Characteristics of nine extra-pulmonary tuberculosis inpatients in nine designated tuberculosis hospitals, 2018−2020
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摘要:
目的 分析住院肺外结核病患者的流行病学特征,为肺外结核病的防治政策和措施制定提供科学依据。 方法 采用回顾性调查的方法,从全国东中西部共选取9家结核病定点医疗机构,利用医院信息系统(HIS)收集出院第一诊断为“肺外结核”和“结核性胸膜炎”患者的人口学特征和临床特征等。 采用频数、构成比和中位数对患者的相关资料进行描述性统计分析;采用χ2检验比较组间分布是否具有差异。 结果 本研究共纳入3451例肺外结核病患者,肺外结核病患者年龄中位数M(P25,P75)为44(29,59)岁;男、女性别比例为1.41∶1;农、牧民患者有1615例(46.80%)。 结核性胸膜炎、淋巴结结核和骨关节结核分别有689例(19.97%)、434例(12.58%)和427例(12.37%)。 肺外结核合并肝胆疾病、肾脏疾病和营养不良分别有533例(15.44%)、354例(10.26%)和258例(7.48%)。 从临床特征分析,入院前病情明确的患者有1973例(57.17%),46.28%(1597例)的患者接受手术治疗。 住院天数中位数为17d。 从肺外结核病患者的医保类型分析,城镇居民医保患者有1244例(占36.05%);全自费患者有398例(占11.53%)。 结论 肺外结核病住院患者主要以男性、中青年和农(牧)民为主体,以结核性胸膜炎、淋巴结结核和骨关节结核最常见。 Abstract:Objective To analyze the epidemiological characteristics of hospitalized patients with extra-pulmonary tuberculosis (TB) in China, and provide scientific basis for the formulation of policies and measures for the prevention and treatment of extra-pulmonary TB. Methods A retrospective survey was conducted in 9 designated tuberculosis hospitals selected in eastern, central and western China. The information about demographic and clinical characteristics of the hospitalized patients with the diagnosis of extra-pulmonary TB or tuberculous pleuritis at discharge were collected from Hospital Information System. Descriptive statistical analyses on the patients’ information were performed by using frequency, constituent ratio and median, and χ2 test was used to compare the differences in distributions among groups. Results A total of 3451 patients with extra-pulmonary TB were included in the study. The median age of the patients was 44(29, 59)years. The male to female ratio of the patients was 1.41∶1. In the extra-pulmonary TB included, 1615 (46.80%) were farmers and herders. Tuberculous pleurisy, lymph node TB and bone and joint TB cases accounted for 19.97% (689 cases), 12.58% (434 cases) and 12.37% (427 cases) respectively. Extra-pulmonary TB complicated with hepatobiliary disease, renal disease and malnutrition were found in 533 cases (15.44%), 354 cases (10.26%) and 258 cases (7.48%) respectively. A total of 1973 patients (57.17%) had clear medical conditions before admission, and 1597 patients (46.28%) had surgical operation. The median length of hospitalization was 17.00 days. The analysis on the type of health insurance for patients with extra-pulmonary TB indicated that 1244 patients (36.05%) had urban residents' health insurance; and 398 patients (11.53%) paid for the medical treatment by themselves. Conclusion The hospitalized patients with extra-pulmonary TB were mainly males, young and middle-aged people and farmers (herdsmen), and tuberculous pleurisy, lymph node TB and bone and joint TB were the most common types. -
表 1 2018-2020年9家结核病定点医疗机构肺外结核病患者总体分布情况
Table 1. Distribution of extra-pulmonary tuberculosis patients in 9 designated tuberculosis hospitals, 2018−2020
年份 东部 中部 西部 总计 2018 291 (8.43) 518 (15.01) 272 (7.88) 1081 (31.32) 2019 301 (8.72) 588 (17.04) 312 (9.04) 1201 (34.80) 2020 260 (7.54) 607 (17.59) 302 (8.75) 1169 (33.88) 合计 852 (24.69) 1713 (49.64) 886 (25.67) 3451 (100.00) 注:括号外数据为例数(例);括号内数据为构成比(%) 表 2 2018-2020年9家不同类型和等级结核病定点医疗机构肺外结核病患者情况
Table 2. Patients with different types and grades of extra-pulmonary tuberculosis in different types and grades of 9 designated tuberculosis hospitals, 2018−2020
变量 例数(例) 构成比(%) 医院类型 专科医院 2518 72.96 综合医院 933 27.04 医院等级 三级甲等 1613 46.74 三级未分等 929 26.92 三级乙等 396 11.47 二级甲等 513 14.87 表 3 2018-2020年9家结核病定点医疗机构肺外结核病患者的人口学特征
