【作者】 邓敏；

【导师】 阮冰；

【作者基本信息】 浙江大学 ， 内科学， 2014， 博士

【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。更多还原

【Abstract】 ObjectiveTo realize the epidemiology situation of tuberculosis (TB) through chest X-ray in major infectious disease demonstration area of Zhejiang Province, and to investigate the influencing factors on TB for prevention and cure of TB.Methods(1)From Mar.2011to Dec.2012, Chest X-ray and interrogation of suspected TB symptoms were conducted among aged15and above the permanent population by stratified clustered-random sampling in different stages in the eight TB demonstration area of Zhejiang Province.(2)714sputum smear positive TB patients and1635controls were randomly selected from the population under study and each case was matched by region, age and sex using a frequency matching method.(3) The chi-square was applied for the comparison of prevalence by SPSS18.0statistical analysis. Single-variable and multiple non-conditional logistic regression modeling were applied for data analysis of risk factors, and odds ratios (ORs) and their corresponding95%confidence intervals (CIs) were estimated.Results(1) A total of355232residents were examined, including male152839, female202393, the male to female ratio of1:1.16. The standardized prevalence of active, smesr positive and bacteriological positive pulmonary TB were181/100000,36/100000and70/100000.(2) The standardized male prevalence of active, smesr positive and bacteriological positive pulmonary TB were314/100000,64/100000and108/100000. The standardized female prevalence of active, smesr positive and bacteriological positive pulmonary TB were125/100000,26/100000and52/100000.(3) There were no statistical difference in the standardized prevalence of active pulmonary TB between island area (257/100000) and inland areas (204/100000). The standardized prevalence of active pulmonary TB in low GDP region (328/100000) was higher than high GDP region (163/100000).(4)732cases of active pulmonary TB,151cases of smesr positive pulmonary TB and271cases of bacteriological positive pulmonary TB were diagnosed.(5) A total of480male cases and252female cases were diagnosed. Elderly people aged60and above in369cases, accounting for50.41%. Engaged in farming and fishing person443cases, accounting for60.52%. Primary and culture under the socioeconomic status of397cases, accounting for54.24%.(6) Results from multiple logistic regression showed that the risk factors of TB would include the following items: history of having had TB (OR=124.040,95%CI:47.573～314.353), history of exposure to TB (OR=8.856,95%CI:4.917～21.064), being immigrants (OR=2.801,95%CI:2.424～3.793) and history of diabetes (OR=2.581,95%CI:1.276～3.559), while having had high degree of education as the protective factor of TB (OR=0.423,95%CI:0.316～0.729).Conclusion(1) Initially found out TB prevalence and characteristics of patients with TB in the different geological features and different economic development levels in zhejiang province, and fixed the study population, distinguished infected and uninfected group, provided baseline data for the second round and the third round of TB screening dynamically, to carry out the changes of TB new infections and the fatality rate. (2) Control programs targeting those ever having TB patients and contacts to TB patients as well as immigrants should be strengthened.更多还原