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Article(id=1311350068863664380, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349984730116963, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202603130, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1772985600000, receivedDateStr=2026-03-09, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579820123, onlineDateStr=2026-09-28, pubDate=1784908800000, pubDateStr=2026-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579820123, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579820123, creator=13701087609, updateTime=1790579820123, updator=13701087609, issue=Issue{id=1311349984730116963, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='1784908800000', pubDateStr='2026-07-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1790579800064, creator='13701087609', updateTime=1790588348354, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311385838924169506, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349984730116963, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311385838924169507, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349984730116963, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2546, endPage=2552, ext={EN=ArticleExt(id=1311350069077573885, articleId=1311350068863664380, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Epidemiological characteristics and treatment outcomes of recurrent pulmonary tuberculosis patients, Shaanxi, 2011-2024, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To retrospectively analyze the epidemiological characteristics and treatment outcomes of patients with recurrent pulmonary tuberculosis in Shaanxi Province from 2011 to 2024, so as to provide a scientific basis for the prevention and control of recurrent pulmonary tuberculosis and the formulation of relevant strategies in Shaanxi Province.

Methods

The medical records of all patients with recurrent pulmonary tuberculosis registered in the Tuberculosis Information Management System (TIMS) of Shaanxi Province from 2011 to 2024 were collected. Descriptive epidemiological methods were used to analyze the epidemiological characteristics of the subjects, chi-square test was used for inter-group comparison, and Joinpoint regression model was applied for time trend analysis.

Results

A total of 11 715 patients with recurrent pulmonary tuberculosis were cumulatively reported in Shaanxi Province from 2011 to 2024. The registration rate of recurrent pulmonary tuberculosis in the province decreased from 3.94/100 000 population in 2011 to 1.46/100 000 population in 2024, showing an overall significant downward trend (AAPC=-8.6%, P<0.05). The composition of patient detection sources underwent a fundamental shift: the dominant detection route changed from “direct consultation” (accounting for 52.45% in 2011) to “referral”(with the proportion peaking at 73.13% in 2020). During the study period, the cumulative etiologically positive rate of recurrent patients was 56.18%, which was significantly higher than 35.91% of all notified pulmonary tuberculosis patients in the general population, with a statistically significant difference (χ2=1 983.846, P<0.05). The demographic characteristics showed that patients with recurrent pulmonary tuberculosis were predominantly concentrated in male farmers aged 40-64 years, accounting for a cumulative 36.46% of all enrolled subjects. Meanwhile, although the average annual consultation delay rate of recurrent patients was 56.93%, it showed a significant continuous downward trend during the study period (AAPC=-2.50%, P<0.05). Treatment outcome analysis showed that the cumulative treatment success rate of patients with recurrent pulmonary tuberculosis from 2011 to 2024 was 82.41%, while Joinpoint regression indicated a significant downward trend of this rate (AAPC=-1.43%, P<0.05).

Conclusion

The epidemic of recurrent pulmonary tuberculosis in Shaanxi Province has shown an overall downward trend, but the etiologically positive rate is significantly higher than that of all notified pulmonary tuberculosis patients, and the composition of patient detection sources has changed dramatically. Recurrent patients are concentrated in middle-aged and elderly male farmers, and the treatment success rate is on a downward trend, suggesting that there are still weak links in the treatment and management of recurrent patients. It is recommended to strengthen active screening and health management for high-risk groups such as farmers, optimize the referral network to reduce consultation delay, and improve the quality of treatment and management for recurrent patients to increase the treatment success rate.

, authors=Jing XU1, Lin ZHANG1, Yu MA1, Ning GUO2, authorsList=Jing XU, Lin ZHANG, Yu MA, Ning GUO, authorCompany=null, correspAuthors=Ning GUO, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1311350069870297344, articleId=1311350068863664380, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=陕西省2011—2024年复发肺结核患者流行病学特征及转归情况分析, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

回顾性分析2011—2024年陕西省复发肺结核患者流行病学特征及治疗转归情况，为陕西省复发肺结核防治及策略研究提供科学依据。

方法

收集2011—2024年陕西省"结核病信息管理系统"中登记的全部复发肺结核患者资料，采用描述性流行病学方法分析其流行病学特征，运用Joinpoint回归模型进行时间趋势分析。

