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Article(id=1325530099344498938, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325530078536553117, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025261, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1747152000000, receivedDateStr=2025-05-14, revisedDate=1751212800000, revisedDateStr=2025-06-30, acceptedDate=null, acceptedDateStr=null, onlineDate=1793960602841, onlineDateStr=2026-11-06, pubDate=1758729600000, pubDateStr=2025-09-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793960602841, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793960602841, creator=13701087609, updateTime=1793960602841, updator=13701087609, issue=Issue{id=1325530078536553117, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='9', pageStart='1217', pageEnd='1368', issueExtLink='null', onlineDate='null', pubDate='1758729600000', pubDateStr='2025-09-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793960597879, creator='13701087609', updateTime=1793960597879, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1328, endPage=1332, ext={EN=ArticleExt(id=1325530101177409787, articleId=1325530099344498938, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Adverse treatment outcome and spatio-temporal characteristics of pulmonary tuberculosis cases among students in Qinghai Province, 2013-2023, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the adverse treatment outcome status and spatio-temporal characteristics of pulmonary tuberculosis cases among students in Qinghai Province, providing a reference basis for pulmonary tuberculosis prevention and control in schools.

Methods

The data of student pulmonary tuberculosis cases during 2013-2023 in Qinghai Province were obtained through the "National Tuberculosis Management Information System", and the treatment outcome was retrospectively analyzed. The Joinpoint model was applied to analyze the adverse outcome rate trend. Global and local spatial autocorrelation analysis, and spatiotemporal scan cluster analysis were conducted on the adverse outcome rate of pulmonary tuberculosis among students in Qinghai Province.

Results

During 2013-2023, 488 cases of adverse outcomes were reported among 6 155 students with pulmonary tuberculosis in Qinghai Province, with an adverse outcome rate of 7.93%. The reporting adverse outcome rate of pulmonary tuberculosis among students showed a downward trend from 2013 to 2023 (APC=-16.20, t=-3.89, P < 0.05). The results of spatial autocorrelation showed that the adverse outcome rate of pulmonary tuberculosis was Moran's I >0 among students in Qinghai Province. Among them, there was a spatially positive correlation in the adverse outcome rate of pulmonary tuberculosis among students in 2020, 2021 and 2022(all Z>1.96, all P < 0.05). The results of clustering and outlier analysis in local spatial autocorrelation showed that the areas with high-high aggregation were mainly concentrated in Yushu Prefecture(Zhiduo County, Zaduo County, Nangqian County, Yushu City), Huangnan Prefecture (Zeku County, Henan County) and Hainan Prefecture (Tongde County). The low-low concentration areas were distributed in Haidong City, Xining City, Haibei Prefecture (Gangcha County, Qilian County), Haixi Prefecture (Tianjun County, Ulan County), Hainan Prefecture (Gonghe County, Guide County) and Huangnan Prefecture (Tongren City, Jianzha County). The spatio-temporal scanning showed that a total of two possible aggregation areas had been detected. Among them, the first-level aggregation area composed of 10 counties and districts in Yushu Prefecture and Guoluo Prefecture of Qinghai Province, and the cluster radius was 658.09 km, the RR was 10.58, and the LLR was 305.91; the second-level aggregation area was composed of 16 counties and districts in Hainan Prefecture, Haixi Prefecture, Huangnan Prefecture and Guoluo Prefecture, and the cluster radius was 407.02 km, the RR was 9.83, and the LLR was 152.48 (both P < 0.05).

Conclusions

The reporting rates of adverse treatment outcome of pulmonary tuberculosis cases among students in Qinghai Province remain relatively high and unevenly distribute throughout the province. Supervision should be strengthened to improve cases compliance, and to reduce student pulmonary tuberculosis adverse treatment outcomes incidence.

