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Article(id=1241034447336820984, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202501066, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1736092800000, receivedDateStr=2025-01-06, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773815269550, onlineDateStr=2026-03-18, pubDate=1749484800000, pubDateStr=2025-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773815269550, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773815269550, creator=13701087609, updateTime=1773815269550, updator=13701087609, issue=Issue{id=1241034441380917539, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773815268130, creator=13701087609, updateTime=1773815340947, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241034746873049765, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241034746873049766, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2090, endPage=2095, ext={EN=ArticleExt(id=1241034447689142555, articleId=1241034447336820984, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of factors affecting delays in diagnosis and treatment of tuberculosis in Xizang: monitoring from 2014 to 2023, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To describe the trends in treatment and diagnosis delays for tuberculosis patients in Xizang from 2014 to 2023 and to explore the influencing factors, providing a scientific basis for tuberculosis prevention and control in Xizang.

Methods

Tuberculosis patients diagnosed between 2014 and 2023 in Xizang were selected from the “Tuberculosis Management Information System” sub-system of the “China Disease Prevention and Control Information System”. The factors influencing treatment and diagnosis delays were analyzed using univariate χ2 tests and multivariate logistic regression analysis.

Results

Among the 34 469 reported tuberculosis patients in Xizang from 2014 to 2023, the median (interquartile range) time from symptom onset to first consultation (treatment delay) was 24 (10, 46) days, with a treatment delay rate of 67.5%; the median (interquartile range) time from first consultation to diagnosis (diagnosis delay) was 0 (0, 1) days, with a diagnosis delay rate of 7.6%. The treatment delay rate showed a downward trend from 2014 to 2023 (trend χ2=1 798.083, P<0.001), while the diagnosis delay rate exhibited an upward trend (trend χ2=197.689, P<0.001). Multivariate logistic regression analysis indicated that being aged ≤20 years, 21-40 years, having local residency, undergoing health examinations, lacking microbiological results, and the first consultation being in Lhasa, Linzhi, Naqu, or Ali regions were protective factors for treatment delay.Seeking treatment based on symptoms, referrals, being a farmer or herdsman, being a child or student, and the first consultation being in Shigatse or Changdu were risk factors for treatment delay. Recommendations based on symptoms and first consultation in Shigatse, Changdu, or Naqu were protective factors for diagnosis delay. Local residency and first consultation in Lhasa were risk factors for diagnosis delay.

Conclusion

There is a serious delay in treatment among tuberculosis patients in Xizang, while the level of diagnosis delay is relatively low. It is recommended to enhance tuberculosis awareness and education among key populations and improve the diagnostic and treatment capabilities of grassroots medical institutions to reduce delays in treatment and diagnosis for tuberculosis patients.

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目的

描述2014—2023年西藏肺结核患者就诊和诊断延迟趋势，并探讨其影响因素，为西藏肺结核防控提供科学依据。

方法

在“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”中选取登记日期2014—2023年且确诊地区为西藏的肺结核患者，采用单因素χ2检验和多因素logistic回归分析就诊和诊断延迟的影响因素。

结果

2014—2023年西藏报告的34 469例肺结核患者中，就诊时间（症状出现日期到首诊日期之间的时间间隔）的中位数（四分位数）为24（10,46) d，就诊延迟率为67.5%；诊断时间（首诊日期至确诊日期的时间间隔）中位数（四分位数）为0（0,1）d，诊断延迟率为7.6%。2014—2023年就诊延迟率呈下降趋势（趋势χ2=1 798.083，P<0.001），诊断延迟率呈上升趋势（趋势χ2=197.689，P<0.001）。多因素logistic分析结果显示，≤20岁、21～40岁、本地户籍、健康体检、无病原学结果、首诊地区为拉萨市、林芝市、那曲市和阿里地区是就诊延迟的保护因素。因症就诊、因症推荐、转诊、农牧民、儿童及学生、首诊地区为日喀则市和昌都市是就诊延迟的危险因素。因症推荐、首诊地区为日喀则市、昌都市和那曲市是诊断延迟的保护因素。本地户籍、首诊地区为拉萨市是诊断延迟的危险因素。

结论

西藏肺结核患者就诊延迟情况较为严重，诊断延迟水平较低。建议针对重点人群，加强结核病宣传教育，提高基层医疗机构结核病诊疗水平，从而减少肺结核患者就诊及诊断延迟的发生。

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赵英，E-mail:
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桑素娟（1989—），女，硕士，主管护师，研究方向：结核病临床护理和科研工作