Table 3. Demographic characteristics of extra-pulmonary tuberculosis patients in 9 designated tuberculosis hospitals, 2018−2020
变量 例数(例) 构成比(%) 性别 男性 2017 58.45 女性 1434 41.55 年龄组(岁) 1~ 109 3.16 15~ 445 12.89 25~ 718 20.81 35~ 498 14.43 45~ 556 16.11 55~ 496 14.37 65~ 435 12.61 75~ 194 5.62 职业 农民/牧民 1615 46.80 家务/待业 327 9.48 学生 273 7.91 工人 115 3.33 退休 114 3.30 其他a 1007 29.18 注:a. 指包含各单一人群分类报告肺外结核病患者数均低于前5位的人群 表 4 2018-2020年9家结核病定点医疗机构不同类型肺外结核病患者分布情况
Table 4. Distribution of patients with different types of extra-pulmonary tuberculosis in 9 designated tuberculosis hospitals, 2018−2020
结核病类型 例数(例) 构成比(%) 单纯肺外结核 单个系统(或组织)肺外结核 2148 62.24 多个系统(或组织)肺外结核 143 4.14 小计 2291 66.38 肺外结核合并肺结核 1160 33.62 合计 3451 100.00 表 5 2018-2020年9家结核病定点医疗机构肺外结核患者常见合并症情况
Table 5. Common comorbidities of extra-pulmonary tuberculosis patients in 9 designated tuberculosis hospitals, 2018−2020
合并症 例数(例) 构成比(%) 肝胆疾病 533 15.44 肾脏疾病 354 10.26 营养不良(贫血、低蛋白血症) 264 7.65 肺部感染 187 4.01 艾滋病病毒感染者/艾滋病患者 104 3.01 胃部疾病 92 2.67 糖尿病 73 2.12 甲状腺疾病 67 1.94 白细胞减少症 34 0.99 精神疾病 9 0.26 注:按照肺外结核病患者合并单一疾病资料进行分类统计 表 6 2018-2020年9家结核病定点医疗机构分性别肺外结核病患者类型的分布情况
Table 6. Distribution of patients with extra-pulmonary tuberculosis patients by gender in 9 designated tuberculosis hospitals, 2018−2020
结核病类型 男性 女性 例数(例) 构成比(%) 例数(例) 构成比(%) 结核性胸膜炎 482 13.97 207 6.00 骨关节结核 227 6.58 200 5.79 结核性胸膜炎合并肺结核 219 6.35 82 2.37 淋巴结结核 161 4.66 273 7.91 神经系统结核合并肺结核 118 3.42 51 1.48 多系统肺外结核合并肺结核 117 3.39 69 2.00 神经系统结核 110 3.19 56 1.62 消化系统结核 93 2.69 79 2.29 泌尿生殖系统结核 77 2.23 88 2.55 淋巴结结核合并肺结核 76 2.20 101 2.93 其他 337 9.77 228 6.61 合计 2017 58.45 1434 41.55 表 7 2018-2020年9家结核病定点医疗机构分年龄肺外结核病患者类型的分布情况
Table 7. Distribution of patients with extra-pulmonary tuberculosis patients by age group in 9 designated tuberculosis hospitals, 2018−2020
结核病类型 1~岁 15~岁 25~岁 35~岁 45~岁 55~岁 65~岁 75~岁 结核性胸膜炎 11(0.32) 104(3.01) 140(4.06) 93(2.69) 113(3.27) 96(2.78) 87(2.52) 45(1.30) 淋巴结结核 28(0.81) 55(1.59) 118(3.42) 74(2.14) 62(1.80) 55(1.59) 30(0.87) 12(0.35) 结核性胸膜炎合并肺结核 3(0.09) 51(1.48) 61(1.77) 44(1.27) 45(1.30) 43(1.25) 34(0.99) 20(0.58) 淋巴结结核合并肺结核 3(0.09) 40(1.16) 62(1.80) 22(0.64) 24(0.70) 13(0.38) 13(0.38) 0(0.00) 多系统肺外结核合并肺结核 10(0.29) 37(1.07) 57(1.65) 21(0.61) 23(0.67) 22(0.64) 9(0.26) 7(0.20) 神经系统结核合并肺结核 10(0.29) 37(1.07) 22(0.64) 21(0.61) 30(0.87) 18(0.52) 27(0.78) 4(0.12) 骨关节结核 16(0.46) 20(0.58) 40(1.16) 55(1.59) 73(2.12) 73(2.12) 105(3.04) 45(1.30) 神经系统结核 9(0.26) 14(0.41) 42(1.22) 24(0.70) 24(0.70) 34(0.99) 15(0.43) 4(0.12) 消化系统结核 7(0.20) 12(0.35) 41(1.19) 27(0.78) 35(1.01) 27(0.78) 15(0.43) 8(0.23) 泌尿生殖系统结核 1(0.03) 11(0.32) 30(0.87) 41(1.19) 33(0.96) 24(0.70) 19(0.55) 6(0.17) 其他 11(0.32) 64(1.85) 105(3.04) 76(2.20) 94(2.72) 91(2.64) 81(2.35) 43(1.25) 合计 109(3.16) 445(12.89) 718(20.81) 498(14.43) 556(16.11) 496(1.37) 435(12.61) 194(5.62) 注:括号外数据为例数(例);括号内数据为构成比(%) 表 8 2018-2020年9家结核病定点医疗机构肺外结核病患者的临床学特征
Table 8. Clinical characteristics of patients with extra-pulmonary tuberculosis in 9 designated tuberculosis hospitals, 2018−2020
变量 例数(例) 构成比(%) 入院途径 新入院 520 15.07 其他途径入院a 2931 84.93 入院前病情是否明确 是 1973 57.17 否 1478 42.83 转科 是 263 7.62 否 3188 92.38 手术 是 1597 46.28 否 1854 53.72 住院天数(d) 1~ 1442 41.78 15~ 1253 36.31 30~ 756 21.91 注:a. 指包括经由本院急(门)诊诊疗后入院、经由其他医疗机构转诊入院、其他途径入院、不详等入院方式 表 9 2018-2020年9家结核病定点医疗机构肺外结核病患者医疗付费方式分布情况
Table 9. Distribution of medical payment methods for patients with extra-pulmonary tuberculosis in 9 designated tuberculosis hospitals, 2018−2020
医疗付费方式 例数(例) 构成比(%) 城镇居民基本医疗保险 1244 36.05 新型农村合作医疗 625 18.11 城乡居民基本医疗保险 561 16.26 城镇职工基本医疗保险 418 12.11 其他社会医疗保险 36 1.04 全公费 8 0.23 贫困救助 11 0.32 商业医疗保险 2 0.06 全自费 398 11.53 不详 148 4.29 合计 3451 100.00 -
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