, authors=Binzhong MA1, Yongsheng LI*, 1, Da LIANG1, Yajing SI2, authorsList=Binzhong MA, Yongsheng LI, Da LIANG, Yajing SI, authorCompany=null, correspAuthors=Yongsheng LI, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., 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=1325530101773000956, articleId=1325530099344498938, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=青海省2013—2023年学生肺结核治疗不良结局及时空特征, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

分析青海省学生肺结核治疗不良结局状况及时空特征，为学校肺结核防控提供参考依据。

方法

通过“全国结核病管理信息系统”获得2013—2023年青海省学生肺结核病例资料，回顾性分析其治疗转归情况。运用Joinpoint模型分析不良结局报告率趋势，对青海省学生肺结核不良结局报告率进行全局和局部空间自相关及时空扫描聚集性分析。

结果

2013—2023年青海省学生肺结核患者不良结局报告率为7.93%(488/6 155)。2013—2023年学生肺结核不良结局报告率呈下降趋势(APC=-16.20, t=-3.89，P＜0.05)。空间自相关结果显示，青海省学生肺结核不良结局率的Moran's I＞0，其中2020、2021和2022年学生肺结核不良结局率存在空间正相关性(Z值均>1.96，P值均 < 0.05)；局部空间自相关中聚类和异常值分析结果显示，高—高聚集区主要集中在玉树州(治多县、杂多县、囊谦县、玉树市)、黄南州(泽库县、河南县)和海南州(同德县)；低—低聚集区分布在海东市、西宁市、海北州(刚察县、祁连县)、海西州(天峻县、乌兰县)、海南州(共和县、贵德县)和黄南州(同仁市、尖扎县)。时空扫描结果显示，共探测到2个可能聚集区域，其中一级聚集区覆盖青海省的玉树州和果洛州10个县区，聚集半径为658.09 km，RR=10.58，LLR=305.91；二级聚集区覆盖海南州、海西州、黄南州和果洛州16个县区，聚集半径为407.02 km，RR=9.83，LLR=152.48(P值均 < 0.05)。

结论

青海省学生肺结核治疗不良结局报告率仍较高且在全省范围内分布不均。应强化督导提高病例的依从性，进一步降低学生肺结核的不良结局发生率。

, authors=马斌忠1, 李永盛*, 1, 梁达1, 司雅婧2, authorsList=马斌忠, 李永盛, 梁达, 司雅婧, authorCompany=null, correspAuthors=李永盛, authorNote=

马斌忠(1979-)，男，青海海东人，硕士，副主任医师，主要从事传染性疾病防控工作

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李永盛，E-mail：
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马斌忠(1979-)，男，青海海东人，硕士，副主任医师，主要从事传染性疾病防控工作

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Distribution of treatment outcomes of students with pulmonary tuberculosis in Qinghai Province from 2013 to 2023

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年份例数成功治疗不良结局
治愈完成疗程死亡不良反应丢失其他失败
201322488(39.29)103(45.98)1(0.45)2(0.89)1(0.45)029(12.95)
201417334(19.65)110(63.58)04(2.31)02(1.16)23(13.29)
201530160(19.93)168(55.81)06(1.99)14(4.65)2(0.66)51(16.94)
201643854(12.32)326(74.43)05(1.14)10(2.28)2(0.46)41(9.36)
201764668(10.53)482(74.61)2(0.31)3(0.46)8(1.24)083(12.85)
2018758109(14.38)613(80.87)2(0.26)3(0.40)8(1.06)023(3.03)
2019898148(16.48)723(80.51)1(0.11)01(0.11)1(0.11)24(2.67)
2020815139(17.06)645(79.14)1(0.12)002(0.25)28(3.44)
2021789146(18.50)584(74.02)1(0.13)001(0.13)57(7.22)
2022391120(30.69)249(63.68)000022(5.63)
2023722290(40.17)408(56.51)000024(3.32)
合计6 1551 256(20.41)4 411(71.67)8(0.13)23(0.37)42(0.68)10(0.16)405(6.58)
), ArticleFig(id=1325530105220718879, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530099344498938, language=CN, label=表1, caption=