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桑素娟（1989—），女，硕士，主管护师，研究方向：结核病临床护理和科研工作

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桑素娟（1989—），女，硕士，主管护师，研究方向：结核病临床护理和科研工作

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Disease Surveillance, 2024, 39(4):1003-9961.(In Chinese), articleTitle=Analysis of treatment-seeking and diagnostic delays among pulmonary tuberculosis patients in Gansu Province:Surveillance data from 2016 to 2022, refAbstract=null)], funds=[Fund(id=1241050835921195357, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, awardId=23XMZ057, language=CN, fundingSource=国家社会科学基金项目(23XMZ057), fundOrder=null, country=null), Fund(id=1241050836059607393, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, awardId=null, language=CN, fundingSource=国家疾控局“揭榜”调研课题, fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241050823636079491, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, xref=1., ext=[AuthorCompanyExt(id=1241050823648662406, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, companyId=1241050823636079491, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Pulmonary Tuberculosis, Third People’s Hospital of Xizang Autonomous Region, Lhasa, Xizang 850000, China), AuthorCompanyExt(id=1241050823661245320, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, companyId=1241050823636079491, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.西藏自治区第三人民医院结核一科，西藏 拉萨 850000)]), AuthorCompany(id=1241050825208943508, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, xref=2., ext=[AuthorCompanyExt(id=1241050825217332119, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, companyId=1241050825208943508, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.西藏自治区第三人民医院院部)]), AuthorCompany(id=1241050825569653663, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, xref=3., ext=[AuthorCompanyExt(id=1241050825578042270, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, companyId=1241050825569653663, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.武警山东总队医院泌尿外科)]), AuthorCompany(id=1241050825712260010, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, xref=4., ext=[AuthorCompanyExt(id=1241050825724842925, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, companyId=1241050825712260010, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.西藏民族大学 医学部基础研究院)]), AuthorCompany(id=1241050825863254964, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, xref=5., ext=[AuthorCompanyExt(id=1241050825871643574, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, companyId=1241050825863254964, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=5.西藏自治区第三人民医院护理部，西藏 拉萨 850000)])], figs=[ArticleFig(id=1241050833861792025, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, language=EN, label=Table 1, caption=

Univariate analysis of delays in treatment-seeking and diagnosis among pulmonary tuberculosis patients in Xizang, 2014—2023 ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量组别患者总数就诊延迟诊断延迟
例数（延迟率）χ2值P值例数（延迟率）χ2值P值
总体34 46923 283（67.5）2 609（7.6）
性别男19 321(56.1)13 125（67.9）2.9510.0861 470(7.6)0.0960.756
女15 148(43.9)10 158（67.0）1 139(7.5)
年龄（岁）≤203 044(8.8)1 538（50.5)628.712<0.001221(7.3)25.314<0.001
21~4013 514(39.2)8 814(65.2)912(6.7)
41~608 948(26.0)6 333(70.7)727(8.1)
≥618 963(26.0)6 598(73.6)749(8.4)
民族藏族33 864(98.2)22 988(67.9)99.156<0.0012 569(7.6)0.8070.369
汉族及其他少数民族605(1.8)295(48.7)40(6.6)
户籍地本地户籍30 521(88.5)20 845(68.3)68.303<0.0012 414(7.9)44.078<0.001
非本地户籍3 948(11.5)2 438(61.7)195(4.9)
职业农牧民24 031(69.7)17 225(71.7)633.295<0.0011 872(7.8)13.0800.001
儿童及学生7 254(21.1)4 123(56.8)478(6.6)
其他劳动者3 184(9.2)1 935(60.7)259(8.1)
患者来源健康体检717(2.1)266(37.1)898.637<0.00157(7.9)119.627<0.001
因症推荐1 605(4.7)1 252(78.0)159(9.9)
因症就诊15 444(44.8)11 256(72.9)932(6.0)
主动筛查126(0.4)52(41.3)11(8.7)
转诊9 517(27.6)6 324(66.4)891(9.4)
追踪6 854(19.8)3 993(58.2)531(7.7)
其他206(0.6)140(67.9)28(13.6)
治疗分类初治31 577(91.6)21 315(67.5)0.3630.5472 368(7.5)2.6350.105
复治2 892(8.4)1 968(68.0)241(8.3)
病原学结果阳性6 300(18.3)4 319(68.5)219.359<0.001483(7.7)4.5940.101
阴性25 187(73.0)17 312(68.7)1 872(7.4)
无结果2 982(8.7)1 652(55.4)254(8.5)
首诊地区拉萨市3 179(9.2)2 016(63.4)1 843.187<0.001354(11.1)137.235<0.001
林芝市3 084(9.0)1 378(44.7)236(7.7)
山南市3 149(9.1)2 256(71.6)296(9.4)
日喀则市7 930(23.0)5 980(75.4)641(8.1)
昌都市10 489(30.4)7 967(75.9)613(5.8)
那曲市5 827(16.9)3 332(57.2)385(6.6)
阿里地区811(2.4)354(43.6)84(10.4)
), ArticleFig(id=1241050833987621157, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, language=CN, label=表1, caption=