结果

2011—2024年陕西省累计报告复发肺结核患者11 715例，全省复发肺结核登记率由2011年3.94/10万下降至2024年1.46/10万，整体呈显著下降趋势［平均年度变化百分比（average annual percentage change，AAPC）=-8.6%, P<0.05）。患者来源结构发生根本转变，主要构成从“直接就诊”（2011年占52.45%）转变为“转诊”（2020年构成比达峰值73.13%）。在研究期间，复发患者累计阳性率为56.18%，显著高于全人群患者的35.91%，差异具有统计学意义（χ2=1 983.846, P<0.05）。人群分布特征显示，复发肺结核患者集中于40~64岁男性农民群体，累计占比达36.46%。同时，复发肺结核患者虽年均就诊延迟率56.93%，但研究期间呈持续改善趋势（AAPC=-2.50%, P<0.05）。治疗转归分析显示，2011—2024年复发肺结核患者累计治疗成功率为82.41%，然而Joinpoint回归提示其呈显著下降趋势（AAPC=-1.43%, P<0.05）。

结论

陕西省复发肺结核疫情整体呈下降趋势，但病原学阳性率显著高于全人群，且患者来源结构改变。复发患者集中于中老年男性农民，治疗成功率呈下降趋势，提示复发患者的治疗与管理仍存在薄弱环节。建议加强针对农民等高危人群的主动筛查与健康管理；强化转诊网络，减少就诊延迟；提升复发患者的治疗管理质量，提高治疗成功率。

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许静（1982-），女，硕士，副主任医师，研究方向：结核病控制

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郭宁，E-mail:
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许静（1982-），女，硕士，副主任医师，研究方向：结核病控制

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许静（1982-），女，硕士，副主任医师，研究方向：结核病控制

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注：*P<0.05。

, figureFileSmall=+s3DM/aAKV+yBNTYEpPX2Q==, figureFileBig=QddyO4G+Wzuhr4lTAaj9iw==, tableContent=null), ArticleFig(id=1311350071812260130, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350068863664380, language=EN, label=Table 1, caption=

Trend of changes in registration rate, proportion, and etiological positive rate of recurrent patients from 2011 to 2024

, figureFileSmall=null, figureFileBig=null, tableContent=
变量APC［%,（95%CI）］P值AAPC［%,（95%CI）］P值
复发患者登记率-8.6（-15.7～-0.9）<0.001
2011—2014-19.83（-35.37～-0.56）0.046
2014—20187.62（-16.19～38.19）0.499
2018—2024-12.49（-20.24～-3.99）0.013
复发患者在全人群患者中的占比-3.2（-6.8～0.4）0.10
2011—2013-17.24（-35.48～6.16）0.120
2013—2024-0.46（-2.72～1.87）0.665
复发患者病原学阳性率-0.3（-3.2～2.5）0.80
2011—2016-18.9（-21.02～-16.72）<0.001
2016—201928.65（11.93～47.87）0.004
2019—20245.04（1.93～8.25）0.007
), ArticleFig(id=1311350071912923427, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350068863664380, language=CN, label=表1, caption=

2011—2024年复发患者登记率、占比及病原学阳性率变化趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
变量APC［%,（95%CI）］P值AAPC［%,（95%CI）］P值
复发患者登记率-8.6（-15.7～-0.9）<0.001
2011—2014-19.83（-35.37～-0.56）0.046
2014—20187.62（-16.19～38.19）0.499
2018—2024-12.49（-20.24～-3.99）0.013
复发患者在全人群患者中的占比-3.2（-6.8～0.4）0.10
2011—2013-17.24（-35.48～6.16）0.120
2013—2024-0.46（-2.72～1.87）0.665
复发患者病原学阳性率-0.3（-3.2～2.5）0.80
2011—2016-18.9（-21.02～-16.72）<0.001
2016—201928.65（11.93～47.87）0.004
2019—20245.04（1.93～8.25）0.007
), ArticleFig(id=1311350072034558245, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350068863664380, language=EN, label=Table 2, caption=

