浙江省结核病防治示范区规模化现场流行病学调查及发病危险因素分析

发布时间：2018-01-27 01:21

本文关键词： 结核病流行病学抽样调查危险因素　出处：《浙江大学》2014年博士论文　论文类型：学位论文

【摘要】：研究目的：通过对普通居民开展胸部x线检查,了解浙江省重大传染病示范区结核病流行病学特点。探讨结核病发病危险因素,为结核病防治工作提供参考依据。方法： (1)2011年3月-2012年12月,对浙江省重大传染病防治示范区8个结核病防治示范现场15岁及以上常住户籍人口开展胸部x线检查和结核病疑似症状问诊。 (2)在绍兴和桐乡示范现场调查714例结核病患者,从源人口中按地区、年龄、性别进行频数匹配,随机抽取1635位非结核病患者作为对照组,进行发病危险因素病例对照研究。 (3)应用SPSS18.0进行统计分析,患病率之间的比较采用卡方检验,双侧水准为双侧α=0.05。发病危险因素分析采用单因素和多因素非条件logistic回归分析。结果 (1)实检人口355232人,其中男152839人,女202393人,男女比例为1：1.16。活动性肺结核患病率为181/10万,涂阳肺结核患病率为36/10万,菌阳肺结核患病率为70/10万。 (2)男性活动性肺结核患病率为314/10万,涂阳肺结核患病率为64/10万,菌阳肺结核患病率为108/10万。女性活动性肺结核患病率为125/10万,涂阳肺结核患病率为26/10万,菌阳肺结核患病率为52/10万。 (3)海岛地区活动性肺结核患病率为257/10万,内陆地区为204/10万,两者之间的差异无统计学意义。GDP低地区活动性肺结核患病率为328/10万,GDP高地区活动性肺结核患病率为163/10万,两者之间的差异有统计学意义。 (4)发现活动性肺结核患者732例,涂阳肺结核患者151例,菌阳肺结核患者271例。 (5)肺结核患者男480例,女252例。60岁及以上老年人369例,占50.41%。从事农渔业者443例,占60.52%。小学及以下文化程度者397例,占54.24%。 (6)多因素分析显示：结核病病史(OR=124.040,95%CI:47.573～314.353).结核病患者接触史(OR＝8.856,　95%CI:　4.917　～　21.064).外来人口(OR=2.801,95%CI:2.424　～　3.793).糖尿病史(OR=2.581,95%CI：1.276～3.559)是结核病发生的危险因素,文化程度高(OR=0.423,95%CI:0.316　～　0.729)是保护因素。结论： (1)初步摸清了浙江省重大传染病防治示范区不同地理地貌、不同经济发展水平结核病流行情况和结核病患者特征,固定了研究人群,区分了患病人群和未患病人群,为浙江省结核病防治示范区开展第二轮、第三轮结核病动态筛查提供本底,最终探明结核病新发感染率、病死率变化。 (2)加强对既往有结核病史者、结核病接触者、外来人口、糖尿病患者的结核病管理工作,将有助于降低结核病的流行强度。
[Abstract]:Objectives of the study: In order to understand the epidemiological characteristics of tuberculosis in the demonstration area of major infectious diseases in Zhejiang Province, the risk factors of tuberculosis were discussed by means of chest X-ray examination of ordinary residents. To provide reference for tuberculosis prevention and control. Methods: March 2011-December 2012. Chest X-ray examination and suspected tuberculosis symptom examination were carried out in 8 demonstration sites of TB prevention and control in Zhejiang Province. (2) 714 tuberculosis patients were investigated in Shaoxing and Tongxiang demonstration field. 1635 non-tuberculosis patients were randomly selected as control group according to region, age and sex. A case-control study of risk factors was carried out. Statistical analysis was carried out with SPSS18.0, and the prevalence rate was compared by chi-square test. The bilateral level was bilateral 伪 0. 05. Univariate and multi-factor non-conditional logistic regression analysis was used to analyze the risk factors. Results (1) the actual population was 355232, including 152839 males and 202393 females, the ratio of male to female was 1: 1.16.The prevalence rate of active pulmonary tuberculosis was 181/10 000. The prevalence rate of smear positive pulmonary tuberculosis and bacterial positive tuberculosis was 36/10 million and 70/10 million respectively. (2) the prevalence rate of active pulmonary tuberculosis and smear positive tuberculosis was 314/10 000 and 64/10 000 respectively. The prevalence rate of active pulmonary tuberculosis, smear positive pulmonary tuberculosis and bacterial positive pulmonary tuberculosis was 125/10, 26/10 and 52/10, respectively. The prevalence of active pulmonary tuberculosis was 257/10 000 in the island area and 204/10 million in the inland area. The prevalence rate of active pulmonary tuberculosis in low GDP areas was 328/10 000. The prevalence rate of active pulmonary tuberculosis in high GDP areas was 163/10 million. The difference between the two is statistically significant. (4) 732 cases of active pulmonary tuberculosis, 151 cases of smear positive pulmonary tuberculosis and 271 cases of bacterial positive pulmonary tuberculosis were found. (5) 443 cases were engaged in agriculture and fishery. There were 480 cases of pulmonary tuberculosis and 252 cases of women aged 60 and above in 369 cases (50.41%). There were 397 cases (54.24%) with primary school education or below. The multivariate analysis showed that the history of tuberculosis was 124.04095 CI: 47.573and 314.353.The contact history of tuberculosis patients was 8.856. 95 CI: 4.917 ~ 21.064. The alien population is 2.801. 95 CI: 2.424 ~ 3.793.The history of diabetes is a risk factor for tuberculosis. Higher education level: 0.42395% CI: 0.316 ~ 0.729) is the protective factor. Conclusion: 1) the epidemic situation of tuberculosis and the characteristics of tuberculosis patients in different geographical landforms, different economic development levels and the characteristics of tuberculosis patients in the demonstration area of prevention and control of major infectious diseases in Zhejiang Province were preliminarily identified, and the study population was fixed. In order to provide the background for the second round and the third round of tuberculosis dynamic screening in Zhejiang Province, the new infection rate and mortality rate of tuberculosis were determined. 2) strengthening the management of tuberculosis among people with history of tuberculosis, contacts of tuberculosis, foreign population, and diabetes will help to reduce the epidemic intensity of tuberculosis.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R52

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