2014—2023年西藏肺结核患者就诊及诊断延迟的单因素分析［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量组别患者总数就诊延迟诊断延迟
例数（延迟率）χ2值P值例数（延迟率）χ2值P值
总体34 46923 283（67.5）2 609（7.6）
性别男19 321(56.1)13 125（67.9）2.9510.0861 470(7.6)0.0960.756
女15 148(43.9)10 158（67.0）1 139(7.5)
年龄（岁）≤203 044(8.8)1 538（50.5)628.712<0.001221(7.3)25.314<0.001
21~4013 514(39.2)8 814(65.2)912(6.7)
41~608 948(26.0)6 333(70.7)727(8.1)
≥618 963(26.0)6 598(73.6)749(8.4)
民族藏族33 864(98.2)22 988(67.9)99.156<0.0012 569(7.6)0.8070.369
汉族及其他少数民族605(1.8)295(48.7)40(6.6)
户籍地本地户籍30 521(88.5)20 845(68.3)68.303<0.0012 414(7.9)44.078<0.001
非本地户籍3 948(11.5)2 438(61.7)195(4.9)
职业农牧民24 031(69.7)17 225(71.7)633.295<0.0011 872(7.8)13.0800.001
儿童及学生7 254(21.1)4 123(56.8)478(6.6)
其他劳动者3 184(9.2)1 935(60.7)259(8.1)
患者来源健康体检717(2.1)266(37.1)898.637<0.00157(7.9)119.627<0.001
因症推荐1 605(4.7)1 252(78.0)159(9.9)
因症就诊15 444(44.8)11 256(72.9)932(6.0)
主动筛查126(0.4)52(41.3)11(8.7)
转诊9 517(27.6)6 324(66.4)891(9.4)
追踪6 854(19.8)3 993(58.2)531(7.7)
其他206(0.6)140(67.9)28(13.6)
治疗分类初治31 577(91.6)21 315(67.5)0.3630.5472 368(7.5)2.6350.105
复治2 892(8.4)1 968(68.0)241(8.3)
病原学结果阳性6 300(18.3)4 319(68.5)219.359<0.001483(7.7)4.5940.101
阴性25 187(73.0)17 312(68.7)1 872(7.4)
无结果2 982(8.7)1 652(55.4)254(8.5)
首诊地区拉萨市3 179(9.2)2 016(63.4)1 843.187<0.001354(11.1)137.235<0.001
林芝市3 084(9.0)1 378(44.7)236(7.7)
山南市3 149(9.1)2 256(71.6)296(9.4)
日喀则市7 930(23.0)5 980(75.4)641(8.1)
昌都市10 489(30.4)7 967(75.9)613(5.8)
那曲市5 827(16.9)3 332(57.2)385(6.6)
阿里地区811(2.4)354(43.6)84(10.4)
), ArticleFig(id=1241050834075701554, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, language=EN, label=Table 2, caption=

Status of treatment-seeking and diagnostic delays among pulmonary tuberculosis patients in Xizang, 2014—2023 ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
年份（年）患者
总数		就诊延迟
例数（延迟率）		诊断延迟
例数（延迟率）
20144 0693 304(81.2)265(6.5)
20153 7272 912(78.1)241(6.5)
20163 5322 712(76.8)189(5.4)
20173 6302 570(70.8)277(7.6)
20183 6602 556(69.8)231(6.3)
20193 6862 376(64.5)290(7.9)
20203 9482 507(63.5)291(7.4)
20213 5932 186(60.8)255(7.1)
20222 2771 199(52.3)284(12.5)
20232 347970(41.5)286(12.2)
总数34 46923 283(67.5)2 609(7.6)
χ2趋势—1 798.083197.689
P值—<0.001<0.001
), ArticleFig(id=1241050834214113591, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, language=CN, label=表2, caption=