Proportion of sources of recurrent patients from 2011 to 2024（%）

, figureFileSmall=null, figureFileBig=null, tableContent=
年份（年）直接就诊占比转诊占比追踪占比推介占比健康检查占比主动筛查占比其他占比
201152.4525.3714.906.330.680.000.27
201248.5533.219.077.861.030.000.28
201347.2332.4111.067.851.000.110.33
201448.0636.3010.143.881.250.130.25
201555.8932.326.804.440.420.000.14
201651.1539.757.370.920.580.120.12
201736.2955.836.181.100.400.000.20
201840.7849.448.290.650.470.000.37
201938.3556.295.050.000.210.000.10
202015.4773.1310.100.810.160.000.33
202114.1472.5912.760.340.170.000.00
202223.4761.2214.290.610.200.200.00
202321.3563.0214.760.520.000.350.00
202428.9452.6914.732.080.870.690.00
合计40.1545.7810.123.090.570.090.20
), ArticleFig(id=1311350072110055718, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350068863664380, language=CN, label=表2, caption=

2011—2024年复发患者来源占比情况（%）

, figureFileSmall=null, figureFileBig=null, tableContent=
年份（年）直接就诊占比转诊占比追踪占比推介占比健康检查占比主动筛查占比其他占比
201152.4525.3714.906.330.680.000.27
201248.5533.219.077.861.030.000.28
201347.2332.4111.067.851.000.110.33
201448.0636.3010.143.881.250.130.25
201555.8932.326.804.440.420.000.14
201651.1539.757.370.920.580.120.12
201736.2955.836.181.100.400.000.20
201840.7849.448.290.650.470.000.37
201938.3556.295.050.000.210.000.10
202015.4773.1310.100.810.160.000.33
202114.1472.5912.760.340.170.000.00
202223.4761.2214.290.610.200.200.00
202321.3563.0214.760.520.000.350.00
202428.9452.6914.732.080.870.690.00
合计40.1545.7810.123.090.570.090.20
), ArticleFig(id=1311350072185553191, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350068863664380, language=EN, label=Table 3, caption=

Occupational distribution characteristics of relapsed pulmonary tuberculosis patients, 2011-2024

, figureFileSmall=null, figureFileBig=null, tableContent=
职业报告病例数（例）构成比
（%）
农民9 32079.57
离退人员7556.46
家政、家务及待业6155.24
工人2632.24
其它2251.91
干部职员1291.1
学生1191.01
不详840.71
民工750.64
商业服务530.47
教师310.26
医务人员280.24
牧民50.04
餐饮食品业 40.03
公共场所服务员40.03
海员及长途驾驶员40.03
渔（船）民10.01
合计11 715100.00
), ArticleFig(id=1311350072261050664, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350068863664380, language=CN, label=表3, caption=

2011—2024年复发肺结核患者职业分布特征

, figureFileSmall=null, figureFileBig=null, tableContent=
职业报告病例数（例）构成比
（%）
农民9 32079.57
离退人员7556.46
家政、家务及待业6155.24
工人2632.24
其它2251.91
干部职员1291.1
学生1191.01
不详840.71
民工750.64
商业服务530.47
教师310.26
医务人员280.24
牧民50.04
餐饮食品业 40.03
公共场所服务员40.03
海员及长途驾驶员40.03
渔（船）民10.01
合计11 715100.00
), ArticleFig(id=1311350072340742441, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350068863664380, language=EN, label=Table 4, caption=

Consultation delay status of relapsed pulmonary tuberculosis patients, 2011-2024

, figureFileSmall=null, figureFileBig=null, tableContent=
年份
（年）		复发患者数（例）就诊延迟数（例）就诊延迟率（%）APC［%,（95%CI）］P值AAPC［%,（95%CI）］P值
20111 47097466.26
20121 06968363.89
201390454259.96
201479950062.58
201572145763.38
201686850458.06
20171 00351351.15-2.50（-3.30～-1.69）<0.001-2.50（-3.30～-1.69）<0.001
20181 07456752.79
201997049450.93
202061433754.89
202158029450.69
202249024048.98
202357625343.92
202457731153.90
合计11 7156 66956.93
), ArticleFig(id=1311350072420434218, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350068863664380, language=CN, label=表4, caption=