青海省2013—2023年学生肺结核患者治疗转归情况分布

, figureFileSmall=null, figureFileBig=null, tableContent=
年份例数成功治疗不良结局
治愈完成疗程死亡不良反应丢失其他失败
201322488(39.29)103(45.98)1(0.45)2(0.89)1(0.45)029(12.95)
201417334(19.65)110(63.58)04(2.31)02(1.16)23(13.29)
201530160(19.93)168(55.81)06(1.99)14(4.65)2(0.66)51(16.94)
201643854(12.32)326(74.43)05(1.14)10(2.28)2(0.46)41(9.36)
201764668(10.53)482(74.61)2(0.31)3(0.46)8(1.24)083(12.85)
2018758109(14.38)613(80.87)2(0.26)3(0.40)8(1.06)023(3.03)
2019898148(16.48)723(80.51)1(0.11)01(0.11)1(0.11)24(2.67)
2020815139(17.06)645(79.14)1(0.12)002(0.25)28(3.44)
2021789146(18.50)584(74.02)1(0.13)001(0.13)57(7.22)
2022391120(30.69)249(63.68)000022(5.63)
2023722290(40.17)408(56.51)000024(3.32)
合计6 1551 256(20.41)4 411(71.67)8(0.13)23(0.37)42(0.68)10(0.16)405(6.58)
), ArticleFig(id=1325530105292022048, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530099344498938, language=EN, label=Tab.2, caption=

Global autocorrelation analysis of adverse outcome reporting rates of pulmonary tuberculosis among students in Qinghai Province from 2013 to 2023

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年份Moran's I值Z值P值
2013-0.15-1.560.12
20140.091.370.17
2015-0.010.180.85
2016-0.04-0.250.80
20170.040.840.40
2018-0.010.250.80
20190.061.300.19
20200.213.22＜0.01
20210.456.30＜0.01
20220.212.95＜0.01
2023-0.04-0.200.84
), ArticleFig(id=1325530105375908129, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530099344498938, language=CN, label=表2, caption=

青海省2013—2023年学生肺结核不良结局报告率全局自相关分析

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年份Moran's I值Z值P值
2013-0.15-1.560.12
20140.091.370.17
2015-0.010.180.85
2016-0.04-0.250.80
20170.040.840.40
2018-0.010.250.80
20190.061.300.19
20200.213.22＜0.01
20210.456.30＜0.01
20220.212.95＜0.01
2023-0.04-0.200.84
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青海省2013—2023年学生肺结核治疗不良结局及时空特征
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马斌忠 1 , 李永盛 *, 1 , 梁达 1 , 司雅婧 2
中国学校卫生 | 疾病控制 2025,46(9): 1328-1332
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中国学校卫生 |疾病控制 2025 , 46 (9) : 1328 -1332
青海省2013—2023年学生肺结核治疗不良结局及时空特征
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马斌忠1, 李永盛*, 1 , 梁达1, 司雅婧2
作者信息
  • 1青海省疾病预防控制中心免疫规划所，西宁 810021
  • 2青海大学医学院公共卫生系，西宁 810021
通讯作者:
李永盛，E-mail：
作者简介:

马斌忠(1979-)，男，青海海东人，硕士，副主任医师，主要从事传染性疾病防控工作

Adverse treatment outcome and spatio-temporal characteristics of pulmonary tuberculosis cases among students in Qinghai Province, 2013-2023
Binzhong MA1, Yongsheng LI*, 1 , Da LIANG1, Yajing SI2
Affiliations
  • 1Institute of Immunization Program, Qinghai Provincial Center for Disease Control and Prevention, Xining 810021, Qinghai Province, China
出版时间: 2025-09-25 doi: 10.16835/j.cnki.1000-9817.2025261
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摘要
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目的

分析青海省学生肺结核治疗不良结局状况及时空特征，为学校肺结核防控提供参考依据。

方法

通过“全国结核病管理信息系统”获得2013—2023年青海省学生肺结核病例资料，回顾性分析其治疗转归情况。运用Joinpoint模型分析不良结局报告率趋势，对青海省学生肺结核不良结局报告率进行全局和局部空间自相关及时空扫描聚集性分析。