2014—2023年西藏肺结核患者就诊和诊断延迟情况［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
年份（年）患者
总数		就诊延迟
例数（延迟率）		诊断延迟
例数（延迟率）
20144 0693 304(81.2)265(6.5)
20153 7272 912(78.1)241(6.5)
20163 5322 712(76.8)189(5.4)
20173 6302 570(70.8)277(7.6)
20183 6602 556(69.8)231(6.3)
20193 6862 376(64.5)290(7.9)
20203 9482 507(63.5)291(7.4)
20213 5932 186(60.8)255(7.1)
20222 2771 199(52.3)284(12.5)
20232 347970(41.5)286(12.2)
总数34 46923 283(67.5)2 609(7.6)
χ2趋势—1 798.083197.689
P值—<0.001<0.001
), ArticleFig(id=1241050834453188927, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, language=EN, label=Table 3, caption=

Multivariate analysis of treatment-seeking and diagnostic delays among pulmonary tuberculosis patients in Xizang, 2014—2023

, figureFileSmall=null, figureFileBig=null, tableContent=
变量组别就诊延迟诊断延迟
OR值(95%CI)P值OR值(95%CI)P值
年龄（岁）≤200.500(0.449～0.556)<0.0011.137(0.937～1.381)1.194
21～400.865(0.810～0.925)<0.0010.905(0.808～1.014)0.084
41～60参考组参考组
≥611.053(0.983～1.127)0.1401.004(0.900～1.119)0.948
民族藏族1.152(0.967～1.373)0.113
汉族及其他少数民族参考组
户籍地本地户籍0.862(0.797～0.932)<0.001<0.0012.037(1.736～2.390)
非本地户籍参考组参考组
职业农牧民1.247(1.149～1.354)<0.0010.9770.998(0.867～1.149)
儿童及学生1.119(1.016～1.234)0.0230.0560.843(0.708～1.004)
其他劳动者参考组参考组
患者来源健康体检0.439(0.371～0.520)<0.0010.848(0.634～1.134)0.265
因症就诊2.080(1.815～2.384)<0.0010.902(0.742～1.098)0.304
因症推荐1.375(1.276～1.481)<0.0010.621(0.547～0.706)<0.001
主动筛查0.730(0.499～1.067)0.1040.913(0.485～1.718)0.777
转诊1.265(1.176～1.360)<0.0011.048(0.929～1.182)0.448
追踪参考组参考组
其他1.350(0.991～1.840)0.0571.402(0.926～2.120)0.110
病原学结果阳性1.053(0.983～1.127)0.140
阴性参考组
无结果0.773(0.710～0.842)<0.001
首诊地区拉萨市0.735(0.659～0.821)<0.0010.0131.238(1.047～1.464)
林芝市0.357(0.320～0.399)<0.0010.1110.861(0.716～1.035)
山南市参考组参考组
日喀则市1.186(1.078～1.304)<0.0010.0030.799(0.690～0.925)
昌都市1.454(1.322～1.598)<0.001<0.0010.633(0.544～0.738)
那曲市0.775(0.700～0.859)<0.001<0.0010.584(0.493～0.692)
阿里地区0.361(0.306～0.425)<0.0010.5131.091(0.841～1.416)
), ArticleFig(id=1241050834650321227, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447336820984, language=CN, label=表3, caption=

