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目的通过对2013~2015年乌鲁木齐市耐多药结核病患者病案信息的分析,了解该市耐多药结核病就诊延迟现状及影响因素,为降低耐多药结核病就诊延迟率提供理论依据。方法收集2013年1月1日-2015年12月31日乌鲁木齐市耐多药结核病患者病案信息,并分析该类患者就诊延迟现状及影响因素。影响因素分析采用χ2检验、秩和检验及Fisher确切概率法。结果就诊延迟中位延迟时间为31 d,(P25-P75)为(28.00~83.75)d;最大延迟时间为378 d,最小延迟时间为4 d。3年期间耐多药结核病患者就诊延迟比例无趋势性变化(χ2=1.311,P=0.252)。治疗结局以治愈比重最大,其次为失访及死亡。影响因素除HIV检查结果差异有统计学意义外(Z=3.082,P=0.002),性别、年龄、民族、职业、人口类型、患者来源等11种因素差异均无统计学意义(P>0.05);HIV检查结果呈阳性的患者耐多药结核病就诊延迟率较HIV检查结果阴性的患者低;就诊延迟患者完成治疗情况较未就诊延迟者差(P=0.035)。结论该市目前耐多药结核病存在就诊延迟现象,且就诊延迟率较高(66.667%);今后应加大管理力度,变被动监测为主动监测;同时加大对普通人群(至少是耐多药结核病易感人群)的结核病筛查力度,以便早期发现耐多药结核病患者,降低该市耐多药结核病就诊延迟率,严防耐多药结核病就诊延迟现象的反弹。
OBJECTIVE: To analyze the case record of MDR-TB patients in Urumqi from 2013 to 2015 so as to understand the status quo and influencing factors of delayed-treatment of multidrug-resistant tuberculosis in the city and provide a theoretical basis for reducing the delay rate of MDR TB treatment. Methods The medical records of MDR-TB patients in Urumqi from January 1, 2013 to December 31, 2015 were collected, and the current status and influencing factors of delayed treatment in such patients were analyzed. Analysis of influencing factors using χ2 test, rank sum test and Fisher exact test. Results The median delay of treatment was 31 days (P25-P75) and (28.00-83.75) days respectively. The maximum delay time was 378 days and the minimum delay time was 4 days. There was no trend change in the delayed proportion of MDR-TB patients over the three-year period (χ2 = 1.311, P = 0.252). The treatment outcome to cure the largest proportion, followed by loss of follow-up and death. There were no significant differences among the 11 factors including gender, age, nationality, occupation, type of population and source of patients except for the HIV test results (Z = 3.082, P = 0.002) ; HIV-positive patients had a lower delay in MDR-TB treatment than those with negative HIV-test results; and those with delayed HIV-positive treatment performed worse than those without delay (P = .035). Conclusions There is a delay in the treatment of multidrug-resistant tuberculosis in the city, and the delay rate of visiting is higher (66.667%). In the future, management should be strengthened and passive monitoring should be taken as active monitoring. At the same time, the general population (at least MDR TB susceptible population) screening efforts to early detection of MDR-TB patients, to reduce the city’s delay in treatment of multi-drug-resistant tuberculosis and prevent delays in treatment of multi-drug resistant TB rebound.