结核病与肺部健康杂志 ›› 2017, Vol. 6 ›› Issue (3): 254-259.doi: 10.3969/j.issn.2095-3755.2017.03.000

• 论著 • 上一篇    下一篇

耐多药肺结核患者治疗转归的影响因素分析

王丹吉,卢鹏,刘巧,周扬   

  1. 210009 南京,东南大学公共卫生学院(王丹吉);江苏省疾病预防控制中心慢性传染病防制所(卢鹏、刘巧、周扬)
  • 收稿日期:2017-07-26 出版日期:2017-09-30 发布日期:2017-09-30
  • 作者简介:周扬
  • 基金资助:
    江苏省卫生计生委科研项目(Z201505)

Analysis of influencing factors of successful treatment of multidrug-resistant pulmonary tuberculosis

WANG Dan-ji, LU Peng, LIU Qiao, ZHOU Yang   

  1. Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China.
  • Received:2017-07-26 Online:2017-09-30 Published:2017-09-30

摘要: 目的 分析耐多药肺结核患者治疗转归情况并探讨影响治疗成功的相关因素。方法 从2013年1月至2014年12月,在江苏省徐州市、镇江市、连云港市和南通市纳入完成治疗的耐多药患者(至少同时耐利福平与异烟肼)524例作为回顾性调查研究对象。剔除了21例广泛耐多药患者,3例孕产妇的耐多药患者,51例有严重胃肠道疾病或精神疾病患者,28例不愿配合参与调查的患者,最终共纳入耐多药肺结核患者421例。以病案资料调查为主、电话访谈方式为辅获取研究资料,采用卡方检验进行单因素分析,logistic回归分析对变量进行多因素分析,探索可能影响耐多药肺结核病患者治疗转归的影响因素。结果 耐多药患者治疗成功率为52.7%(222/421),其中完成治疗率7.6%(32/421),治愈率45.1%(190/421),治疗失败、丢失与因其他原因而终止治疗的患者占39.7%(167/421),因结核病死亡的患者占5.5%(23/421),因非结核病死亡的患者占2.1%(7/421)。多因素logistic回归分析显示55岁以上患者(aRR=2.643,95%CI=1.409~4.959,P=0.002)(aRR=adjusted RR,矫正的RR值)、不良反应史(aRR=1.872,95%CI=1.041~3.365,P=0.036)、治疗前痰涂片阳性等级为++~++++(aRR=2.835,95% CI=1.476~5.446,P=0.002)、复治患者(aRR=4.512,95%CI=1.283~15.872,P=0.019)是耐多药肺结核患者治疗成功的负面影响因素。结论 55岁以上患者、不良反应史、治疗前痰涂片阳性等级为++~++++、复治患者对于患者治疗成功具有明显的负面影响。

Abstract: Objective To analyze the treatment success of multidrug-resistant tuberculosis patients and to investigate factors that affect the success of treatment. Methods From January 2013 to December 2014, 524 multidrug resistant patients (at least simultaneously resistant to rifampin and isoniazid) in Xuzhou, Zhenjiang, Lianyungang and Nantong City of Jiangsu Province, were invited to join this retrospective study. In the end, 421 patients were included, excluding 3 pregnant women with MDR TB, 51 patients with severe gastrointestinal diseases or mental disorders and 28 patients who were unwilling to cooperate with the investigated. Research data was based primarily on the investigation of medical records with additional telephone interviews. Univariate analysis was performed by chi square test, and multivariable logistic regression analysis was applied to explore the factors that might affect the treatment success of MDR patients. Results Out of the 421 subjects included in this study, the successful rate of treatment was 52.7% (222/421). The complete treatment rate was 7.6% (32/421), and the cure rate was 45.1% (190/421). Treatment failure, loss and discontinue treatment cases accounted for 39.7% (167/421), 5.5% died due to tuberculosis (23/421), and 2.1% died due to non-tuberculosis (7/421). In the multivariable logistic regression analysis, age(aRR=2.643,95%CI=1.409~4.959,P=0.002)(aRR is an adjusted RR value), adverse reaction history(aRR=1.872,95%CI=1.041~3.365,P=0.036), positive sputum smear before treatment(aRR=2.835,95% CI=1.476~5.446,P=0.002), and retreatment patients(aRR=4.512,95%CI=1.283~15.872,P=0.019)are the factors negatively affecting the success of multidrug-resistant pulmonary tuberculosis treatment. Conclusion Patients who are over 55 years old, with a history of adverse reactions, with a positive grade of sputum smear before treatment of ++~++++and retreatment patients have an obvious negative influence on the success of the treatment.