关键词: 结核,肺, 结核,抗多种药物性, 治疗结果, 因素分析,统计学

Abstract:

Objective: To analyze the treatment outcome and its influencing factors of patients with multidrug-resistant/rifampicin-resistant pulmonary tuberculosis (MDR/RR-PTB) in Ningxia Hui Autonomous Region from 2018 to 2022, so as to provide a theoretical basis for further strengthening prevention and control of drug-resistant pulmonary tuberculosis in this region. Methods: A retrospective research method was adopted to collect medical record information of MDR/RR-PTB patients in Ningxia region from 2018 to 2022 from the Tuberculosis Information Management System (including patients’ gender, age, occupation, educational level, date of first medical visit, reason for discontinuation of treatment, medical record status, results of drug susceptible tests, previous history of anti-tuberculosis treatment, treatment classification, and whether anti-tuberculosis treatment was received, etc.), which was then matched with relevant information of drug-resistant pulmonary tuberculosis patients treated in the Fourth People’s Hospital of Ningxia Hui Autonomous Region from 2018 to 2022 collected in its Hospital Information System (HIS). Univariable and multivariable logistic regression were used to analyze the treatment outcome and its influencing factors of matched MDR/RR-PTB patients. Results: A total of 362 patients with MDR/RR-PTB were identified in Ningxia region from 2018 to 2022, and 318 cases were included in treatment, the treatment inclusion rate was 87.85%. Treatment inclusion rates of students (100.00%, 30/30) and patients with high school education or above (96.97%, 64/66) were significantly higher than farmers (84.39%, 173/205) and patients with junior high school education or below (85.81%, 254/296), respectively, with statistically significant differences (χ²=10.904, P=0.012; χ²=6.294, P=0.043). Among the 318 treated patients, their treatment success rate was 61.95% (197/318), and rose from 62.37% (58/93) in 2018 to 64.91% (37/57) in 2020, and then dropped to 58.54% (24/41) in 2022, showing an overall downward trend ($\chi_{\text {trend }}^2$=59.285, P<0.001). Multivariable logistic regression showed that treatment success rate was higher in the age groups of 20-39 and 40-59 years old, students, other occupation groups, farmers, and newly diagnosed patients compared with those aged 60-94 years old, homemaker/unemployed people, and patients undergoing re-treatment (OR=4.468, 95%CI: 2.146-9.302; OR=2.205, 95%CI: 1.146-4.241; OR=27.819, 95%CI: 3.155-245.292; OR=5.887, 95%CI: 2.263-15.314; OR=4.019, 95%CI: 1.801-8.966; OR=1.808, 95%CI: 1.041-3.141). Conclusion: The MDR/RR-PTB patient treatment inclusion rate in Ningxia region from 2018 to 2022 had met the requirement of a treatment inclusion rate of ≥80% as in the provincial tuberculosis control plan. But attention should be paid to the downward trend from 2021 to 2022. The financial support policy for MDR/RR-PTB patients should be strengthened to reduce their economic burden as much as possible and improve their treatment compliance. High attention should be paid to health education and treatment management towards patients aged 60 and above, farmers, homemaker/unemployed people, and re-treatment patients.

Key words: Tuberculosis, pulmonary, Tuberculosis, multidrug-resistant, Treatment outcome, Factor analysis, statistical