Wang, Jian-Ping Deng. Epidemiological characteristics of tuberculosis in Zigong city, Sichuan province, 2018-2021[J]. Medical Journal of Chinese People’s Liberation Army, 2023 , 48 (7) : 749 -755 . DOI: 10.11855/j.issn.0577-7402.0943.2022.1017
正文
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结核病是由结核分枝杆菌引起的传染性疾病，其病灶通常位于肺部，从而引起肺结核，有时病灶也会出现在身体的其他部位，如皮肤、关节、淋巴结等。结核病是全球主要的死亡原因之一，世界卫生组织(WHO)发布的《2021年全球结核病报告》指出：2020年全球新增结核患者990万人，130万人死于结核病；我国仍然是结核病高负担国家，新增结核病患者人数(84.2万)居世界第2位，仅次于印度[1]。一直以来，结核病的防控存在着诸多阻碍(如细菌耐药、治疗周期长、卫生支出较高等)，2019年末爆发的新型冠状病毒感染疫情(简称新冠疫情)更是给结核病防治带来了新的挑战[2]。自贡市位于四川盆地南部，全市面积4381 km2，共管辖4个区、2个县，是川南区域、成渝经济圈南部中心。本研究对自贡市2018－2021年报告结核病患者的相关资料进行分析，了解自贡市结核病的基本流行特征，比较新冠疫情前后自贡市结核病的发病情况及流行特点，为结核病的进一步防治提供数据支持。
1 资料与方法
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1.1 资料来源
病例资料均来源于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，内容包括患者的年龄、性别、住址、职业、民族、随访结局等信息，疾病分类符合《WS 196-2017结核病分类》及《WS 288-2017结核病诊断》。常住人口信息来源于自贡市统计局(http://www.zg.gov.cn/web/stjj)相关年份的统计年鉴和统计公报。研究对象为登记时间在2018年1月1日－2021年12月31日，登记现住址在四川省自贡市的结核病患者。实验室检测信息来源于自贡市疾病预防控制中心微生物检验所。
1.2 研究方法
采用描述性统计学方法，对自贡市结核病的报告发病率、三间分布、肺外结核及结核合并症、初复治类型、就诊延迟等方面的资料进行分析，并结合实验室结核病原学检出阳性率探讨新冠疫情对当地结核病流行的影响。以患者出现临床症状到首次前往医疗机构问诊的间隔时间为就诊时间，就诊时间>14 d定义为就诊延迟[3]。
1.3 统计学处理
采用Excel 2010进行数据整理，用SPSS 26.0软件进行统计学分析。人口标化发病率采用第七次全国普查标准人口构成进行标化。率的比较采用χ2检验，率的趋势性检验采用趋势χ2检验。P<0.05为差异有统计学意义。
2 结果
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2.1 总体流行情况
2018－2021年，自贡市累计登记结核病患者5289例，4年报告发病率49.29/10万～55.19/10万，平均52.54/10万。
2.2 时间分布
2.2.1 不同年份发病情况
2018－2021年，自贡市每年分别报告发病1401、1398、1274、1216例，每年报告发病率为54.39/10万、55.19/10万、51.16/10万、49.29/10万。自贡市2018年与2019年结核病的发病率基本持平，2020年报告发病率较前一年下降了7.30%，2021年较前一年下降了3.66%，4年发病率的χ2线性趋势性检验差异有统计学意义(χ2=8.873，P=0.003)。
2.2.2 不同月份发病情况
12个月份均有病例报告，发病的季节性不是很明显，但总体来说，2018、2019、2021年的报告例数在春季(3、4、5月)有1个高峰，6月下降，7、8月又出现发病高峰，之后9～12月发病人数略有下降并趋于平缓。而2020年前10个月份报告例数均较少，但逐月攀升，直至9月达到顶点，然后10月骤降，11月、12月略有回升(图1)。
2.3 人群分布
2.3.1 性别、年龄分布
