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中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (9): 1394-1401.doi: 10.19982/j.issn.1000-6621.20260244

• 论著 • 上一篇    下一篇

2024—2025年浙江省桐乡市流动人口肺结核患者主动发现双重对比研究

曹元1, 许皓1, 姚晓英1, 盛钟嘉1, 陈松华2()   

  1. 1 浙江省桐乡市疾病预防控制中心结核病预防控制科, 嘉兴 314500
    2 浙江省疾病预防控制中心结核病预防控制所, 杭州 310000
  • 收稿日期:2026-04-28 出版日期:2026-09-10 发布日期:2026-09-08
  • 通信作者: 陈松华 E-mail:shchen@cdc.zj.cn
  • 基金资助:
    2026年浙江省疾病预防控制科技计划项目(2026JKY036)

Dual comparative study on active case finding for pulmonary tuberculosis among the migrant population in Tongxiang City, Zhejiang Province, 2024—2025

Cao Yuan1, Xu Hao1, Yao Xiaoying1, Sheng Zhongjia1, Chen Songhua2()   

  1. 1 Institute of Tuberculosis Prevention and Control, Tongxiang Center for Disease Control and Prevention, Jiaxing 314500, China
    2 Institute of Tuberculosis Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310000, China
  • Received:2026-04-28 Online:2026-09-10 Published:2026-09-08
  • Contact: Chen Songhua E-mail:shchen@cdc.zj.cn
  • Supported by:
    2026 Zhejiang Province Disease Prevention and Control Science and Technology Plan Project(2026JKY036)

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摘要：

目的: 通过对2024—2025年浙江省桐乡市流动人口肺结核患者主动发现双重对比研究,为优化区域结核病防控策略提供参考依据。 方法: 通过“中国疾病预防控制信息系统”的子系统“结核病管理信息系统”收集2024—2025年浙江省桐乡市肺结核患者相关临床资料。第一重对比以流动人口肺结核患者为研究对象,比较主动发现和被动发现两类患者群体的特征差异;第二重对比以全市所有主动发现肺结核患者为研究对象,比较流动人口患者和本地户籍患者之间的特征差异。进一步结合双重对比结果进行交叉验证,识别现有主动发现体系的覆盖盲区。 结果: 2024—2025年桐乡市共登记流动人口肺结核患者175例,其中主动发现66例(37.71%),被动发现109例(62.29%)。第一重对比显示,流动人口肺结核主动发现患者产业中心区居住占比(90.91%,60/66)、病原学阴性占比(51.52%,34/66)均高于被动发现患者(77.98%,85/109;26.61%,29/109),就诊延误占比(31.82%,21/66)低于被动发现患者(62.39%,68/109),差异均有统计学意义(χ2=4.837, P=0.028; χ2=11.071, P<0.001; χ2=15.368, P<0.001); 多因素logistic回归分析显示,主动发现是流动人口肺结核患者病原学阳性的保护因素(OR=0.387,95%CI:0.197~0.761)。第二重对比显示,同期全市共登记肺结核主动发现患者156例,其中流动人口66例(42.31%),本地户籍人口90例(57.69%);流动人口主动发现患者25~64岁青壮年占比(83.33%,55/66)、务工人员占比(63.64%,42/66)、产业中心区居住占比(90.91%,60/66)、病原学阴性占比(51.52%,34/66)均高于本地户籍主动发现患者(54.44%,49/90;27.78%,25/90;74.44%,67/90;28.89%,26/90),差异均有统计学意义(Fisher精确概率法,P<0.001; χ2=35.299, P<0.001; χ2=6.820, P=0.009; χ2=8.236, P=0.004),相应地,本地户籍主动发现患者≥65岁老年人占比(40.00%,36/90)和周边乡镇居住占比(25.56%,23/90)均高于流动人口患者(4.55%,3/66;9.09%,6/66)。 结论: 主动发现可有效识别流动人口中处于疾病早期的病原学阴性肺结核患者,且就诊延误比例更低;现有主动发现体系对流动人口和本地户籍人口肺结核患者的覆盖特征存在明显差异,周边乡镇流动人口为覆盖短板。

关键词: 结核,肺, 流动人口, 主动发现, 被动发现, 就诊延误

Abstract:

Objective: With a dual comparative study on active case finding (ACF) for pulmonary tuberculosis (PTB) patients among migrant population in Tongxiang City, Zhejiang Province from 2024 to 2025, to provide evidences for optimizing regional TB control strategies. Methods: Data on all notified PTB patients in Tongxiang City from 2024 to 2025 were collected from the Tuberculosis Management Information System, a subsystem of the China Information System for Disease Control and Prevention. The first comparison was conducted to explore differences in epidemiological and clinical characteristics between active and passive case finding among the migrant population and the second comparison was performed to study characteristic differences between migrant and local patients among all cases identifed through ACF. Cross-validation was performed by combining the results of the two comparisons to identify coverage gaps in the current ACF system. Results: A total of 175 migrant PTB patients were notified in Tongxiang City from 2024 to 2025, with 66 (37.71%) identified through ACF and 109 (62.29%) through passive case-finding (PCF). The first comparison showed that the proportions of patients residing in industrial core areas (90.91%, 60/66) and with bacteriologically negative results (51.52%, 34/66) in ACF group were higher than those in PCF group (77.98%, 85/109; 26.61%, 29/109) respectively, while the proportion of diagnostic delay (31.82%, 21/66) was lower than that in the PCF group (62.39%, 68/109), with statistically significant differences (χ2=4.837, P=0.028; χ2=11.071, P<0.001; χ2=15.368, P<0.001). Multivariate logistic regression revealed that ACF was a protective factor against bacteriologically positive PTB among migrant patients (OR=0.387, 95%CI: 0.197~0.761). The second comparison showed that a total of 156 patients were identified through ACF during the same period, including 66 migrants (42.31%) and 90 local residents (57.69%). The proportions of patients aged 25-64 years (83.33%, 55/66), working as migrant workers (63.64%, 42/66), residing in industrial core areas (90.91%, 60/66), and with bacteriologically negative results (51.52%, 34/66) among the migrant population were significantly higher than those among the local residents (54.44%, 49/90; 27.78%, 25/90; 74.44%, 67/90; 28.89%, 26/90), with statistically significant differences (Fisher’s exact test, P<0.001; χ2=35.299, P<0.001; χ2=6.820, P=0.009; χ2=8.236, P=0.004). Correspondingly, the local subgroup had statistically significantly higher proportions of elderly patients aged ≥65 years (40.00%, 36/90) and residents of peripheral townships (25.56%, 23/90) than the migrant subgroup (4.55%, 3/66; 9.09%, 6/66). Conclusion: ACF facilitates early identification of bacteriologically negative PTB patients among the migrant population and is associated with a lower proportion of diagnositc delay. There are significant differences in the current ACF coverage characteristics between the migrant population and local residents, with migrants residing in peripheral townships identified as the coverage gap.

Key words: Tuberculosis, pulmonary, Migrant population, Active case finding, Passive case finding, Diagnostic delay

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