2011—2024年复发肺结核患者就诊延迟情况

, figureFileSmall=null, figureFileBig=null, tableContent=
年份
（年）		复发患者数（例）就诊延迟数（例）就诊延迟率（%）APC［%,（95%CI）］P值AAPC［%,（95%CI）］P值
20111 47097466.26
20121 06968363.89
201390454259.96
201479950062.58
201572145763.38
201686850458.06
20171 00351351.15-2.50（-3.30～-1.69）<0.001-2.50（-3.30～-1.69）<0.001
20181 07456752.79
201997049450.93
202061433754.89
202158029450.69
202249024048.98
202357625343.92
202457731153.90
合计11 7156 66956.93
), ArticleFig(id=1311350072504320299, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350068863664380, language=EN, label=Table 5, caption=

Treatment outcomes of relapsed pulmonary tuberculosis patients, 2011-2024

, figureFileSmall=null, figureFileBig=null, tableContent=
年份
（年）		治疗成功数（例）治疗成功率（%）APC［%,（95%CI）］P值AAPC［%,（95%CI）］P值
完成疗程数（例）治愈数（例）
20113031 02690.41
201227966688.40
201329148085.29
201433231681.10
201541523490.01
201665013690.55
201762022584.25-1.43（-2.04～-0.82）<0.001-1.43（-2.04～-0.82）<0.001
201854236384.26
201942135379.79
202022523174.27
202118827479.66
202216122177.96
202316528277.60
202413627270.71
合计4 7285 07982.41
), ArticleFig(id=1311350072592400684, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350068863664380, language=CN, label=表5, caption=

2011—2024年复发肺结核患者治疗转归情况

, figureFileSmall=null, figureFileBig=null, tableContent=
年份
（年）		治疗成功数（例）治疗成功率（%）APC［%,（95%CI）］P值AAPC［%,（95%CI）］P值
完成疗程数（例）治愈数（例）
20113031 02690.41
201227966688.40
201329148085.29
201433231681.10
201541523490.01
201665013690.55
201762022584.25-1.43（-2.04～-0.82）<0.001-1.43（-2.04～-0.82）<0.001
201854236384.26
201942135379.79
202022523174.27
202118827479.66
202216122177.96
202316528277.60
202413627270.71
合计4 7285 07982.41
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陕西省2011—2024年复发肺结核患者流行病学特征及转归情况分析
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许静 1 , 张琳 1 , 马煜 1 , 郭宁 2
现代预防医学 | 流行病与统计方法 2026,53(14): 2546-2552
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现代预防医学 |流行病与统计方法 2026 , 53 (14) : 2546 -2552
陕西省2011—2024年复发肺结核患者流行病学特征及转归情况分析
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许静（1982-），女，硕士，副主任医师，研究方向：结核病控制

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许静（1982-），女，硕士，副主任医师，研究方向：结核病控制

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许静1, 张琳1, 马煜1, 郭宁2
作者信息
  • 1.陕西省疾病预防控制中心，陕西 西安 710054
  • 2.空军军医大学第一附属医院放射科
通讯作者:
郭宁，E-mail:
作者简介:

许静（1982-），女，硕士，副主任医师，研究方向：结核病控制

Epidemiological characteristics and treatment outcomes of recurrent pulmonary tuberculosis patients, Shaanxi, 2011-2024
Jing XU1, Lin ZHANG1, Yu MA1, Ning GUO2
Affiliations
  • Shaanxi Center for Disease Control and Prevention, Xi’an, Shaanxi 710054, China
出版时间: 2026-07-25 doi: 10.20043/j.cnki.MPM.202603130
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摘要
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目的

回顾性分析2011—2024年陕西省复发肺结核患者流行病学特征及治疗转归情况，为陕西省复发肺结核防治及策略研究提供科学依据。

方法

收集2011—2024年陕西省"结核病信息管理系统"中登记的全部复发肺结核患者资料，采用描述性流行病学方法分析其流行病学特征，运用Joinpoint回归模型进行时间趋势分析。

结果

2011—2024年陕西省累计报告复发肺结核患者11 715例，全省复发肺结核登记率由2011年3.94/10万下降至2024年1.46/10万，整体呈显著下降趋势［平均年度变化百分比（average annual percentage change，AAPC）=-8.6%, P<0.05）。患者来源结构发生根本转变，主要构成从“直接就诊”（2011年占52.45%）转变为“转诊”（2020年构成比达峰值73.13%）。在研究期间，复发患者累计阳性率为56.18%，显著高于全人群患者的35.91%，差异具有统计学意义（χ2=1 983.846, P<0.05）。人群分布特征显示，复发肺结核患者集中于40~64岁男性农民群体，累计占比达36.46%。同时，复发肺结核患者虽年均就诊延迟率56.93%，但研究期间呈持续改善趋势（AAPC=-2.50%, P<0.05）。治疗转归分析显示，2011—2024年复发肺结核患者累计治疗成功率为82.41%，然而Joinpoint回归提示其呈显著下降趋势（AAPC=-1.43%, P<0.05）。

