Comparative analysis on treatment effect between aged 65 and above and under aged 65 years with pulmonary tuberculosis patients

doi:10.3969/j.issn.2095-3755.2018.01.012

Abstract

Abstract:

Objective To analyze treatment effect between aged 65 and above and under aged 65 years with pulmonary tuberculosis patients, and provide reference for tuberculosis prevention and control strategy.Methods Two thousand and seventy five patients diagnosed and treated from 8 provinces were enrolled in the study, 282 patients were 65 years old and above,ranging from 65 to 91 years old with an average of (73.6±16.4)years old. 1793 cases were under 65 years old ranging from 15 to 64 years old with an average (38.3±18.6)years old among 2075 patients. Chi-square test and Fisher exact test were used to compare the following variables between aged 65 and above and under aged 65 years with pulmonary tuberculosis patients: adverse reactions (ADR), cavity closure, lesions absorption, sputum-culture results at the end of the 2nd month of treatment, and treatment outcome. A P-value of less than 0.05 is considered statistically significant.Results Sixty five years old and above patients accounted for 13.6% (282/2075), ADR rate, no change and deterioration of lesions among aged 65 and above group was 24.8% (70/282) and 9.9% (20/203) respectively and was higher than under 65 years old group which was 22.0% (390/1793) and 7.8% (111/1419), but the difference was not significant (χ ² value was 0.249 and 0.248,respectively; P-value >0.05);meanwhile no change and deterioration of cavities, sputum-culture rate at the end of the 2nd month of treatment and failure rate among aged 65 and above group were 17.6% (13/74), 20.2% (44/218) and 12.8% (36/282) respectively, was significant higher than under 65 years old non-elderly group which was 8.9% (51/575),14.6% (217/1491) and 7.8% (139/1793)(χ ² value was 0.041, 0.034 and 0.001,respectively; P-value <0.05).Conclusion Treatment effect aged 65 and above group was inferior to those under 65 years old group with higher ADR rate, higher deterioration of lesions and cavities, higher sputum-culture rate at the end of the 2 ^nd month, higher failure and death rate.

Key words: Aged, Tuberculosis, pulmonary, Age groups, Comparative effectiveness research

Yan MA,Mai-ling HUANG,Jian DU,Wei SHU,Shi-heng XIE,Hong-hong WANG,Shou-yong TAN,Xiang-qun LI,Yan-yong FU,Li-ping MA,Lian-ying ZHANG,Fei-ying LIU,Dai-yu HU,Yan-ling ZHANG,Yu-hong LIU,Liang LI. Comparative analysis on treatment effect between aged 65 and above and under aged 65 years with pulmonary tuberculosis patients[J]. Journal of Tuberculosis and Lung Health , 2018, 7(1): 54-59. doi: 10.3969/j.issn.2095-3755.2018.01.012