在所有登记的5289例患者中，男女比例为3.14∶1(4010/1279)，男女平均发病率之比为3.17∶1(80.95/10万∶25.56/10万)，4年间各年份登记患者的男女比例差异无统计学意义(χ2=5.152，P=0.161)。登记患者的中位年龄为56岁，发病年龄主要集中在45～75岁，共3316例，占所有患者的62.7%。4年间自贡市0～15岁人口的平均发病率为1.85/10万，15～60岁人口的平均发病率为53.01/10万，≥60岁人口的平均发病率为82.89/10万。在不同发病年龄段的患者中，男性比例高于女性，差异有统计学意义(χ2=209.589，P<0.001，图2)。
2.3.2 职业分布
农民是2018－2021年自贡市结核病患者的主要职业，占所有患者数的56.06%(2965/5289)，其次是家政、家务及待业人员(22.67%)和离退休人员(5.90%)(表1)。
2.3.3 肺外结核及结核合并症
结核性胸膜炎是最主要的肺外结核类型，占肺外结核患者人数的69%(267/386，图3A)；糖尿病是最主要的结核合并症类型，占有合并症结核病患者的75%(518/697，图3B)。
2.4 地区分布
2018－2021年自贡市下属的4个区(自流井区、沿滩区、大安区、贡井区)、2个县(荣县、富顺县)每年均有病例报告，其中患者较多的地区是富顺县(1535例)和荣县(1134例)，每年自流井区均是发病率最低的地区(图4)。
2.5 初复治情况
自贡市结核病患者主要以初治患者为主，初治患者与复治患者的比例为14.6:1(4950/339)，各年份复治患者占比略呈上升趋势，χ2线性趋势性检验差异有统计学意义(χ2=6.189，P=0.013，表2)。
2.6 就诊延迟情况
2018－2021年的就诊延迟率依次为68.52%、66.60%、67.11%及63.16%，最低的是2021年，各年份之间差异有统计学意义(χ2=8.872，P=0.031)。不同性别、年龄段的就诊延迟率差异无统计学意义，但不同职业、患者来源、患者治疗分类的就诊延迟率差异有统计学意义，其中就诊延迟率较高的是干部职员、复治、因症就诊/因症推荐人群(表3)。
2.7 新冠疫情对自贡市结核病流行的影响
因国内新冠疫情暴发时间在2019年12月末，因此本研究用2018年和2019年的数据代表新冠疫情发生前自贡市结核病的流行情况，2020年和2021年的数据代表新冠疫情发生后结核病的流行情况，具体分析如下。
2.7.1 报告发病率
新冠疫情后，结核病的报告发病率低于新冠疫情前，差异有统计学意义(P<0.05，表4)。
2.7.2 实验室检查阳检率
新冠疫情发生后，不论是痰培养还是Gene-Xpert，结核病原检出阳性率均低于新冠疫情前，差异有统计学意义(P<0.05，表5)。
3 讨论
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自贡市作为四川省南部较为发达的城市，属于成渝经济区的核心地区之一，对其结核病流行病学特征进行分析，有助于了解川南及成渝片区的结核病流行趋势。
自贡市2020年结核病的年龄标化发病率(SMR)为47.45/10万，低于当年全省(54.18/10万)[4]及全国(59/10万)[1]的水平。自贡市2020年结核病的报告患者数较2019年下降了8.87%，与全国报告患者下降幅度(8%)趋同[1]。自贡市2018年、2019年及2021年的报告患者情况都呈“双峰”现象，发病高峰往往出现在3－5月(春季)及8月(夏季)，与全省及全国其他地区的研究一致[5-7]。春夏高发可能是由于春节过后，迎来开学及外出务工高峰，8月正值暑假，相对来说也是出游旺季，人员流动性加大；加上季节变换后，气温骤升或骤降，引起机体的免疫力降低。而2020年的前9个月报告患者数较低，且出现报告患者数逐月攀升的现象，可能是因为当时正值新冠疫情暴发时期，社区管控较严，很多患者就医不便，所以在社区管控逐渐放开之后，才开始出门就诊。到2021年，新冠疫情开始常态化管理，病例报告情况恢复到疫情前的“双峰”趋势。
从发病年龄及性别来看，结核患者以45岁及以上的中老年男性为主，总的性别比例没有明显差别，但是各年龄段患者的性别比例有明显区别，30岁以前患者的性别比例接近1:1，而30岁以后的患者中男性占比急剧上升。结合职业分布中农民占比最高这一点来看，造成这一现象的可能原因是农村男性在成年以后，经常外出务工后又回乡务农，导致社会流动性大，感染结核的概率高，且农村男性中有吸烟、饮酒等损伤肺部功能习惯的人居多，所以更容易在青壮年时期成为结核潜伏感染者，然后逐渐进展为活动性结核。