结论

陕西省复发肺结核疫情整体呈下降趋势，但病原学阳性率显著高于全人群，且患者来源结构改变。复发患者集中于中老年男性农民，治疗成功率呈下降趋势，提示复发患者的治疗与管理仍存在薄弱环节。建议加强针对农民等高危人群的主动筛查与健康管理；强化转诊网络，减少就诊延迟；提升复发患者的治疗管理质量，提高治疗成功率。

复发  /  肺结核  /  流行特征
Objective

To retrospectively analyze the epidemiological characteristics and treatment outcomes of patients with recurrent pulmonary tuberculosis in Shaanxi Province from 2011 to 2024, so as to provide a scientific basis for the prevention and control of recurrent pulmonary tuberculosis and the formulation of relevant strategies in Shaanxi Province.

Methods

The medical records of all patients with recurrent pulmonary tuberculosis registered in the Tuberculosis Information Management System (TIMS) of Shaanxi Province from 2011 to 2024 were collected. Descriptive epidemiological methods were used to analyze the epidemiological characteristics of the subjects, chi-square test was used for inter-group comparison, and Joinpoint regression model was applied for time trend analysis.

Results

A total of 11 715 patients with recurrent pulmonary tuberculosis were cumulatively reported in Shaanxi Province from 2011 to 2024. The registration rate of recurrent pulmonary tuberculosis in the province decreased from 3.94/100 000 population in 2011 to 1.46/100 000 population in 2024, showing an overall significant downward trend (AAPC=-8.6%, P<0.05). The composition of patient detection sources underwent a fundamental shift: the dominant detection route changed from “direct consultation” (accounting for 52.45% in 2011) to “referral”(with the proportion peaking at 73.13% in 2020). During the study period, the cumulative etiologically positive rate of recurrent patients was 56.18%, which was significantly higher than 35.91% of all notified pulmonary tuberculosis patients in the general population, with a statistically significant difference (χ2=1 983.846, P<0.05). The demographic characteristics showed that patients with recurrent pulmonary tuberculosis were predominantly concentrated in male farmers aged 40-64 years, accounting for a cumulative 36.46% of all enrolled subjects. Meanwhile, although the average annual consultation delay rate of recurrent patients was 56.93%, it showed a significant continuous downward trend during the study period (AAPC=-2.50%, P<0.05). Treatment outcome analysis showed that the cumulative treatment success rate of patients with recurrent pulmonary tuberculosis from 2011 to 2024 was 82.41%, while Joinpoint regression indicated a significant downward trend of this rate (AAPC=-1.43%, P<0.05).

Conclusion

The epidemic of recurrent pulmonary tuberculosis in Shaanxi Province has shown an overall downward trend, but the etiologically positive rate is significantly higher than that of all notified pulmonary tuberculosis patients, and the composition of patient detection sources has changed dramatically. Recurrent patients are concentrated in middle-aged and elderly male farmers, and the treatment success rate is on a downward trend, suggesting that there are still weak links in the treatment and management of recurrent patients. It is recommended to strengthen active screening and health management for high-risk groups such as farmers, optimize the referral network to reduce consultation delay, and improve the quality of treatment and management for recurrent patients to increase the treatment success rate.