2014—2023年西藏肺结核患者就诊和诊断延迟的多因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量组别就诊延迟诊断延迟
OR值(95%CI)P值OR值(95%CI)P值
年龄（岁）≤200.500(0.449～0.556)<0.0011.137(0.937～1.381)1.194
21～400.865(0.810～0.925)<0.0010.905(0.808～1.014)0.084
41～60参考组参考组
≥611.053(0.983～1.127)0.1401.004(0.900～1.119)0.948
民族藏族1.152(0.967～1.373)0.113
汉族及其他少数民族参考组
户籍地本地户籍0.862(0.797～0.932)<0.001<0.0012.037(1.736～2.390)
非本地户籍参考组参考组
职业农牧民1.247(1.149～1.354)<0.0010.9770.998(0.867～1.149)
儿童及学生1.119(1.016～1.234)0.0230.0560.843(0.708～1.004)
其他劳动者参考组参考组
患者来源健康体检0.439(0.371～0.520)<0.0010.848(0.634～1.134)0.265
因症就诊2.080(1.815～2.384)<0.0010.902(0.742～1.098)0.304
因症推荐1.375(1.276～1.481)<0.0010.621(0.547～0.706)<0.001
主动筛查0.730(0.499～1.067)0.1040.913(0.485～1.718)0.777
转诊1.265(1.176～1.360)<0.0011.048(0.929～1.182)0.448
追踪参考组参考组
其他1.350(0.991～1.840)0.0571.402(0.926～2.120)0.110
病原学结果阳性1.053(0.983～1.127)0.140
阴性参考组
无结果0.773(0.710～0.842)<0.001
首诊地区拉萨市0.735(0.659～0.821)<0.0010.0131.238(1.047～1.464)
林芝市0.357(0.320～0.399)<0.0010.1110.861(0.716～1.035)
山南市参考组参考组
日喀则市1.186(1.078～1.304)<0.0010.0030.799(0.690～0.925)
昌都市1.454(1.322～1.598)<0.001<0.0010.633(0.544～0.738)
那曲市0.775(0.700～0.859)<0.001<0.0010.584(0.493～0.692)
阿里地区0.361(0.306～0.425)<0.0010.5131.091(0.841～1.416)
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西藏肺结核就诊及诊断延迟影响因素分析——2014—2023年监测
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桑素娟 1 , 严小松 2 , 毛雪雯 3 , 张金静 4 , 平措扎西 2 , 赵英 5
现代预防医学 | 疾病预防控制 2025,52(11): 2090-2095
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现代预防医学 | 疾病预防控制 2025, 52(11): 2090-2095
西藏肺结核就诊及诊断延迟影响因素分析——2014—2023年监测
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桑素娟1, 严小松2, 毛雪雯3, 张金静4, 平措扎西2, 赵英5
作者信息
  • 1.西藏自治区第三人民医院结核一科，西藏 拉萨 850000
  • 2.西藏自治区第三人民医院院部
  • 3.武警山东总队医院泌尿外科
  • 4.西藏民族大学 医学部基础研究院
  • 5.西藏自治区第三人民医院护理部，西藏 拉萨 850000

    • 桑素娟（1989—），女，硕士，主管护师，研究方向：结核病临床护理和科研工作

通讯作者:

赵英，E-mail:
Analysis of factors affecting delays in diagnosis and treatment of tuberculosis in Xizang: monitoring from 2014 to 2023
Su-juan SANG1, Xiao-song YAN2, Xue-wen MAO3, Jin-jing ZHANG4, Zha-xi PINGCUO2, Ying ZHAO5
Affiliations
  • Department of Pulmonary Tuberculosis, Third People’s Hospital of Xizang Autonomous Region, Lhasa, Xizang 850000, China
出版时间: 2025-06-10 doi: 10.20043/j.cnki.MPM.202501066
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摘要
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目的

描述2014—2023年西藏肺结核患者就诊和诊断延迟趋势，并探讨其影响因素，为西藏肺结核防控提供科学依据。

方法

在“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”中选取登记日期2014—2023年且确诊地区为西藏的肺结核患者，采用单因素χ2检验和多因素logistic回归分析就诊和诊断延迟的影响因素。

结果

2014—2023年西藏报告的34 469例肺结核患者中，就诊时间（症状出现日期到首诊日期之间的时间间隔）的中位数（四分位数）为24（10,46) d，就诊延迟率为67.5%；诊断时间（首诊日期至确诊日期的时间间隔）中位数（四分位数）为0（0,1）d，诊断延迟率为7.6%。2014—2023年就诊延迟率呈下降趋势（趋势χ2=1 798.083，P<0.001），诊断延迟率呈上升趋势（趋势χ2=197.689，P<0.001）。多因素logistic分析结果显示，≤20岁、21～40岁、本地户籍、健康体检、无病原学结果、首诊地区为拉萨市、林芝市、那曲市和阿里地区是就诊延迟的保护因素。因症就诊、因症推荐、转诊、农牧民、儿童及学生、首诊地区为日喀则市和昌都市是就诊延迟的危险因素。因症推荐、首诊地区为日喀则市、昌都市和那曲市是诊断延迟的保护因素。本地户籍、首诊地区为拉萨市是诊断延迟的危险因素。

结论

西藏肺结核患者就诊延迟情况较为严重，诊断延迟水平较低。建议针对重点人群，加强结核病宣传教育，提高基层医疗机构结核病诊疗水平，从而减少肺结核患者就诊及诊断延迟的发生。

结核  /  肺  /  就诊延迟  /  诊断延迟  /  影响因素  /  西藏
Objective

To describe the trends in treatment and diagnosis delays for tuberculosis patients in Xizang from 2014 to 2023 and to explore the influencing factors, providing a scientific basis for tuberculosis prevention and control in Xizang.

