Abstract: Background　Early detection of cases, early diagnosis and early standardized treatment are key to controlling human brucellosis and prevent its chronic development. It is important to study the causes and influencing factors of delayed detection of brucellosis by stages for comprehensive measures, targeted prevention and control of brucellosis. Objective　To study factors influencing delay in visit and diagnosis of human brucellosis, and provide basis for targeted risk control.Methods　Patients with brucellosis reported in Tianjin from 2012 to 2017 were selected as the research object.Self-designed questionnaires were used to collect the data of patients' gender, age, occupation, residence, clinical symptoms and signs, the name of diagnostic disease, the type of preferred hospital, the location of preferred hospital, the clinical stages at the time of consultation, and the first-visit department. According to whether the patient had delay in visit or initial diagnosis, they were divided into the timely visit group, the delayed visit group, the timely initial diagnosis and the delayed initial diagnosis group. Logistic regression was used to analyze the influencing factors of delayed visit and initial diagnosis. Results　A total of 808 cases with brucellosis were investigated. The delayed visit rate was 34.8%（281/808） and the delayed rate of initial diagnosis was 60.9%（492/808）．There were significant differences in fever, preferred hospital type and preferred hospital location between delayed visit group and timely visit group（P<0.05）．Multivariate Logistic regression analysis showed that the type of preferred hospital〔OR=1.70，95%CI（1.48，1.97）〕, the location of preferred hospital〔OR=1.25，95%CI（1.04，1.49）〕were the influencing factors of delay（P<0.05）．There were significant differences in occupation, residence, type of first-visit hospital, location of first-visit hospital, clinical stage and first-visit department between the timely initial diagnosis and the delayed initial diagnosis group（P<0.05）．Multivariate Logistic regression analysis showed that residence 〔OR=1.53，95%CI（1.11，2.10）〕, type of first-visit hospital〔OR=1.37，95%CI（1.24，1.51）〕, first-visit department〔OR=1.55，95%CI（1.39，1.73）〕were the influencing factors of delay in initial diagnosis（P<0.05）．Conclusion　Patients with brucellosis have different degrees of delay in the visit and diagnosis. To reduce the detection delay, we should focus on reducing the first diagnosis delay. Residence, type of preferred hospital and first-visit department may be the factors influencing the delay of first-time diagnosis of brucellosis.

Key words: Communicable diseases, Brucellosis, Delayed diagnosis, Root cause analysis, Questionnaires

摘要： 背景　病例早发现、早诊断、早期规范治疗是控制人群布鲁杆菌病（简称布病）疫情和防止病情慢性化发展的关键。通过研究布病病例发现延迟分阶段原因及影响因素，对于综合施策，精准防控布病有重要意义。目的　了解布病患者就诊及首次诊断延迟影响因素，为制定有针对性的风险管控措施提供依据。方法　以中国疾病预防控制信息系统中2012—2017年报告的天津市布病患者为研究对象，采用自行设计的调查问卷收集患者性别、年龄、职业、居住地、临床症状与体征、诊断疾病名称、首选医院类型、首选医院位置、就诊时临床分期、首诊科室等资料，并根据患者是否就诊或首次诊断延迟分为就诊及时组、就诊延迟组及首次诊断及时组、首次诊断延迟组。采用Logistic回归分析患者就诊、首次诊断延迟的影响因素。结果　共调查布病患者808例，就诊延迟率为34.8%（281/808），首次诊断延迟率为60.9%（492/808）。就诊延迟组与就诊及时组患者是否出现发热、首选医院类型、首选医院位置比较，差异均有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，首选医院类型〔OR=1.70，95%CI（1.48，1.97）〕、首选医院位置〔OR=1.25，95%CI（1.04，1.49）〕是就诊延迟的影响因素（P<0.05）。首次诊断及时组与首次诊断延迟组患者间职业、居住地、首诊医院类型、首诊医院位置、就诊时临床分期、首诊科室比较，差异均有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，居住地〔OR=1.53，95%CI（1.11，2.10）〕、首诊医院类型〔OR=1.37，95%CI（1.24，1.51）〕、首诊科室〔OR=1.55，95%CI（1.39，1.73）〕是首次诊断延迟的影响因素（P<0.05）。结论　布病患者在就诊和诊断阶段均有不同程度的延迟，减少布病患者的发现延迟主要应减少首次诊断延迟。而居住地、首选医院类型、首诊科室可能是布病患者首次诊断延迟的影响因素。

关键词: 传染病, 布鲁杆菌病, 延迟诊断, 影响因素分析, 问卷调查