Recurrence  /  Pulmonary tuberculosis  /  Epidemiological characteristics
许静, 张琳, 马煜, 郭宁. 陕西省2011—2024年复发肺结核患者流行病学特征及转归情况分析. 现代预防医学, 2026 , 53 (14) : 2546 -2552 . DOI: 10.20043/j.cnki.MPM.202603130
Jing XU, Lin ZHANG, Yu MA, Ning GUO. Epidemiological characteristics and treatment outcomes of recurrent pulmonary tuberculosis patients, Shaanxi, 2011-2024[J]. Modern Preventive Medicine, 2026 , 53 (14) : 2546 -2552 . DOI: 10.20043/j.cnki.MPM.202603130
正文
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肺结核是由结核分枝杆菌引起的慢性呼吸道传染病，目前已成为全球单一传染源致死人数最多的疾病[1-2]，是全球重大公共卫生威胁之一。尽管全球结核病发病率在2023至2024年间出现小幅下降，且耐药结核病负担自2015年起持续减轻，但无论是结核高负担还是低负担国家，肺结核复发已成为阻碍结核消除的关键挑战[3]，并给患者健康、家庭经济及社会防控带来沉重负担。全球范围及中国不同地区复发情况不尽相同[4-8]，目前陕西省有关复发肺结核患者情况的研究十分有限。本研究基于2011年1月1日至2024年12月31日陕西省登记在册的复发肺结核患者信息开展分析，为肺结核的复发及防治提供科学依据。
1　资料和方法
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1.1　资料来源
从《全民健康保障信息化工程疾病预防控制信息系统》的子系统《结核病管理信息系统》中按照登记分类，查询2011年1月-2024年的复发肺结核患者。人口学资料来源于《陕西省统计年鉴》。
1.2　研究方法
采用 Excel 2019 软件建立数据库，完成数据清理、核对与逻辑校验。使用SPSS 25.0 软件进行统计学分析，计数资料采用绝对数、率、构成比进行描述性分析。采用 Joinpoint Regression Program 4.8.0.1 软件开展时间趋势分析：以年份为自变量，复发患者登记率、人群占比、病原学阳性率、就诊延迟率等指标为因变量，拟合对数线性模型；通过置换检验（Permutation Test）筛选最优拐点数量，设定最大拐点数量为 2、拐点间最小观察值为 2，检验水准α=0.05；分别计算各趋势段的年度变化百分比（Annual Percent Change, APC）、全研究周期的平均年度变化百分比（Average Annual Percent Change, AAPC）及其95%置信区间（95%CI）。
1.3　定义 [9]
1.3.1　复发
指既往有明确肺结核规范治疗史，完成规定抗结核疗程并被判定为治愈，此次再次出现肺结核可疑症状，经病原学检查和（或）影像学检查确诊为活动性肺结核的患者。
1.3.2　治愈
病原学阳性肺结核患者完成规定的疗程，在治疗最后一个月末，以及上一次的涂片或培养结果为阴性。
1.3.3　完成疗程
病原学阴性患者完成规定的疗程，治疗末痰涂片或培养结果阴性或未痰检；病原学阳性患者完成规定疗程，疗程结束时无痰检结果，但在最后一次痰涂片或培养结果为阴性。
1.3.4　治疗成功
包括治愈和完成疗程。
1.3.5　病原学阳性肺结核
指符合以下任意一项者：① 痰涂片抗酸杆菌染色阳性；② 结核分枝杆菌培养阳性；③ 结核分枝杆菌核酸检测阳性。
1.3.6　就诊延迟
患者从出现肺结核临床症状至首次就诊于相关医疗机构的时间间隔超过14天。
2　结果
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2.1　复发肺结核患者登记情况
2011—2024年，全省复发肺结核患者登记率由3.94/10万下降至1.46/10万（AAPC为-8.6%（95%CI：-15.7%~-0.9%，P<0.05）其中，2011—2014年、2018—2024年的年度变化百分比（APC）分别为-19.83%（95%CI：-35.37%~-0.56%，P<0.05）和12.49%（95%CI：-20.24%~ -3.99%，P<0.05）。见表1。
2.2　复发肺结核患者来源情况