Methods

Tuberculosis patients diagnosed between 2014 and 2023 in Xizang were selected from the “Tuberculosis Management Information System” sub-system of the “China Disease Prevention and Control Information System”. The factors influencing treatment and diagnosis delays were analyzed using univariate χ2 tests and multivariate logistic regression analysis.

Results

Among the 34 469 reported tuberculosis patients in Xizang from 2014 to 2023, the median (interquartile range) time from symptom onset to first consultation (treatment delay) was 24 (10, 46) days, with a treatment delay rate of 67.5%; the median (interquartile range) time from first consultation to diagnosis (diagnosis delay) was 0 (0, 1) days, with a diagnosis delay rate of 7.6%. The treatment delay rate showed a downward trend from 2014 to 2023 (trend χ2=1 798.083, P<0.001), while the diagnosis delay rate exhibited an upward trend (trend χ2=197.689, P<0.001). Multivariate logistic regression analysis indicated that being aged ≤20 years, 21-40 years, having local residency, undergoing health examinations, lacking microbiological results, and the first consultation being in Lhasa, Linzhi, Naqu, or Ali regions were protective factors for treatment delay.Seeking treatment based on symptoms, referrals, being a farmer or herdsman, being a child or student, and the first consultation being in Shigatse or Changdu were risk factors for treatment delay. Recommendations based on symptoms and first consultation in Shigatse, Changdu, or Naqu were protective factors for diagnosis delay. Local residency and first consultation in Lhasa were risk factors for diagnosis delay.

Conclusion

There is a serious delay in treatment among tuberculosis patients in Xizang, while the level of diagnosis delay is relatively low. It is recommended to enhance tuberculosis awareness and education among key populations and improve the diagnostic and treatment capabilities of grassroots medical institutions to reduce delays in treatment and diagnosis for tuberculosis patients.

