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摘要:
背景 热带岛礁特殊气候与当地常见病的发生相关，热带常见病特征的研究报道较少。 目的 回顾性分析热带岛礁某二级医院门诊就诊情况，探讨与大陆常见疾病谱的差异性，为热带岛礁常见病精准化防治提供参考。 方法 按照国际疾病分类(International Classification of Diseases，ICD)-10标准，统计分析热带岛礁某二级医院2016年1月 - 2019年12月门诊病历中62870例次诊断信息。 结果 就诊人群18 ~ 30岁年龄段占比最高(60.15%)，男性(95.83%)占比远高于女性(4.17%)。按人体系统分，排名前5位的是肌肉骨骼系统和结缔组织疾病(19.15%)、呼吸系统疾病(17.57%)、消化系统疾病(15.50%)、皮肤和皮下组织疾病(10.24%)、损伤和中毒(8.13%)。按疾病类型分，排名前5位的是上呼吸道感染(9.81%)、腰痛(5.64%)、意外事故(5.58%)、皮炎(2.96%)、陈旧性肌肉劳损(2.08%)。 结论 热带岛礁常见疾病中上呼吸道感染是主要疾病类型，病原体不明确，存在流感暴发风险，应提高检测能力，予以针对性防控；同时应提高肌肉骨骼系统疾病和皮肤、皮下组织疾病的防治。 Abstract:Background Special climates in tropical regions affect the occurrence of common diseases, but studies describing the characteristics of common diseases in the tropics are lacking. Objective To retrospectively analyze the outpatient visit data of a secondary hospital in a tropical island, and explore the differences in the spectrum of common diseases between the tropical island and the mainland, so as to provide references for the precise prevention and treatment of common diseases in the tropical island. Methods According to the International Classification of Diseases (10th Revision), the outpatient medical records of 62 870 cases from 2016 to 2019 in a secondary hospital in the tropical island were analyzed. Results The proportion of patients aged from 18 to 30 years had the highest incidence (60.15%). The proportion of male patients (95.83%) was higher than that of female patients (4.17%). The top five systemic diseases were diseases of the musculoskeletal system and connective tissue (19.15%), diseases of the respiratory system (17.57%), diseases of the digestive system (15.50%), diseases of the skin and subcutaneous tissue (10.24%), and injury, poisoning and certain other consequences of external causes (8.13%). The top five diseases were upper respiratory tract infections (9.81%), back pain (5.64%), accidents (5.58%), dermatitis (2.96%), and old muscle strain (2.08%). Conclusion Among common diseases in the tropical island, upper respiratory tract infections are the most frequent and its pathogens are unclear. Since there is a risk of influenza outbreaks, it is necessary to improve detection capacity and formulate targeted prevention and control strategies. At the same time, attention should be paid to improving the prevention and treatment of musculoskeletal system and connective tissue disorders and skin and subcutaneous tissue disorders. -
图 1 占比前10位的一级诊断编码疾病构成比
M：肌肉骨骼系统和结缔组织病； J：呼吸系统病 K消化系统病； L：皮肤和皮下组织疾病； S：损伤、中毒和外因的某些其他后果； R：症状、体征和临床与实验异常所见，不可归类在他处者； X：暴露于某些有害因素下； Z：影响健康状态和保健机构接触因素； H：眼和附器疾病； B：某些传染病和寄生虫病
Figure 1. Composition ratio of the top ten primary diagnosis-coded diseases
