艾滋病合并肺结核患者就诊与确诊延迟的影响因素

Factors influencing the delay in medical consultation and diagnosis for patients with AIDS co-infected with tuberculosis

    摘要
  • 摘要:
    目的 了解艾滋病合并肺结核患者的就医行为，分析出现就诊、确诊延迟的影响因素，为实施结核病干预性控制措施提供理论依据。
    方法 选取2020年1月-2023年12月云南省传染病医院收治的202例首次住院的艾滋病合并肺结核患者，通过住院病历系统收集其临床资料。多因素logistic回归模型用于分析就诊与确诊延迟的影响因素。
    结果 入院时间、居住地、肺部是否出现空洞、肺部病灶分布、中途就诊医院、痰培养结果、病原学情况、CD4+/CD8+细胞比值及CD8+细胞计数均是患者出现就诊延迟的影响因素(P＜0.05)。首次诊断情况、Gene-Xpert结果则是患者出现确诊延迟的影响因素(P＜0.05)。多因素logistic回归分析显示，2021年入院(OR=3.842, 95%CI：1.651~8.966)、肺部出现空洞(OR=8.007, 95%CI：1.381~6.436)、病灶累积单肺(OR=0.637, 95%CI：0.049~8.267)是出现就诊延迟的危险因素。体质量减少自身10%(OR=2.070, 95%CI：1.056~4.059)、Gene-Xpert结果呈阴性(OR=1.667, 95%CI：0.688~4.038)是出现确诊延迟的危险因素。
    结论 艾滋病合并肺结核患者出现就诊、确诊延迟问题依然严重，且影响因素各不相同。要特别重视对艾滋病毒感染者的结核潜伏感染筛查工作，患者在出现可疑症状时到结核病定点医院进行检查、多次留取痰标本、关注体质量变化情况均对减少延迟的发生有着积极意义。

     

    Abstract:
    OBJECTIVE To understand the healthcare-seeking behavior of patients with AIDS co-infected with tuberculosis and analyze the factors influencing delayed consultation and diagnosis, and to provide a theoretical basis for the implementation of interventional tuberculosis control measures.
    METHODS Two hundred and two patients with AIDS complicated with tuberculosis who were first admitted to Yunnan Infectious Diseases Hospital from Jan. 2020 to Dec. 2023 were selected, and their clinical data were collected through the inpatient medical record system. Multivariate logistic regression model was used to analyze the factors influencing delayed consultation and diagnosis.
    RESULTS Time of admission, place of residence, presence of lung cavities, distribution of lung lesions, intermediate hospital visited, sputum culture results, etiological situation, CD4+/CD8+ cell ratio, and CD8+ cell counts were the factors influencing delayed consultation (P < 0.05). The initial diagnosis and Gene-Xpert results were the factors influencing delayed diagnosis (P < 0.05). Multivariate logistic regression analysis showed that admission in 2021 (OR=3.842, 95%CI: 1.651-8.966), and presence of lung cavity (OR=8.007, 95%CI: 1.381-6.436), single lung lesion accumulation (OR=0.637, 95%CI: 0.049-8.267) were risk factors for delayed consultation. A 10% reduction in body mass (OR=2.070, 95%CI: 1.056-4.059) and negative Gene-Xpert results (OR=1.667, 95%CI: 0.688-4.038) were risk factors for delayed diagnosis.
    CONCLUSIONS The issues of delayed medical consultation and diagnosis in patients with AIDS complicated with tuberculosis remain severe, with different factors influencing the delay. Special attention should be paid to the screening for latent tuberculosis infection in people infected with HIV. When experiencing suspicious symptoms, patients should go be encouraged to take exams at designated tuberculosis hospitals, repeatedly collect sputum samples and monitor changes in body mass, all of which are positively significant in reducing delays.

     

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