北京市初治肺结核患者治疗成功后复发情况及危险因素分析

张红伟 陈曦 孙闪华 许琰 李波 赵鑫 高志东

张红伟, 陈曦, 孙闪华, 许琰, 李波, 赵鑫, 高志东. 北京市初治肺结核患者治疗成功后复发情况及危险因素分析[J]. 疾病监测, 2021, 36(8): 818-823. doi: 10.3784/jbjc.202106110332
引用本文: 张红伟, 陈曦, 孙闪华, 许琰, 李波, 赵鑫, 高志东. 北京市初治肺结核患者治疗成功后复发情况及危险因素分析[J]. 疾病监测, 2021, 36(8): 818-823. doi: 10.3784/jbjc.202106110332
Zhang Hongwei, Chen Xi, Sun Shanhua, Xu Yan, Li Bo, Zhao Xin, Gao Zhidong. Recurrence and risk factors to the pulmonary tuberculosis patients after successful initial treatment in Beijing[J]. Disease Surveillance, 2021, 36(8): 818-823. doi: 10.3784/jbjc.202106110332
Citation: Zhang Hongwei, Chen Xi, Sun Shanhua, Xu Yan, Li Bo, Zhao Xin, Gao Zhidong. Recurrence and risk factors to the pulmonary tuberculosis patients after successful initial treatment in Beijing[J]. Disease Surveillance, 2021, 36(8): 818-823. doi: 10.3784/jbjc.202106110332

北京市初治肺结核患者治疗成功后复发情况及危险因素分析

doi: 10.3784/jbjc.202106110332
基金项目: 首都卫生发展科研专项基金(No. 2011–1012–01);北京结核病控制研究所科研基金(No. JKS2021–01)
详细信息
    作者简介:

    张红伟,女,北京市人,硕士,主管医师,主要从事耐药结核病防治和结核病流行病学监测工作,Email:zhw841128@126.com

    通讯作者:

    高志东,Tel:18501139263,Email:guhu751029@126.com

  • 中图分类号: R211; R521

Recurrence and risk factors to the pulmonary tuberculosis patients after successful initial treatment in Beijing

Funds: This study was supported by the fund for the Capital Health Research and Development of Special (No. 2011–1012–01) and Research Fund of Beijing Institute of Tuberculosis Control (No. JKS2021–01)
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  • 摘要:   目的  分析北京市初治肺结核患者治疗成功后的复发情况及其影响因素。  方法  采用回顾性队列分析,从结核病管理信息系统中导出北京市2015 — 2017年登记并治疗成功的户籍初治肺结核患者为研究对象,匹配截至2020年12月31日的病案和报告卡,查找复发病例并进行生存分析,通过寿命表法估算肺结核复发情况,复发的单因素分析采用Kaplan-Meier法,组间比较采用log-rank法检验,多因素分析采用时依Cox回归模型。  结果  纳入研究的8 503例成功治疗户籍初治结核病患者中,共有253例(2.98%)复发,复发率密度为8.14/1 000人年,其中88.54%(224例)的患者3年内复发,5年累计复发率为3.57%。 在单因素分析基础上进行的多因素分析发现,肺部空洞[调整后的风险比(aHR)为1.592,95%置信区间(CI):1.166~2.172,P=0.003)]、时依变量中的年龄(aHR=1.004,95%CI:1.001~1.008,P=0.008)、被动就诊(aHR=1.200,95%CI:1.008~1.428,P=0.040)、病原学阳性(aHR=1.154,95%CI:1.034~1.289,P=0.011)是肺结核复发的独立危险因素。  结论  应加强结核病患者治疗成功后的随访和管理,对肺结核复发的高危人群开展针对性干预措施,加强对公众的健康教育,及早发现、尽快规范治疗,减少复发。
  • 图  1  累积复发风险曲线

    Figure  1.  Cumulative recurrence risk curve

    表  1  北京市本地初治肺结核患者治疗成功后的复发情况

    Table  1.   Recurrence of pulmonary TB cases after successful initial treatment in Beijing

    观察年数
    (年)
    期初观察
    病例数
    (例)
    有复发风险
    病例数
    (例)
    复发
    病例数
    (例)
    n
    复发率
    (%)
    n年累计
    复发率
    (%)
    18 5038 503941.111.11
    28 4098 347841.012.10
    38 2007 068460.652.74
    45 8904 671200.433.15
    53 4312 11290.433.57
    6 784 39200.003.57
    下载: 导出CSV

    表  2  初治肺结核患者治疗成功后复发的可能影响因素赋值

    Table  2.   Values of possible risk factors for recurrence of pulmonary TB cases after successful initial treatment

     变量赋 值
    性别女性=0,男性=1
    年龄<45岁=0,45~60岁=1,≥60岁=2
    职业其他=0,离退、家政家务及待业=1,
    农民、民工、牧民=2
    被动就诊否=0,是=1
    诊断延误<30 d=0,≥30 d=1
    治疗单位级别市级=0,区级=1
    病原学分类阴性=0,阳性=1
    肺部空洞无=0,有=1
    合并其他结核病否=0,是=1
    合并糖尿病否=0,是=1
    下载: 导出CSV

    表  3  肺结核复发单因素分析结果

    Table  3.   Univariate analysis on risk factors for pulmonary TB recurrence

      变量
    总病例数
    复发病例数
    复发病例占比(%)
    log-rank检验
    χ2P
    性别 7.544 0.006
     女性2 876652.26
     男性5 6271883.34
    年龄组(岁)14.4900.001
     <453 571782.18
     45 ~ 2 096793.77
     60 ~ 2 836963.39
    职业26.811<0.001
     农民、民工、牧民1 567694.40
     离退、家政家务及待业3 9601313.31
     其他2 976531.78
    被动就诊6.3630.012
     否1 167231.97
     是7 3362303.14
    诊断延误(d)4.3940.036
     <3047861252.61
     ≥3037171283.44
    治疗单位级别0.1050.746
     市级3270922.81
     区级52331613.08
    病原学分类a34.151<0.001
     阴性49291082.19
     阳性28741294.49
    肺部空洞a26.502<0.001
     无41281082.62
     有1657875.25
    合并其他结核病a0.3110.577
     否72062082.89
     是 741243.24
    合并糖尿病18.996<0.001
     否74522002.68
     是1051535.04
      注:a. 变量有缺失值
    下载: 导出CSV

    表  4  初治肺结核患者治疗成功后首次复发的多因素分析结果

    Table  4.   Multivariate analysis on risk factors for pulmonary TB cases recurrence after successful initial treatment

      变量β${s_{\bar x } } $Wald χ2调整后的风险比95% CIP
    T_COV_年龄0.0040.0027.0981.0041.001~1.0080.008
    T_COV_男性0.0980.0612.6331.1030.980~1.2430.105
    职业4.7990.091
     农民、民工、牧民0.3900.2213.1261.4770.959~2.2760.077
     离退、家政家务及待业0.0620.2110.0881.0640.704~1.6090.767
    T_COV_被动就诊0.1820.0894.1961.2001.008~1.4280.041
    T_COV_延误就诊≥30 d0.0390.0530.5571.0400.938~1.1540.455
    T_COV_合并糖尿病0.0650.0651.0191.0670.940~1.2120.313
    T_COV_病原学阳性0.1430.0566.4871.1541.034~1.2890.011
    肺部空洞0.4650.1598.5851.5921.166~2.1720.003
    下载: 导出CSV
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  • 收稿日期:  2021-06-11
  • 网络出版日期:  2021-08-03
  • 刊出日期:  2021-08-31

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