Characteristics of multidrug-resistant /rifampicin-resistant tuberculosis patients and factors associated with treatment effect in Hubei, 2015−2021
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摘要:
目的 了解湖北省耐多药/利福平耐药结核病患者特征及治疗效果影响因素。 方法 采用描述性流行病学方法，分析湖北省登记的耐多药/利福平耐药结核病患者特征，利用非条件logistic回归模型分析耐多药/利福平耐药结核病治疗效果的影响因素。 结果 2015—2021年纳入分析的3799例耐多药/利福平耐药结核病患者，主要以男性（72.91%）、中青年（84.71%）和农民/民工患者（37.06%）为主。 耐多药/利福平耐药结核病患者治疗成功率为61.30%。 单因素和多因素logistic回归结果均表明男性、年龄≥65岁、复治、职业为农民/民工、未使用阿米卡星/卷曲霉素及治疗时间≤1年患者成功治疗比例较低，且差异有统计学意义（P<0.05）。 结论 湖北省耐多药/利福平耐药结核病疫情防控的重点人群为中青年、男性及农民/民工。 为提高湖北省耐多药/利福平耐药结核病患者的治疗效果，治疗时还需对年龄65岁以上的患者、男性和农民/民工人群加大关注力度。 治疗方案中使用二线注射类药物，治疗后重点关注造成治疗时长较短的原因，对提高治疗效果具有一定作用。 Abstract:Objective To analyze the characteristics of multidrug-resistant/rifampicin-resistant tuberculosis(TB) patients and factors assocoated with treatment effect in Hubei province. Methods Descriptive epidemiological method was used to analyze the characteristics of multidrug-resistant/rifampicin-resistant TB patients in Hubei, and unconditional Logistic regression model was used to identify the factors associated with the treatment effect of multidrug-resistant/rifampicin-resistant TB. Results From 2015 to 2021, a total of 3799 patients with multidrug-resistant/rifampicin-resistant tuberculosis were included in the analysis, in whom men, middle-aged people and farmers/migrant workers accounted for 72.91%, 84.71% and 37.06% respectively. The treatment success rate in the patients was 61.3%. Both univariate and multivariate logistic regression analysis results showed that the proportion of unsuccessful treatment was higher in men, those aged ≥65 years, retreatment cases, farmers/migrant workers, those using no Amikacin/ Capreomycin and those with treatment duration ≤1 year, and the difference was statistically significant (P<0.05). Conclusion Young and middle-aged people, men and famers/migrant workers are key population in the prevention and control of multidrug-resistant/rifampicin-resistant TB in Hubei. In the treatment of multidrug/rifampicin-resistant TB patients, more attention should be paid to those aged ≥65 years, men and farmers/migrant workers, the second-line injectable drugs are suggested to use and identifying the reasons causing shorter treatment duration can improve treatment outcomes. -
图 1 2015－2021年湖北省耐多药/利福平耐药结核病患者登记情况
Figure 1. Registration of multidrug-resistant/rifampicin-resistant tuberculosis patients in Hubei, 2015–2021
表 1 2015－2021年登记的耐多药/利福平耐药结核病患者人口学特征
Table 1. Demographic characteristics of registered multidrug-resistant/rifampicin-resistant tuberculosis patients, 2015−2021
特征 例数 构成比（%） 性别 男性 2770 72.91 女性 1029 27.09 年龄组（岁） 0～ 14 0.37 15～ 3218 84.71 65～ 567 14.92 职业 农民/民工 1408 37.06 待业及家务 1192 31.38 离退人员 287 7.56 学生与教师 184 4.84 其他a 728 19.16 来源地 本地市 3127 82.31 省内流动 551 14.50 省间流动 121 3.19 合计 3799 100.00 注：a. 包括商业及公共场所服务员、工人、干部职员、餐饮工作人员、驾驶员、其他人员和职业不详 
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表 2 耐多药/利福平耐药结核病患者治疗效果的单因素logistic回归分析
Table 2. Univariate logistic regression analysis of the treatment effects in multidrug-resistant/rifampicin-resistant tuberculosis patients
影响因素 总例数 成功治疗 Z值 OR值（95%CI） P值 例数 比例（%） 来源地 本地市 1877 1146 61.05 1.00 省内流动 361 220 60.94 0.040 1.00（0.80～1.26） 0.968 省间流动 75 52 69.33 1.437 0.69（0.41～1.12） 0.151 性别 男性 1666 950 57.02 6.725 1.97（1.62～2.41） <0.001 女性 647 468 72.33 1.00 年龄组（岁） <65 2034 1330 65.39 1.00 ≥65 279 88 31.54 10.300 4.10（3.14～5.38） <0.001 职业 农民/民工 807 443 54.89 4.623 1.51（1.27～1.80） <0.001 非农民/民工 1506 975 64.74 1.00 治疗分类 初治 1061 686 64.66 1.00 复治 1252 732 58.47 3.043 1.29（1.10～1.54） 0.002 是否使用Am/Cma 是 559 370 66.19 1.00 否 1754 1048 59.75 2.718 1.32（1.08～1.61） 0.007 是否使用Bdqb 是 82 55 67.07 1.00 否 2231 1363 61.09 1.089 1.30（0.82～2.10） 0.276 治疗时长 ≤1年 656 63 9.60 25.470 42.23（31.89～56.79） <0.001 ＞1年 1657 1355 81.77 1.00 治疗管理单位 市级 1971 1216 61.69 1.00 县/区级 342 202 59.06 0.922 1.12（0.88～1.41） 0.357 注： a. Am：阿米卡星，Cm：卷曲霉素；b. Bdq：贝达喹啉
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表 3 耐多药/利福平耐药结核病患者治疗效果的多因素logistic回归分析
Table 3. Multivariate logistic regression analysis of the treatment effects in multidrug-resistant/rifampicin-resistant tuberculosis patients
影响因素 $ \beta $ $s_{\bar x }$ Wald χ2值 OR值（95%CI） P值 性别 男性 0.65 0.14 21.492 1.92（1.46～2.53） <0.001 女性 1.00 年龄组（岁） <65 1.00 <0.001 ≥65 1.14 0.18 41.486 3.13（2.21～4.43） <0.001 职业 非农民/民工 1.00 农民/民工 0.47 0.12 15.031 1.61（1.27～2.05） <0.001 治疗分类 初治 1.00 复治 0.49 0.12 16.314 1.63（1.29～2.08） <0.001 是否使用Am/Cma 是 1.00 否 0.56 0.15 14.410 1.75（1.32～2.34） <0.001 治疗时长（年） ≤1 3.82 0.16 607.524 45.74（34.01～62.51） <0.001 ＞1 1.00 注：a. Am：阿米卡星，Cm：卷曲霉素
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