结果

2013—2023年青海省学生肺结核患者不良结局报告率为7.93%(488/6 155)。2013—2023年学生肺结核不良结局报告率呈下降趋势(APC=-16.20, t=-3.89，P＜0.05)。空间自相关结果显示，青海省学生肺结核不良结局率的Moran's I＞0，其中2020、2021和2022年学生肺结核不良结局率存在空间正相关性(Z值均>1.96，P值均 < 0.05)；局部空间自相关中聚类和异常值分析结果显示，高—高聚集区主要集中在玉树州(治多县、杂多县、囊谦县、玉树市)、黄南州(泽库县、河南县)和海南州(同德县)；低—低聚集区分布在海东市、西宁市、海北州(刚察县、祁连县)、海西州(天峻县、乌兰县)、海南州(共和县、贵德县)和黄南州(同仁市、尖扎县)。时空扫描结果显示，共探测到2个可能聚集区域，其中一级聚集区覆盖青海省的玉树州和果洛州10个县区，聚集半径为658.09 km，RR=10.58，LLR=305.91；二级聚集区覆盖海南州、海西州、黄南州和果洛州16个县区，聚集半径为407.02 km，RR=9.83，LLR=152.48(P值均 < 0.05)。

结论

青海省学生肺结核治疗不良结局报告率仍较高且在全省范围内分布不均。应强化督导提高病例的依从性，进一步降低学生肺结核的不良结局发生率。

结核，肺  /  治疗结果  /  回顾性研究  /  学生
Objective

To analyze the adverse treatment outcome status and spatio-temporal characteristics of pulmonary tuberculosis cases among students in Qinghai Province, providing a reference basis for pulmonary tuberculosis prevention and control in schools.

Methods

The data of student pulmonary tuberculosis cases during 2013-2023 in Qinghai Province were obtained through the "National Tuberculosis Management Information System", and the treatment outcome was retrospectively analyzed. The Joinpoint model was applied to analyze the adverse outcome rate trend. Global and local spatial autocorrelation analysis, and spatiotemporal scan cluster analysis were conducted on the adverse outcome rate of pulmonary tuberculosis among students in Qinghai Province.

Results

During 2013-2023, 488 cases of adverse outcomes were reported among 6 155 students with pulmonary tuberculosis in Qinghai Province, with an adverse outcome rate of 7.93%. The reporting adverse outcome rate of pulmonary tuberculosis among students showed a downward trend from 2013 to 2023 (APC=-16.20, t=-3.89, P < 0.05). The results of spatial autocorrelation showed that the adverse outcome rate of pulmonary tuberculosis was Moran's I >0 among students in Qinghai Province. Among them, there was a spatially positive correlation in the adverse outcome rate of pulmonary tuberculosis among students in 2020, 2021 and 2022(all Z>1.96, all P < 0.05). The results of clustering and outlier analysis in local spatial autocorrelation showed that the areas with high-high aggregation were mainly concentrated in Yushu Prefecture(Zhiduo County, Zaduo County, Nangqian County, Yushu City), Huangnan Prefecture (Zeku County, Henan County) and Hainan Prefecture (Tongde County). The low-low concentration areas were distributed in Haidong City, Xining City, Haibei Prefecture (Gangcha County, Qilian County), Haixi Prefecture (Tianjun County, Ulan County), Hainan Prefecture (Gonghe County, Guide County) and Huangnan Prefecture (Tongren City, Jianzha County). The spatio-temporal scanning showed that a total of two possible aggregation areas had been detected. Among them, the first-level aggregation area composed of 10 counties and districts in Yushu Prefecture and Guoluo Prefecture of Qinghai Province, and the cluster radius was 658.09 km, the RR was 10.58, and the LLR was 305.91; the second-level aggregation area was composed of 16 counties and districts in Hainan Prefecture, Haixi Prefecture, Huangnan Prefecture and Guoluo Prefecture, and the cluster radius was 407.02 km, the RR was 9.83, and the LLR was 152.48 (both P < 0.05).