2011—2024年，全省复发肺结核患者主要来源从“直接就诊”（2011年占52.45%）转变为“转诊”（2020年峰值占73.13%）。自2017年起“转诊“成为主要来源。同期，“追踪”占比从2011年14.90%，降至2017年6.18%，后2024 年回升至14.73%；“推介”占比从 2011年的6.33% 持续走低，2016 年起基本维持在1% 以下的较低水平；“健康检查”、“主动筛查”及“其他”占比全程维持在较低水平，14年间合计占比分别仅为 0.57%、0.09% 和 0.20%。见表2。
2.3　复发肺结核患者病原学阳性率情况
2011—2024年，复发患者的累计病原学阳性率为56.18%。整个观察期间的AAPC为-0.3%（95%CI：-3.2%~2.5%，P=0.80），但2011-2016年病原学阳性率呈下降趋势，2016—2019年、2019—2024年病原学阳性率呈上升趋势，APC分别为 -18.90%（95%CI：-21.02%~-16.72%，P<0.05）、 28.65%（95%CI：11.93%~47.87%，P<0.05）和5.04%（95%CI：1.93%~8.25%，P<0.05）。见表1，图1。
2.4　复发肺结核患者人群分布特征
2011—2024年，全省累计11 715例复发患者中，男性8 626例（72.12%），女性3 089例（27.88%），男女性别比为2.79:1。40～64岁年龄组患者最多，累计5 585例，占总体的47.67%（其中男性36.46%，女性11.21%）。其次为≥65岁组，累计3 509例（29.96%），18～39岁组2 565例（21.89%），而<18岁组患者最少，仅56例，占总体的0.48%。男性患者的总体构成比从2011年的69.86% 波动上升至2024年的76.84%；≥65岁男性患者从2011年的19.52% 增长至2024年的27.73%；同时，40～64岁女性患者的构成比则从期初的14.83% 逐步下降至2024年的6.24%。
2011—2024年累计报告的复发肺结核患者中以农民为主，共报告9 320例（79.57%），其次为离退人员755例（6.46%）和家政、家务及待业人员615例（5.24%）。上述前三类职业的累计构成比已超达91.27%。见表3。
2.5　复发肺结核患者就诊延迟变化趋势
2011—2024年累计报告的11 715例复发肺结核患者中，就诊延迟6 669例，年均就诊延迟率56.93%。2011年就诊延迟率为66.26%，2024年下降为53.90%，APC与AAPC均为-2.50%（95%CI: -3.30%~1.69%, P<0.05）。见表4。
2.6　复发肺结核患者治疗转归情况
2011—2024年复发患者累计治疗成功9 654例，总体治疗成功率为82.41%。治疗成功率从2011年的90.41% 波动性下降至2024年的70.71%，APC与AAPC均为-1.43%（95%CI: -2.04%~0.82%, P<0.05）。见表5。
3　讨论
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本研究分析了2011—2024年陕西省复发肺结核患者的基本流行病学特征与治疗转归情况。2011—2024年，陕西省复发肺结核登记率年均下降8.6%，反映出全省结核病整体防控的成效，这一趋势与全国复发率下降的背景相符。值得注意的是，研究期间患者来源结构发生根本转变，由2011年的“直接就诊”为主（52.45%）转变为2020年的以"转诊"为主（73.13%），这可能与三级诊疗体系推进、基层筛查力度加大以及非定点医院转诊规范化有关。多项研究表明，“转诊”流程可能因机构间衔接不畅而导致就诊延迟[10-11]。然而在本研究中，尽管“转诊”已成为复发患者最主要的发现方式（2020年构成比达73.13%），但同期年均就诊延迟率却呈持续下降趋势（AAPC=-2.50%，P<0.05），提示我省以“转诊”为主的病人发现模式过程中，体现了转诊流程的规范化、基层医疗机构结核病识别能力的提升、以及患者健康意识的增强，有效抵消了因转诊环节增多可能带来的延迟风险。2024年就诊延迟率出现小幅回升，可能的原因：一是患者发现方式出现变化，2024年追踪病例占比回升至14.73%，此类方式发现的病例易因自身认知不足延误就诊；二是高危人群占比持续攀升，2024 年男性患者构成比达76.84%、≥65 岁男性患者占比达27.73%，均为研究期间峰值，而中老年男性农民作为就诊延迟高危群体，其占比升高直接推高了整体延迟就诊率。该回升仍警示我们，必须针对性加强复发高危人群的结核病健康教育，同时加大老年男性等重点群体的主动筛查力度，从源头减少就诊延迟。