M: Diseases of the musculoskeletal system and connective tissue; J: Diseases of the circulatory system; K: Diseases of the digestive system; L: Diseases of the skin and subcutaneous tissue; S: Injury, poisoning and other consequences of external causes; R: Abnormal symptoms, signs different from clinical and laboratory findings; X: Other external causes of accidental injury; Z: Factors influencing health status and contact with health services; H: Diseases of the eye and adnexa; B: Certain infectious and parasitic diseases
图 2 占比前10位的二级诊断编码疾病构成比
J06：多发性和未特指部位的急性上呼吸道感染；M54：背痛；X59：暴露于未特指的因素下；K05：龈炎和牙周疾病；L30：其他皮炎 M62肌肉其他疾患；Z00：无主诉或诊断报告的人接受的一般性检查和调查；B35：皮真菌病；J02：急性咽炎；H10：结膜炎
Figure 2. Composition ratio of the top ten secondary diagnosis-coded diseases
J06: Acute upper respiratory infections of multiple and unspecified sites; M54: Dorsalgia; X59: Exposure to unspecified factor; K05: Gingivitis and periodontal diseases; L30: Other dermatitis; M62: Other disorders of muscle; Z00: General examination and investigation of persons without complaint and reported diagnosis B35: Dermatophytosis; J02: Acute pharyngitis; H10: Conjunctivitis
图 3 占比前10位的三级诊断编码疾病构成比
J06.903：上呼吸道感染；M54.503：腰痛；X59.996：意外事故；Z00.001：健康查体；L30.901：皮炎；M62.691：陈旧性肌肉劳损；M62.681：陈旧性腰肌劳损；B35.301：足癣；H10.901：结膜炎；R10.401：腹痛
Figure 3. Composition ratio of the top ten tertiary diagnosis-coded diseases
J06.903: Upper respiratory infections; M54.503: Lumbago; X59.996: Accidents; Z00.001: Health check-up; L30.901: Dermatitis; M62.691: Obsolete muscle strain; M62.681: Old lumbar muscle strain; B35.301: Foot ringworm; H10.901: Conjunctivitis; R10.401: Abdominal pain
图 4 不同发病月份占比前十位的一级诊断编码疾病构成比
Figure 4. The composition ratio of the top ten primary diagnosis-coded diseases in different onset months
图 5 不同发病月份占比前十位的二级诊断编码疾病构成比
Figure 5. The composition ratio of the top ten secondary diagnosis-coded diseases in different onset months
图 6 不同发病月份占比前十位的三级诊断编码疾病构成比
Figure 6. The composition ratio of the top ten tertiary diagnosis-coded diseases in different onset months
表 1 门诊就诊情况
Table 1. Outpatient clinic visits information
分类 例数 构成比/% 临床科室 急诊外科 6634 13.29 康复医学科 4905 9.83 皮肤科 4781 9.58 骨科 4658 9.33 呼吸内科 4298 8.61 急诊内科 4127 8.27 口腔科 3708 7.43 创伤外科 2757 5.52 综合内科 2626 5.26 消化内科 2574 5.16 年龄 ＜18岁 726 1.30 18 ~ 29岁 33511 60.15 30 ~ 39岁 13473 24.18 40 ~ 50岁 6576 11.80 ＞50岁 1429 2.56 性别 女 2324 4.17 男 53391 95.83 地区 华东 8391 28.55 华中 7470 25.41 华北 4596 15.64 华南 4271 14.53 东北 1932 6.57 西南 1668 5.67 西北 1065 3.62 发病季节 夏季风期 28512 50.27 冬季风期 28201 49.73 
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表 2 不同年龄组一级诊断编码疾病比较(例，%)
Table 2. Comparison of primary diagnosis-coded diseases in different age groups (n, %)