结核性胸膜炎是自贡市结核患者中最主要的肺外结核类型，这与山东省的研究结果一致[8]。在结核病患者的合并症中，糖尿病是最主要的类型。流行病学研究表明，糖尿病与结核病的发展存在一定关联[9]；实验室研究也发现，糖尿病会引起机体免疫功能障碍，从而影响免疫系统对细菌的识别[10]。糖尿病是目前全球发达国家及发展中国家面临的最大健康问题之一，2019年，中国已有约1.16亿糖尿病患者，是全球患者数最多的国家。据估计，到2030年，全世界将有约4.63亿人患有糖尿病，占全球成年人口(20～79岁)的9.3%[11]。而随着糖尿病患者数的增加，其与结核病出现共感染的概率也会大大增高。
由于缺乏2021年自贡市各区的常住人口资料，2021年自贡市各区的发病率是以2020年的常住人口计算的。根据当地的统计公报，自贡市2021年存在一定的人口流失，所以本研究中2021年自贡市某些区县的发病率可能会偏低。但总体来说，自贡市各区结核病的防治政策起到了较好的作用，发病率都呈现下降的趋势。
自贡市4年间的结核病患者均是以初治为主，从数值上来看，2018－2021年4年间复治患者占比有所上升。同时，多地的流行病学研究都指出近年复治患者的占比有所升高，提示可能是结核耐药情况增多导致治疗不彻底而复发。
自贡市结核病患者就诊的及时性不够，总体就诊延迟率高于全国的大部分地区[12-15]。在自贡市结核病患者中，学生及医务工作者的就诊延迟率明显低于其他职业，这是因为学生的身体健康一般会受到家长及学校的共同关注，若有不适都会尽早就医；而医务工作者出于对结核病的认识及了解，发现症状后也会主动问诊。从另一方面也说明，提高结核病的知晓率，在全人群中大力宣传结核病的相关知识，有助于降低结核病的就诊延迟率。相较初治患者来说，复治患者的就诊延迟率高。复治患者在了解结核病的基础上，会因顾虑治疗周期长、药物引起的不适反应及可能产生的经济支出等问题而有意识地拖延就医时间。因此，各地的经济发展水平，以及对结核病患者的管理规范程度、医疗保障力度都会影响就诊延迟率。因症就诊和因症推荐人群的就诊延迟率高与目前结核病的发现模式有关，这部分患者出现症状后会选择先去非结核病防治医院就诊，然后根据症状被推荐到结核病定点防治医院就诊，从而明显增加了患者的时间及经济成本。
根据WHO的数据，世界范围内结核病的报告例数在2020年均有大幅度的下降[1]。本研究也发现自贡市结核病的报告发病率在新冠疫情后明显下降。但这种下降趋势并不代表结核病的防控有好转的势头，可能存在两方面的原因：一是各国的医疗服务在2020年更多倾向于应对新冠疫情，导致一些结核相关诊疗服务的中断；二是结核病患者因为临床症状与新冠肺炎有相似之处不便就医，导致有很多患者没有被发现。
综上所述，自贡市2018－2021年结核病的流行情况表明，农民及中老年男性依旧是结核病防治的重点人群，且结核病患者总体呈现就诊延迟率较高的现象。因此，应针对高危人群(如农民、中老年男性、糖尿病患者等)加强宣传教育，明确结核病的典型症状，介绍相关的定点防治机构，争取让患者得到最快的诊断及治疗。此外，“高发现率、高治愈率”是结核病控制工作的策略目标，只有发现更多的患者才能有效切断结核病的传播，即使在新冠疫情期间仍不能放松对结核病的防控。
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2023年第48卷第7期
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doi: 10.11855/j.issn.0577-7402.0943.2022.1017
  • 接收时间：2022-04-27
  • 首发时间：2025-12-03
  • 出版时间：2023-07-28
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  • 收稿日期：2022-04-27
  • 录用日期：2022-08-16
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    1四川大学华西公共卫生学院/四川大学华西第四医院卫生检验与检疫系，四川成都 610041
    2自贡市疾病预防控制中心，四川自贡 643000

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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