Figures/Tables 4

References 23

[1]	World Health Organization . Global tuberculosis report 2017. Geneva: World Health Organization, 2017.
[2]	中华人民共和国国务院人口普查办公室,中华人民共和国国家统计局人口和就业统计司. 中国2010 年人口普查资料(上、中、下册).北京: 中国统计出版社, 2012.
[3]	裴宁, 李波, 曹文利 , 等. 老年肺结核患者的耐药性分析. 中国防痨杂志, 2017,39(9):985-989. doi: 10.3969/j.issn.1000-6621.2017.09.017 URL
[4]	张玉, 叶建君, 杨成凤 , 等. 2006—2015年湖北省老年肺结核疫情特征及变化趋势分析. 中国防痨杂志, 2017,39(2):213-216. doi: 10.3969/j.issn.1000-6621.2017.02.021 URL
[5]	全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告. 中国防痨杂志, 2012,34(8):485-508.
[6]	中华人民共和国卫生部. WS 288—2008 肺结核诊断标准.北京: 人民卫生出版社, 2008.
[7]	中华人民共和国卫生部疾病预防控制局,中华人民共和国卫生部医政司,中国疾病预防控制中心. 中国结核病防治规划实施工作指南(2008年版).北京: 中国协和医科大学出版社, 2009: 52-70.
[8]	中华医学会. 临床诊疗指南:结核病分册.北京: 人民卫生出版社, 2005.
[9]	Hauer B, Brodhun B, Altmann D , et al. Tuberculosis in the elderly in Germany. Eur Respir J, 2011,38(2):467-470. doi: 10.1183/09031936.00199910 URL pmid: 21804163
[10]	Ananthakrishnan R, Kumar K, Ganesh M , et al. The profile and treatment outcomes of the older (aged 60 years and above) tuberculosis patients in Tamilnadu, South India. PLoS One, 2013,8(7):e67288. doi: 10.1371/journal.pone.0067288 URL
[11]	Touré NO, Dia Kane Y, Diatta A , et al. Tuberculosis in elderly persons. Rev Mal Respir, 2010,27(9):1062-1068. doi: 10.1016/j.rmr.2010.04.017 URL
[12]	Oshi DC, Oshi SN, Alobu I , et al. Profile and treatment outcomes of tuberculosis in the elderly in southeastern Nigeria, 2011-2012. PLoS One, 2014,9(11):e111910. doi: 10.1371/journal.pone.0111910 URL
[13]	Ncube RT, Takarinda KC, Zishiri C , et al. Age-stratified tuberculosis treatment outcomes in Zimbabwe: are we paying attention to the most vulnerable? Public Health Action, 2017,7(3):212-217. doi: 10.5588/pha.17.0024 URL
[14]	Gavazzi G, Herrmann F, Krause KH . Aging and infectious diseases in the developing world. Clin Infect Dis, 2004,39(1):83-91. doi: 10.1086/421559 URL pmid: 15206058
[15]	Walubo A, Chan K, Woo J , et al. The disposition of antituberculous drugs in plasma of elderly patients. I. Isoniazid and hydrazine metabolite. Methods Find Exp Clin Pharmacol, 1991,13(8):545-550.
[16]	吴妍, 李琦 . 老年肺结核的诊治现状与进展. 中国防痨杂志, 2015,37(9):975-978. doi: 10.3969/j.issn.1000-6621.2015.09.012 URL
[17]	李剑波, 张丽祥, 陆华 . 肺结核患者不同年龄组发生药物不良反应的对比研究. 中国防痨杂志, 2016,38(12):1109-1114. doi: 10.3969/j.issn.1000-6621.2016.12.019 URL
[18]	Huang YS, Chern HD, Su WJ , et al. Polymorphism of the N-acetyltransferase 2 gene as a susceptibility risk factor for antituberculosis drug-induced hepatitis. Hepatology, 2002,35(4):883-889. doi: 10.1053/jhep.2002.32102 URL
[19]	Teleman MD, Chee CB, Earnest A , et al. Hepatotoxicity of tuberculosis chemotherapy under general programme conditions in Singapore. Int J Tuberc Lung Dis, 2002,6(8):699-705. doi: 10.4028/www.scientific.net/MSF.264-268.1073 URL pmid: 12150482
[20]	Righi E, Della Siega P, Merelli M , et al. Comparison of clinical characteristics of tuberculosis between two age groups at an Italian Tertiary Hospital. Infection, 2015,43(3):361-366. doi: 10.1007/s15010-015-0765-y URL
[21]	Velayutham BR, Nair D, Chandrasekaran V , et al. Profile and response to anti-tuberculosis treatment among elderly tuberculosis patients treated under the TB Control programme in South India. PLoS One, 2014,9(3):e88045. doi: 10.1371/journal.pone.0088045 URL
[22]	Pratt RH, Winston CA, Kammerer JS , et al. Tuberculosis in older adults in the United States, 1993—2008. J Am Geriatr Soc, 2011,59(5):851-857. doi: 10.1111/j.1532-5415.2011.03369.x URL pmid: 21517786
[23]	Patra S, Lukhmana S, Tayler Smith K , et al. Profile and treatment outcomes of elderly patients with tuberculosis in Delhi, India: implications for their management. Trans R Soc Trop Med Hyg, 2013,107(12):763-768. doi: 10.1093/trstmh/trt094 URL