在本研究中，复发肺结核患者累计病原学阳性率达56.18%，这一结果凸显了复发患者作为传染源的重要流行病学意义：其较高的病原学阳性率提示复发患者体内结核分枝杆菌繁殖活性更强，传播风险更高。从时间趋势分析发现，复发及全人群患者的病原学阳性率均呈现明显的“V”形波动，这一现象可能与2015年省政府办公厅制定并发布了《关于进一步做好重点传染病防控工作的通知》有关，文件中提出设立专门的医院进行结核病的诊断治疗工作，并由疾病预防控制中心全权执行监督指导、信息管控及疾病防控反馈数据评估等任务。 转型初期病原学阳性率下降的关键原因：其一，检测设备配置滞后，结核病专项检测设备未及时配齐，部分医院需将样本送至疾控中心代检，运输与交接过程中样本质量受损，导致阳性检出率下降；其二，专业人员能力不足，定点医院医务人员初期缺乏结核病检测专项培训，判读过程中假阴性率较高。随后，随着诊疗体系逐步完善，全省加快推进分子诊断技术在定点医院的普及应用，同时加强实验室能力建设与质量控制，从而使阳性率逐步回升。因此，“V”形轨迹实质上反映了体系转型期间检测能力与质量的动态变化过程，也进一步说明，持续强化医疗机构实验室标准化建设、推广灵敏可靠的检测技术，是提高结核病患者病原学诊断水平、保障监测数据质量的关键举措。
人群分布特征显示，陕西省复发肺结核男性患者构成比从2011年的69.86%波动上升至2024年的76.84%，且集中于40-64岁男性农民群体（累计占比36.46%），这与全国多数省份"男性、中老年、农民为复发高危人群"的分布特点相符[12-14]。可能与男性作为家庭主要劳动力、社会活动范围较广导致暴露机会增多、精神压力较大以及某些不良行为等因素有关[15]。≥65岁患者占比近30%，提示老龄化也可能是复发的重要影响因素。中老年农民常因劳动强度大、收入与文化水平较低、健康意识薄弱、居住与饮食条件较差、医疗服务可及性不足等因素，易导致治疗依从性降低，从而增加复发风险[16-18]。综上，陕西省复发肺结核患者集中表现为“男性、中老年、农民”的人群特征，提示未来防控工作须进一步聚焦农村地区，制定并实施更具针对性的干预措施，从而有效降低复发风险，提升整体防治效果。
陕西省复发肺结核患者年均就诊延迟率为56.93%，虽呈持续下降趋势（AAPC=-2.50%，P<0.05），但仍高于全国平均水平（52.2%）及西部地区平均水平（41.24%）[19-20]。就诊延迟不仅可能导致患者病情加重，也会增加社区传播范围风险[21]，其成因可能涉及基层医疗机构对肺结核症状的识别能力有限、农村地区患者就医便利性差、患者对复发症状认知不足、宣传不到位等多重因素[20,22-26]。
陕西省2011—2024年复发肺结核的累计治疗成功率为82.41%，但呈现显著的下降趋势（AAPC=-1.43%, P<0.05），从2011年的90.41%波动下降至2024年的70.71%。治疗成功率的下降是多重因素作用的结果：首先，复发患者中高龄人群占比较高，我省复发患者中中老年人群就占了77.63%，而年龄是治疗成功的重要阻碍因素[27-28]；其次，多篇报道复治患者因既往用药史，发展成耐药结核的风险显著增加，不良结局风险约为初治患者的2.010倍[29-31]。此外，患者长期治疗带来的药物副作用及由此引发的治疗依从性不足，也是不可忽视的挑战[32]。
本研究局限在于依赖于结核病信息管理系统的登记数据，可能存在部分患者信息缺失或录入误差的情况；此外，研究未深入分析耐药性、治疗依从性等影响复发与治疗转归的具体因素，未来需开展前瞻性研究进一步探索。
综上所述，2011—2024年陕西省复发肺结核防控取得一定成效，但病原学阳性率仍然较高，且治疗成功率持续下降，患者高度集中于40~64岁男性农民。基于此，未来的工作重点应转为：加强中老年男性农民主动筛查，以提早发现病例；在治疗环节，需普及药敏检测和落实全程督导来提升管理质量，提高治疗成功率；此外，还应通过多部门协作来完善社会支持体系，切实帮助患者完成治疗。这些综合措施是控制复发、减轻疾病负担，并最终迈向结核病消除的关键。

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2026年第53卷第14期
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doi: 10.20043/j.cnki.MPM.202603130
  • 接收时间：2026-03-09
  • 首发时间：2026-09-28
  • 出版时间：2026-07-25
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    1.陕西省疾病预防控制中心，陕西 西安 710054
    2.空军军医大学第一附属医院放射科

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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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