Conclusions

The reporting rates of adverse treatment outcome of pulmonary tuberculosis cases among students in Qinghai Province remain relatively high and unevenly distribute throughout the province. Supervision should be strengthened to improve cases compliance, and to reduce student pulmonary tuberculosis adverse treatment outcomes incidence.

Tuberculosis, pulmonary  /  Treatment outcome  /  Retrospective studies  /  Students
马斌忠, 李永盛, 梁达, 司雅婧. 青海省2013—2023年学生肺结核治疗不良结局及时空特征. 中国学校卫生, 2025 , 46 (9) : 1328 -1332 . DOI: 10.16835/j.cnki.1000-9817.2025261
Binzhong MA, Yongsheng LI, Da LIANG, Yajing SI. Adverse treatment outcome and spatio-temporal characteristics of pulmonary tuberculosis cases among students in Qinghai Province, 2013-2023[J]. Chinese Journal of School Health, 2025 , 46 (9) : 1328 -1332 . DOI: 10.16835/j.cnki.1000-9817.2025261
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肺结核是由结核分枝杆菌引起的呼吸道传染病，容易在封闭、人群密集的环境中传播和扩散[1]。近年来我国肺结核报告发病率逐年下降，但学生肺结核病例却逐年增多，且聚集性疫情时有发生[2]。学生长期处于同一空间，持续接触，易引起校内结核病的传播流行，甚至造成严重的社会影响[3-4]。巴西一项研究表明有17%的10~24岁年轻肺结核患者治疗转归不佳[5]，提示对学生肺结核不良转归的分析研究非常重要。青海省地处青藏高原东部，经济欠发达，人口稀少，地域面积广，是结核病疫情高发地区[6-7]。近年来空间流行病学已广泛应用于肺结核时空聚集性研究中，本研究以青海省县区为研究对象，对2013—2023年青海省学生肺结核不良转归状况进行空间自相关分析和时空扫描分析，探索肺结核高危地区，为制定区域性防控措施提供依据。
1　资料来源与方法
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1.1　资料来源
病例资料来源于“全国结核病信息管理系统”中2013—2023年青海省登记职业为“学生”和“幼托儿童”的肺结核患者。青海省各县区人口资料来源于各年度《青海统计年鉴》[8]，青海省矢量地图、经纬度坐标来源于国家基础地理信息系统中心[9]。
1.2　方法
按照《中国结核病预防控治规划实施工作指南(2008年版)》[10]和《中国结核病预防控制工作技术规范(2020年版)》[11]，将治疗转归分为成功治疗(治愈、完成疗程)和不良结局(死亡、不良反应、丢失、失败及其他)。
1.3　统计学分析
采用Excel 2016软件用于数据整理；ArcMap 10.8软件用于三维空间趋势、空间自相关分析及结果可视化展示；SaTScan 10.2软件用于时空扫描分析。以P < 0.05为有统计学意义。
1.3.1　描述性分析
利用Excel 2016软件对2013—2023年发现的青海省学生人群肺结核不良结局发生数据进行录入、整理和分析，使用Joinpoint 5.3.0.0软件分析青海省学生肺结核不良结局率的变化趋势，以年份为自变量，以不良结局率为因变量作对数线性模型，计算年度变化百分比(annual percentage change, APC)。
1.3.2　空间自相关分析