诊断编码 ＜18岁(n=726) 18 ~ 29岁(n=33511) 30 ~ 39岁(n=13473) 40 ~ 50岁(n=6576) ＞50岁(n=1429) χ2 P值 M 94(12.95) 6384(19.05) 2725(20.23) 941(14.31) 237(16.59) 126.90 ＜0.0001 J 191(26.31) 5750(17.16) 2129(15.80) 959(14.58) 247(17.28) 82.69 ＜0.0001 K 70(9.64) 4706(14.04) 1976(14.67) 903(13.73) 189(13.23) 17.21 0.0018 L 89(12.26) 3650(10.89) 1112(8.25) 536(8.15) 85(5.95) 130.55 ＜0.0001 S 38(5.23) 2394(7.14) 1046(7.76) 794(12.07) 101(7.07) 193.55 ＜0.0001 R 63(8.68) 2096(6.25) 1018(7.56) 542(8.24) 110(7.70) 54.31 ＜0.0001 X 44(6.06) 2025(6.04) 718(5.33) 443(6.74) 36(2.52) 47.02 ＜0.0001 Z 42(5.79) 1672(4.99) 686(5.09) 313(4.76) 57(3.99) 5.00 0.2876 H 25(3.44) 1435(4.28) 639(4.74) 338(5.14) 80(5.60) 17.60 0.0015 B 33(4.55) 1611(4.81) 615(4.56) 250(3.80) 42(2.94) 21.90 0.0002
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表 3 不同年龄组二级诊断编码疾病比较(例，%)
Table 3. Comparison of secondary diagnosis-coded diseases in different age groups (n, %)
诊断编码 ＜18岁(n=726) 18 ~ 29岁(n=33511) 30 ~ 39岁(n=13473) 40 ~ 50岁(n=6576) ＞50岁(n=1429) χ2 P值 J06 121(16.67) 3648(10.89) 1194(8.86) 583(8.87) 136(9.52) 90.21 ＜0.0001 M54 37(5.10) 2088(6.23) 974(7.23) 268(4.08) 77(5.39) 78.96 ＜0.0001 X59 44(6.06) 2015(6.01) 716(5.31) 441(6.71) 36(2.52) 46.31 ＜0.0001 K05 20(2.75) 1525(4.55) 573(4.25) 172(2.62) 59(4.13) 54.92 ＜0.0001 L30 30(4.13) 1442(4.30) 553(4.10) 268(4.08) 52(3.64) 2.55 0.6350 M62 23(3.17) 1559(4.65) 505(3.75) 161(2.45) 29(2.0) 93.30 ＜0.0001 Z00 33(4.55) 1206(3.60) 429(3.18) 151(2.30) 22(1.54) 48.05 ＜0.0001 B35 20(2.75) 939(2.80) 382(2.84) 149(2.27) 30(2.10) 8.70 0.0690 J02 16(2.20) 666(1.99) 330(2.45) 149(2.27) 28(1.96) 10.64 0.0310 H10 6(0.83) 511(1.52) 268(1.99) 115(1.75) 31(2.17) 18.21 0.0011
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表 4 不同年龄组三级诊断编码疾病比较(例，%)
Table 4. Comparison of tertiary diagnosis-coded diseases in different age groups (n, %)
诊断编码 ＜18岁(n=726) 18 ~ 29岁(n=33511) 30 ~ 39岁(n=13473) 40 ~ 50岁(n=6576) ＞50岁(n=1429) χ2 P值 J06.903 116(15.98) 3444(10.28) 1142(8.48) 568(8.64) 132(9.24) 77.31 ＜0.0001 M54.503 34(4.68) 1935(5.77) 920(6.83) 233(3.54) 62(4.34) 95.24 ＜0.0001 X59.996 40(5.51) 1965(5.86) 697(5.17) 429(6.52) 33(2.31) 47.66 ＜0.0001 Z00.001 33(4.55) 1206(3.60) 428(3.18) 151(2.30) 22(1.54) 48.15 ＜0.0001 L30.901 18(2.48) 1102(3.29) 357(2.65) 152(2.31) 29(2.03) 31.41 ＜0.0001 M62.691 17(2.34) 824(2.46) 241(1.79) 84(1.28) 13(0.91) 58.53 ＜0.0001 M62.681 6(0.83) 716(2.14) 257(1.91) 69(1.05) 15(1.05) 45.43 ＜0.0001 B35.301 13(1.79) 567(1.69) 256(1.90) 118(1.79) 18(1.26) 4.51 0.3418 H10.901 6(0.83) 501(1.50) 261(1.94) 109(1.66) 31(2.17) 17.29 0.0017 R10.401 11(1.52) 470(1.40) 251(1.86) 149(2.27) 23(1.61) 32.14 ＜0.0001
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