本文關(guān)鍵詞： 結(jié)核病 流行病學(xué) 抽樣調(diào)查 危險(xiǎn)因素　出處：《浙江大學(xué)》2014年博士論文　論文類型：學(xué)位論文

【摘要】：研究目的： 通過(guò)對(duì)普通居民開展胸部x線檢查,了解浙江省重大傳染病示范區(qū)結(jié)核病流行病學(xué)特點(diǎn)。探討結(jié)核病發(fā)病危險(xiǎn)因素,為結(jié)核病防治工作提供參考依據(jù)。方法： (1)2011年3月-2012年12月,對(duì)浙江省重大傳染病防治示范區(qū)8個(gè)結(jié)核病防治示范現(xiàn)場(chǎng)15歲及以上常住戶籍人口開展胸部x線檢查和結(jié)核病疑似癥狀問(wèn)診。 (2)在紹興和桐鄉(xiāng)示范現(xiàn)場(chǎng)調(diào)查714例結(jié)核病患者,從源人口中按地區(qū)、年齡、性別進(jìn)行頻數(shù)匹配,隨機(jī)抽取1635位非結(jié)核病患者作為對(duì)照組,進(jìn)行發(fā)病危險(xiǎn)因素病例對(duì)照研究。 (3)應(yīng)用SPSS18.0進(jìn)行統(tǒng)計(jì)分析,患病率之間的比較采用卡方檢驗(yàn),雙側(cè)水準(zhǔn)為雙側(cè)α=0.05。發(fā)病危險(xiǎn)因素分析采用單因素和多因素非條件logistic回歸分析。 結(jié)果 (1)實(shí)檢人口355232人,其中男152839人,女202393人,男女比例為1：1.16。活動(dòng)性肺結(jié)核患病率為181/10萬(wàn),涂陽(yáng)肺結(jié)核患病率為36/10萬(wàn),菌陽(yáng)肺結(jié)核患病率為70/10萬(wàn)。 (2)男性活動(dòng)性肺結(jié)核患病率為314/10萬(wàn),涂陽(yáng)肺結(jié)核患病率為64/10萬(wàn),菌陽(yáng)肺結(jié)核患病率為108/10萬(wàn)。女性活動(dòng)性肺結(jié)核患病率為125/10萬(wàn),涂陽(yáng)肺結(jié)核患病率為26/10萬(wàn),菌陽(yáng)肺結(jié)核患病率為52/10萬(wàn)。 (3)海島地區(qū)活動(dòng)性肺結(jié)核患病率為257/10萬(wàn),內(nèi)陸地區(qū)為204/10萬(wàn),兩者之間的差異無(wú)統(tǒng)計(jì)學(xué)意義。GDP低地區(qū)活動(dòng)性肺結(jié)核患病率為328/10萬(wàn),GDP高地區(qū)活動(dòng)性肺結(jié)核患病率為163/10萬(wàn),兩者之間的差異有統(tǒng)計(jì)學(xué)意義。 (4)發(fā)現(xiàn)活動(dòng)性肺結(jié)核患者732例,涂陽(yáng)肺結(jié)核患者151例,菌陽(yáng)肺結(jié)核患者271例。 (5)肺結(jié)核患者男480例,女252例。60歲及以上老年人369例,占50.41%。從事農(nóng)漁業(yè)者443例,占60.52%。小學(xué)及以下文化程度者397例,占54.24%。 (6)多因素分析顯示：結(jié)核病病史(OR=124.040,95%CI:47.573～314.353).結(jié)核病患者接觸史(OR＝8.856,　95%CI:　4.917　～　21.064).外來(lái)人口(OR=2.801,95%CI:2.424　～　3.793).糖尿病史(OR=2.581,95%CI：1.276～3.559)是結(jié)核病發(fā)生的危險(xiǎn)因素,文化程度高(OR=0.423,95%CI:0.316　～　0.729)是保護(hù)因素。 結(jié)論： (1)初步摸清了浙江省重大傳染病防治示范區(qū)不同地理地貌、不同經(jīng)濟(jì)發(fā)展水平結(jié)核病流行情況和結(jié)核病患者特征,固定了研究人群,區(qū)分了患病人群和未患病人群,為浙江省結(jié)核病防治示范區(qū)開展第二輪、第三輪結(jié)核病動(dòng)態(tài)篩查提供本底,最終探明結(jié)核病新發(fā)感染率、病死率變化。 (2)加強(qiáng)對(duì)既往有結(jié)核病史者、結(jié)核病接觸者、外來(lái)人口、糖尿病患者的結(jié)核病管理工作,將有助于降低結(jié)核病的流行強(qiáng)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 偽 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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R52

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