空间自相关是基于空间要素位置和空间要素属性度量空间要素的空间分布模式[12-13]。基于特定空间要素及属性信息，评估空间要素分布模式是聚类分布、离散分布还是随机分布模式[14]。空间自相关分析包括全局和局部空间自相关分析，通过Moran's I值评价空间聚集情况，采用蒙特卡洛模拟方法检验其显著性。Moran's I值介于-1~1之间，>0为正相关，越接近1表示分布越聚集； < 0为负相关，越接近-1表示分布越离散，0表示空间呈随机性，不存在空间自相关[15]。局部空间自相关分析常表现为4种关联模式：高—高聚集、高—低聚集、低—高聚集、低—低聚集，其中高—高聚集、低—低聚集为空间正相关模式，表明局部区域与相邻区域的疾病发病率同高或同低；另2种为空间负相关模式，表明局部区域与相邻区域的属性值不同[16-17]。
1.3.3　时空扫描分析
选择SaTScan 10.2.5软件中Possion分布概率模型进行时空扫描分析，基本原理对扫描窗口内和扫描窗口外的实际发病例数和期望发病例数，计算检验统计量对数似然比(log-likelihood ratio, LLR)，并通过LLR值判断聚集区特点[18]，在有统计学意义的情况下LLR为分级依据，即LLR越大，说明扫描窗口越有可能是聚集区[19]。一级聚集区的LLR值最大，二级聚集区较一级聚集区LLR值小，说明其成为空间聚集区域的概率较一级聚集区低。本研究最大扫描时长为总研究期限的50%，最大空间聚集区域为研究期的50%[20]，扫描时间窗口以“月”为单位，蒙特卡洛模拟次数为999次。
2　结果
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2.1　青海省2013—2023年学生肺结核治疗转归基本情况
2013—2023年青海省共报告学生肺结核6 155例，其中成功治疗5 667例，发生不良结局488例，总不良结局占比为7.93%；2015年学生肺结核不良结局占比最高(24.25%)，2019年学生肺结核不良结局占比最低(3.01%)。见表1。2013—2023年学生肺结核不良结局率呈下降趋势(APC=-16.20, t=-3.89，P＜0.05)。
2.2　青海省2013—2023年学生肺结核治疗不良结局空间自相关分析
2.2.1　全局空间自相关分析
2013—2023年青海省学生肺结核不良结局报告率的Moran's I＞0，2020、2021和2022年Z值均＞1.96，P值均 < 0.05，提示3年青海省学生肺结核不良结局率存在空间正相关性且有统计学意义，呈现空间聚集性分布。见表2。
2.2.2　局部空间自相关分析
2013—2023年青海省学生肺结核不良结局报告率局部空间自相关呈现4种聚集模式：高—高、低—低、高—低和低—高。聚类和异常值分析结果显示每年存在多个聚集区域，高—高聚集的区县主要集中在玉树州(治多县、杂多县、囊谦县、玉树市)、黄南州(泽库县、河南县)和海南州(同德县)；低—低聚集区分布在海东市、西宁市、海北州(刚察县、祁连县)、海西州(天峻县、乌兰县)、海南州(共和县、贵德县)和黄南州(同仁市、尖扎县)；高—低聚集区分布在果洛州(班玛县)和西宁市(大通县、湟中区)；低—高聚集区分布在玉树州(称多县)、海北州(祁连县、刚察县、海晏县)。
2.3　青海省2013—2023年学生肺结核治疗不良结局时空扫描分析
2013—2023年青海省学生肺结核不良结局发生情况进行时空扫描分析后共探测到2个可能聚集区域。其中一级聚集区覆盖玉树州囊谦县、玉树市、杂多县、称多县、曲麻莱县和治多县，果洛州玛多县、达日县、甘德县和班玛县，聚集时间为2013年7月—2018年10月；聚集半径658.09 km，涉及病例数287例，期望病例数58例(RR=10.58，LLR=305.91，P < 0.05)。二级聚集区覆盖海南州共和县、同德县、贵德县、贵南县和兴海县，海西州德令哈市、格尔木市、都兰县、天峻县和乌兰县，黄南州河南县、尖扎县、同仁市和泽库县，果洛州久治县和玛沁县，聚集时间为2019年2月—2023年10月；聚集半径407.02 km，涉及病例数120例，期望病例数15例(RR=9.83，LLR=152.48，P < 0.05)。
3　讨论
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2013—2023年青海省共报告学生肺结核6 155例，发生不良结局488例，总不良结局占比为7.93%，高于荆门市(2.33%)[21]和成都市[22](3.95%)报道结果，可能的原因是学生在日常生活与学习等活动时会密切接触，学业压力大会影响其抵抗力，学生发生发热、咳嗽后仍以坚持学业为重[23]，从而延误诊断与治疗；青海省地处青藏高原，偏远地区医疗条件差、学生结核病知识知晓率低[24]等因素可能造成学生肺结核不良结局报告率高于其他省份。2013—2023年不良结局报告率呈下降趋势，与甘肃省趋势一致[25]，原因可能包括以下几点：(1)社会对结核病防控重视度的提升以及防治经费投入的持续增长；(2)青海省长期坚持落实国家结核病防治工作规范，通过标准化诊疗方案与全程化疗程管理，有效提升了患者临床治愈水平；(3)可能与“十三五全国结核病防治规划”[26]以及自2015年起青海省开始全面实施“三位一体”新型结核病防治体系，并全面落实《学校结核病防控工作规范(2017年版)》[27]有关。
