云南省滇东北地区肺结核时空分布特征及影响因素研究

发布时间：2018-08-20 14:20

【摘要】：结核病(tuberculosis,TB)由结核分枝杆菌导致,通常感染并破坏肺(称“肺结核”),是严重危害人类健康的呼吸道传染病。结核病在全球流行广泛,我国病人数全球第三。为有效控制结核病,中国在2011年出台了第十二个国家结核病防治规划。五年规划的实施,有效降低了中国结核病负担。然而,位于云南省滇东北地区的昭通市结核病疫情仍然较高,高于同期全省和全国的平均水平。国内外研究显示,结核病具有时空的异构分布,其分布特征与个人行为和社会经济等因素有关。掌握肺结核的空间分布特征及风险影响因子等信息对于有效的预防与控制相关疫情非常重要。本研究运用时空扫描统计量方法,探讨昭通市肺结核疫情的时空分布特征,找出聚集区域;应用Logistic回归模型分析影响肺结核聚集性的生物学因素、个人行为因素、社会经济状况以及环境因素等影响因素;最后对个人行为因素中的肺结核患者就医行为进行重点研究,深入探讨云南省肺结核疫情的影响因素,为今后制定结核病防治策略、改进防治措施、优化资源配置等提供科学依据。主要研究方法和结果如下:第一部分云南省滇东北地区肺结核病例的时空分布特征研究本研究应用时间序列和时空扫描统计量方法探测昭通市2011-2015年间肺结核病例在乡镇水平的时空聚集特征。结果显示:昭通市肺结核呈非随机分布,具有一定的时空聚集性。时间分布显示出明显季节趋势,发病高峰多在冬季,而登记高峰出现在春季,昭通市的总肺结核登记率共识别出1个最可能的聚集区和6个次级聚集区,初治登记率有1个最可能的聚集区和5个次级聚集区,复治登记率有1个最可能的聚集区。这三个指标的最可能聚集区均位于昭通市东南部的镇雄县,镇雄县人口众多且社会经济发展滞后,是肺结核控制工作应该优先考虑的地区。第二部分云南省滇东北地区肺结核空间聚集性影响因素研究本研究以2015年10月-2016年2月期间到昭通市所辖11个县级疾控中心就诊的活动性肺结核患者为研究对象,通过对聚集区内外肺结核患者的生物学因素、个人行为因素、社会经济状况、环境因素等进行Logistic回归分析探讨肺结核聚集性分布的影响因素,从而为结核病防控工作提供理论和技术支持。结果显示,与空间聚集区独立相关的因素是患有慢性支气管炎、居住地在城区、吸烟、以煤炭为家庭做饭取暖主要燃料,提示昭通市肺结核的防控措施应重点考虑此类人群。第三部分肺结核患者就医行为对肺结核流行的影响研究本研究对昭通市2015年10月-2016年2月期间登记的肺结核患者进行结核病防治知识、就医行为以及诊疗情况问卷调查。结果显示,患者对肺结核相关知识的认识不够全面,调查对象中只有55.0%知道我国对肺结核检查治疗实行的政策。与聚集区外患者相比,聚集区内患者确诊延误时间较长,首诊更多的选择到基层医疗机构就诊,初诊结果多为感冒、气管炎和支气管炎,从发病到前往县级结防机构就诊前经历了较多的就诊次数,复治病例和结核性胸膜炎病例登记比例较高,患者全程督导比例较低,看服药人员多为家人。聚集区内外患者在就医行为上的差异,可能会影响肺结核在该区域内的发生发展。
[Abstract]:Tuberculosis (TB), caused by Mycobacterium tuberculosis, usually infects and destroys the lungs (known as "tuberculosis"), is a respiratory infectious disease that seriously endangers human health. TB is a worldwide epidemic with the third largest number of patients in the world in China. To effectively control TB, China launched the 12th National Tuberculosis Control Plan in 2011. The implementation of the five-year plan has effectively reduced the burden of tuberculosis in China. However, the epidemic situation of tuberculosis in Zhaotong City, northeastern Yunnan Province, is still high, which is higher than the average level of the whole province and the whole country in the same period. Mastering the spatial distribution characteristics and risk factors of pulmonary tuberculosis is very important for effective prevention and control of related epidemics. This study explored the spatial-temporal distribution characteristics of pulmonary tuberculosis epidemic in Zhaotong City by using spatio-temporal scanning statistics, and found out the aggregation areas. Logistic regression model was used to analyze the occurrence of pulmonary tuberculosis aggregation. In the end, the medical behavior of pulmonary tuberculosis patients among individual behavior factors was studied, and the influencing factors of pulmonary tuberculosis epidemic situation in Yunnan Province were discussed in detail, which provided reference for formulating tuberculosis prevention and control strategy, improving prevention and control measures, optimizing resource allocation and so on. The main research methods and results are as follows: The first part is the study on the spatial-temporal distribution of tuberculosis cases in northeastern Yunnan Province. This study used time series and time-space scanning statistics to detect the spatial-temporal aggregation characteristics of tuberculosis cases in Zhaotong from 2011 to 2015. The time distribution shows a clear seasonal trend, the peak of incidence occurs mostly in winter, and the registration peak occurs in spring. The total registration rate of tuberculosis in Zhaotong City identifies one most likely cluster area and six secondary clusters, and the initial treatment registration rate has one most likely cluster area and five secondary clusters. The most likely areas of the three indicators are located in Zhenxiong County in the southeast of Zhaotong City. Zhenxiong County has a large population and lags behind the social and economic development. It is a priority area for tuberculosis control work. Part two: Influencing factors of spatial aggregation of tuberculosis in northeastern Yunnan Province. In this study, 11 active pulmonary tuberculosis patients who visited Zhaotong CDC from October 2015 to February 2016 were selected as the subjects. The aggregation of pulmonary tuberculosis was investigated by logistic regression analysis of the biological factors, personal behavior factors, social and economic conditions, environmental factors and so on. The results showed that the independent factors related to the spatial agglomeration area were chronic bronchitis, living in urban areas, smoking, and using coal as the main fuel for cooking and heating at home, suggesting that the prevention and control measures of tuberculosis in Zhaotong City should focus on such populations. A questionnaire survey was conducted among the registered pulmonary tuberculosis patients in Zhaotong from October 2015 to February 2016. The results showed that the patients'knowledge about tuberculosis was not comprehensive enough, and only one of the respondents was involved in the survey. 55.0% knew the policy of tuberculosis examination and treatment in China.Compared with the patients outside the agglomeration area, the patients in the agglomeration area had a longer time delay in diagnosis and more choice to go to the primary medical institutions for treatment. The number of retreats, the registration rate of tuberculous pleurisy and tuberculous pleurisy were higher, the proportion of patients supervised during the whole course was lower, and the medical staff were mostly family members.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R521

【参考文献】