人口学特征	合计		<65岁		≥65岁		χ²值	P值
人口学特征	例数	构成比 (%)	例数	构成比 (%)	例数	构成比 (%)	χ²值	P值
性别							4.92	0.013
男	1509	72.7	1288	71.8	221	78.4
女	566	27.3	505	28.2	61	21.6
职业							32.75	<0.01
农民及外来务工人员	1111	53.6	919	51.3	192	68.1
企事业单位职工	173	8.3	167	9.3	6	2.1
其他^a	791	38.1	707	39.4	84	29.8
文化程度							252.30	<0.01
文盲	168	8.1	98	5.5	70	24.8
小学	559	26.9	413	23.0	146	51.8
中学	1142	55.1	1086	60.6	56	19.9
大专、本科及以上	206	9.9	196	10.9	10	3.5
户籍							79.41	<0.01
本地户籍人口	1494	72.0	1228	68.5	266	94.3
非本地户籍人口	581	28.0	565	31.5	16	5.7
婚姻							99.19	<0.01
未婚	513	24.7	508	28.3	5	1.8
已婚	1441	69.5	1190	66.4	251	89.0
其他^b	121	5.8	95	5.3	26	9.2
吸烟情况							11.14	0.004
从不吸烟	952	45.9	839	46.8	113	40.1
过去吸烟,现在不吸	758	36.5	630	35.1	128	45.4
现在吸烟	365	17.6	324	18.1	41	14.5
饮酒情况							6.15	0.046
从不饮酒	1124	54.2	978	54.5	146	51.8
过去饮酒,现在不饮	772	37.2	652	36.4	120	42.5
现在饮酒	179	8.6	163	9.1	16	5.7
治疗类型							1.20	0.275
初治	1770	85.3	1536	85.7	234	83.0
复治	305	14.7	257	14.3	48	17.0

观察项目	合计		<65岁		≥65岁		统计学检验值	P值
观察项目	例数	构成比 (%)	例数	构成比 (%)	例数	构成比 (%)	统计学检验值	P值
病灶情况							χ²=2.79	0.248
恶化	26	1.6	20	1.4	6	3.0
不变	105	6.5	91	6.4	14	6.9
吸收	1491	91.9	1308	92.2	183	90.1
合计	1622	100.0	1419	100.0	203	100.0
空洞闭合情况							Fisher精确概率法	0.041
增大	4	0.6	3	0.5	1	1.4
不变	60	9.3	48	8.4	12	16.2
缩小或闭合	585	90.1	524	91.1	61	82.4
合计	649	100.0	575	100.0	74	100.0

不良反应	合计		<65岁组		≥65岁组		χ²值	P值
不良反应	例数	构成比(%)	例数	构成比(%)	例数	构成比(%)	χ²值	P值
							1.33	0.249
有	460	21.8	390	22.0	70	24.8
无	1615	78.2	1403	78.0	212	75.2

比较项目	合计		<65岁组		≥65岁组		χ²值	P值
比较项目	例数	构成比 (%)	例数	构成比 (%)	例数	构成比 (%)	χ²值	P值
2个月末痰培养							4.57	0.034
阴性	1448	84.7	1274	85.4	174	79.8
阳性	261	15.3	217	14.6	44	20.2
治疗转归							34.52	<0.01
治疗成功	1657	79.9	1451	80.9	206	73.0
失败	175	8.4	139	7.8	36	12.8
死亡	47	2.3	29	1.6	18	6.4
其他	196	9.4	174	9.7	22	7.8