Tuberculosis  /  Pulmonary  /  Treatment delay  /  Diagnosis delay  /  Influencing factors  /  Xizang
桑素娟, 严小松, 毛雪雯, 张金静, 平措扎西, 赵英. 西藏肺结核就诊及诊断延迟影响因素分析——2014—2023年监测. 现代预防医学, 2025 , 52 (11) : 2090 -2095 . DOI: 10.20043/j.cnki.MPM.202501066
Su-juan SANG, Xiao-song YAN, Xue-wen MAO, Jin-jing ZHANG, Zha-xi PINGCUO, Ying ZHAO. Analysis of factors affecting delays in diagnosis and treatment of tuberculosis in Xizang: monitoring from 2014 to 2023[J]. Modern Preventive Medicine, 2025 , 52 (11) : 2090 -2095 . DOI: 10.20043/j.cnki.MPM.202501066
正文
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结核病是严重的公共卫生问题。2023年，全球新发病例1 080万例，创自1995年WHO启动全球结核病监测以来新高[1]。我国新发病例74.1万，结核病患者总数居全球第三位[1]。西藏肺结核发病率为105.70/10万，是全国平均发病率（52/10万）的二倍多，位居全国第三[1-2]。患者就诊和诊断延迟，会加重病情、错过最佳时机并增加人群感染风险，严重阻碍肺结核防控工作[3]。既往研究发现，不同地区的就诊延迟和诊断延迟情况存在较大差异，性别、年龄、职业、流动人口、首诊地区、患者来源、病原学结果等是就诊延迟的影响因素[4]。年龄、户籍地、职业、是否使用分子生物学诊断等是诊断延迟的影响因素[5]。
然而，鲜见西藏肺结核患者就诊延迟和诊断延迟的相关研究。本研究旨在描述西藏肺结核患者就诊和诊断延迟情况，并探索其影响因素，为西藏制定有针对性的降低就诊延迟和诊断延迟措施提供科学依据。
1　资料与方法
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1.1　资料来源
资料来源于“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”。收集2014年1月1日— 2023年12月31日首诊地区为西藏的肺结核患者病案数据，包括社会人口学信息、首诊地区、本次症状出现日期、本次首诊日期、确诊日期、患者来源、治疗分类、病原学结果。剔除患者诊断分型为非结核分枝杆菌病、肺外结核患者、数据缺失及逻辑错误的数据。
1.2　相关定义
就诊时间：指本次症状出现日期到本次首诊日期之间的时间间隔。就诊延迟：指就诊时间超过14 d。就诊延迟率=就诊延迟患者数/患者总数×100%[6]。诊断时间：结核病患者本次首诊日期至确诊日期的间隔时间。诊断延迟：诊断时间超过14 d。诊断延迟率=诊断延迟患者数/患者总数×100%[7]。
1.3　统计分析
采用SPSS 26.0进行数据分析。本研究中的计量资料均呈偏态分布，采用中位数（四分位数）[M(P25，P75)]描述；计数资料采用率及构成比进行描述。采用χ2检验比较不同组别之间就诊延迟率的差异；χ2趋势检验分析不同组别就诊延迟率随时间变化的趋势；多因素logistic回归分析肺结核患者就诊延迟和诊断延迟的影响因素。双侧检验，检验水准α= 0.05。
2　结果
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2.1　人口社会学资料
2014—2023年，西藏登记的34 469例肺结核患者中，男性19 321人（占56.1%）；藏族33 864人（占98.2%）；本地户籍30 521例（占88.5%）；农牧民24 031人（占69.7%）。初治病例31 577人（占91.6%）。病原学结果以阴性为主，25 187例（占73.0%）。首诊地区以昌都市最多，10 489例（30.4%）。见表1。
2.2　患者就诊和诊断延迟情况
西藏肺结核患者就诊时间［M（P25，P75）］为24(10,46) d，就诊延迟率为67.5%。诊断时间［M（P25，P75）］为0(0,1) d，诊断延迟率为7.6%。
2014—2023年，西藏肺结核患者就诊延迟率呈下降趋势（趋势χ2=1 798.083，P<0.001），诊断延迟率呈上升趋势（趋势χ2=197.689，P<0.001）。见表2。
2.3　肺结核患者就诊延迟率的影响因素分析
2.3.1　就诊延迟率的单因素分析
不同年龄、民族、户籍地、职业、患者来源、病原学结果、首诊地区的肺结核患者就诊延迟率均存在统计学差异（P<0.001）。见表1。
2.3.2　就诊延迟率的多因素分析
以肺结核患者是否发生就诊延迟为因变量（0=否，1=是），将单因素分析中P<0.05的变量作为自变量纳入多因素logistic回归模型进行分析。结果显示，就诊延迟的保护因素为≤20岁年龄组、21～40岁年龄组、本地户籍、健康体检、无病原学结果、首诊地区为拉萨市、林芝市、那曲市和阿里地区。危险因素为农牧民、儿童及学生、因症就诊、因症推荐、转诊、首诊地区为日喀则市和昌都市。见表3。
2.4　肺结核患者诊断延迟率的影响因素分析
2.4.1　诊断延迟率的单因素分析
不同年龄、户籍地、职业、患者来源、首诊地区的肺结核患者诊断延迟率均存在统计学差异（P<0.001）。见表1。
2.4.2　诊断延迟率的多因素分析
以肺结核患者是否发生诊断延迟为因变量（0=否，1=是），将单因素分析中P<0.05的变量作为自变量纳入多因素logistic回归模型进行分析。结果显示，诊断延迟的保护因素为因症推荐、首诊地区为日喀则市、昌都市和那曲市。危险因素为本地户籍、首诊地区为拉萨市。见表3。
3　讨论