空间流行病学目前在传染病领域应用广泛，对分析传染病在邻近地区的相互影响、探索疾病的分布特征有重要作用[28-29]。空间自相关分析发现，2020—2022年存在全局空间聚集性，其余年份学生肺结核不良结局报告率空间聚集性无统计学意义，可能与学生肺结核不良结局发生者为非随机分布有关。局部空间自相关分析结果显示，高—高聚集区主要集中在玉树州各区县，黄南州和海南州的个别区县，玉树州是学生肺结核不良结局发生的热点地区。分析可能的原因：一方面该地区经济相对落后，肺结核流行与当地经济水平存在一定的关系，经济落后的地区结核病流行严重[30]；另一方面牧区居民以牧民为主，对传染病自我保健意识较差，学生感染肺结核后依从性较差，易造成不良结局的发生。低—低聚集区主要集中在青海省东部区县，可能与青海省东部地区气候相对温和，作为经济、政治中心，医疗资源相对丰富有关。高—高聚集区存在较大的不良结局发生风险，还可能造成耐药菌的产生及传播，应对学生肺结核患者进行规范化治疗；相关卫生部门应加强对该地区医疗卫生资源的配置并严格做好防控工作，防止不良结局的发生。时空扫描分析结果显示，学生肺结核不良结局发生的一类聚集区较局部空间自相关的“高—高聚集区”有所扩大，覆盖玉树州和果洛州各区县。
综上所述，2013—2023年青海省学生肺结核不良结局报告率虽呈下降趋势，但其不良结局报告率仍相对较高。提示青海省应继续强化学生肺结核防控措施，建议将一类、二类聚集区作为重点区域，构建校园结核病防控屏障、阻断疫情传播途径；继续强化学校主体责任意识、落实各项防控措施，通过卫生健康教育进一步加强学生肺结核相关知识、提高成功治疗率[31]，规范治疗并加强依从性管理、避免因擅自停药引发耐药；政府、学校与疾控机构应多部门协作[32]，整合社会资源，建立长期肺结核转归评估机制，动态优化防控策略。
本研究存在一定的局限性：学生肺结核患者数据来源于全国结核病信息管理系统，可能受不同地区病例发现及监测报告能力等影响，造成真实疫情被低估；肺结核的发生及治疗转归与社会经济水平等因素相关，但调查未将该因素纳入对学生结核病不良结局的影响研究，未来将进一步探索学生结核病不良结局的影响因素。
基金
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  • 青海省2022年度“昆仑英才·高原名医”项目(青卫健办[2023]95号)
文献
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2025年第46卷第9期
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doi: 10.16835/j.cnki.1000-9817.2025261
  • 接收时间：2025-05-14
  • 首发时间：2026-11-06
  • 出版时间：2025-09-25
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  • 收稿日期：2025-05-14
  • 修回日期：2025-06-30
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青海省2022年度“昆仑英才·高原名医”项目(青卫健办[2023]95号)
作者信息
    1青海省疾病预防控制中心免疫规划所，西宁 810021
    2青海大学医学院公共卫生系，西宁 810021

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李永盛，E-mail：
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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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