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本研究结果显示，2014—2023年西藏肺结核患者就诊天数（M）和就诊延迟率分别为24 d和67.5%，高于福建省的21 d和59.12%[8]、青海省的18 d和49.6%[9]、西部地区的9 d和41.24%[7]，低于内蒙古自治区32d和70.8%[10]，处于国内中高等水平。就诊延迟率随时间呈现出缓慢下降的趋势。这表明近年来针对群众开展的宣传教育工作已初显成效。
西藏肺结核就诊延迟率与患者来源、首诊地区、职业、年龄、户籍地、病原学结果密切相关。第一，因症就诊、因症推荐、转诊等被动发现方式的就诊延迟率高于健康体检和主动筛查等主动发现方式，这与重庆都市圈的研究结果一致[11]。这提示应将肺结核筛查纳入入职入学体检的必查项目，同时结核病定点医院应主动前往偏远地区开展结核病筛查项目，以降低肺结核就诊延迟率。第二，本研究发现，首诊地区为昌都市和日喀则市的就诊延迟率高于其他地市。其原因可能是昌都市和日喀则市地处西藏南部，许多患者居住于偏远农牧区，距定点医院较远且交通不便，患者就医路途耗时多，导致就诊延迟。第三，职业因素对肺结核就诊延迟率也有一定影响。本研究显示，农牧民及儿童和学生群体的就诊延迟率高于其他职业。这可能是农牧民群体文化水平较低，而大部分儿童和学生来自于农牧民家庭，家长和学生结核病防治知识知晓率较低，重视程度不足有关[12]。第四，年龄因素方面，随着年龄增加，就诊延迟率增高，这与烟台市的研究结果[13]相符。可能是由于身体机能衰退、行动不便、经济条件不佳、家庭和社会支持水平低等原因，致使患者未能及时前往医疗机构就诊。这提示在早期筛查和知识宣传中应重点关注中老年群体。建议在老年人常规年度体检中，将胸片检查列为常规体检项目，以提高患者早发现、早诊断、早治疗水平[14]。第五，流动人口（非本地户籍）因工作生活环境不稳定、经济条件和医疗服务可及性差，加之工作时间长、高强度作业、医疗无保障等问题，出现症状后不愿就诊，易导致就诊延迟[13]。最后，本研究显示无病原学结果患者的就诊延迟率显著低于病原学阳性和阴性患者。可能是因为无病原学结果患者临床症状典型，早期前往定点医院就诊，结合影像学检查、T-SPOT、PPD试验可临床诊断为肺结核，从而减少就诊延迟[15]。建议今后加强对不同人群的结核病防治知识宣传，提高公众对结核病的认知和重视程度；改善偏远地区的医疗交通条件，提高医疗服务可及性；加强对重点职业群体和中老年群体的筛查与关注；同时，优化流动人口的医疗保障体系，以降低肺结核就诊延迟率。
西藏肺结核患者诊断时间M（P25，P75）和诊断延迟率分别为0(0,1) d和7.6%，低于西部地区的12(3,33) d和44.48%[7]，河南省周口市的7(1,30) d和38.12%[16]，处于国内较低水平。诊断延迟率则呈上升趋势。
诊断延迟的发生大多受限于医疗机构的结核病诊疗水平。本研究显示，西藏肺结核诊断延迟与户籍地、首诊地区及患者来源有关。首先，本地户籍人口相较于非本地户籍人口出现诊断延迟的概率更高。此结果与其他研究[7,17]不一致，可能与本地户籍人口多为藏族农牧民有关，该人群对疾病认知水平较低、对肺结核重视程度不足。同时，受宗教观念影响，在到达定点医院前需经历多次转诊[12]，导致诊断延迟。其次，首诊地区为拉萨市的患者诊断延迟率显著高于其他地市。原因可能为居民对基层医疗缺乏信任，来拉萨就诊时倾向于先在综合医院就诊，从而导致诊断延迟。此外，部分不典型病例的诊断困难也可能是原因之一。最后，因症推荐患者相比其他来源患者诊断延迟率低，可能与基层医疗机构和综合医院发现肺结核或疑似肺结核患者后及时推介并转诊至定点医院，从而缩短了诊断时间有关。建议今后加强对本地户籍尤其是藏族农牧民群体的结核病防治知识宣传，提高其对疾病的认知和重视程度；同时，提升基层医疗机构的诊疗水平和公信力，引导患者合理就医，以减少肺结核诊断延迟的发生。
综上所述，西藏肺结核患者就诊延迟率高，而诊断延迟率处于国内较低水平。建议加强藏族群众、农牧民和学生群体的结核病防治知识宣传，提升其对结核病的认知水平和就医意识；改善偏远地区的医疗交通条件，提高医疗服务可及性；加强对重点职业群体和中老年群体的筛查与关注，实现患者的早期发现与及时干预；优化医疗资源配置，提高基层医疗机构的服务能力，确保患者及时获得诊断与治疗。此外，还应关注地区差异，制定针对性的防控措施，提升西藏结核病防控整体成效。
基金
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  • 国家社会科学基金项目(23XMZ057)
  • 国家疾控局“揭榜”调研课题
文献
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2025年第52卷第11期
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doi: 10.20043/j.cnki.MPM.202501066
  • 接收时间：2025-01-06
  • 首发时间：2026-03-18
  • 出版时间：2025-06-10
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  • 收稿日期：2025-01-06
基金
国家社会科学基金项目(23XMZ057)
国家疾控局“揭榜”调研课题
作者信息
    1.西藏自治区第三人民医院结核一科，西藏 拉萨 850000
    2.西藏自治区第三人民医院院部
    3.武警山东总队医院泌尿外科
    4.西藏民族大学 医学部基础研究院
    5.西藏自治区第三人民医院护理部，西藏 拉萨 850000

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2种不同金属材料的力学参数
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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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