Treatment outcomes of 1165 patients with multidrug-resistant and extensively drug-resistant pulmonary tuberculosis and influencing factors
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摘要:
目的 掌握耐多药结核的治疗结局并探讨其影响因素。 方法 2022年通过问卷调查,收集1 165例河南省结核病报告系统中登记报告的耐多药肺结核患者治疗、转归等相关信息进行回顾性分析。 采用SPSS 27.0软件对收集的治疗、转归结果进行流行病学描述,采用单因素与多因素logistic分析的方法分析治疗结局的影响因素。 结果 1 165例耐药结核病患者中,良性结局(成功治疗)的患者占54.7%;多因素logistic回归分析结果显示,年龄≥65岁组的患者发生不良结局的风险是年龄≤25岁组的2.380倍[比值比(OR)=0.390,95%置信区间(CI):1.220~4.643],体质指数(BMI)≥24.0 kg/m2的患者发生不良结局的风险是BMI≤18.4 kg/m2的39.0%(OR=0.390,95%CI:0.182~0.834),复治患者发生不良结局的风险是新患者的1.149倍(OR=1.149,95%CI:1.026~1.287),无规律运动的患者发生不良结局的风险是有规律运动患者的1.709倍(OR=1.709,95%CI:1.128~2.589),耐多药治疗期间存在14 d以上中断治疗的患者发生不良结局的风险是无中断治疗患者的3.762 倍(OR=3.762,95%CI:2.100~6.739)。 结论 河南省耐多药肺结核患者治疗成功率在我国属中等水平,但患者数量多,需要重点关注高年龄段、复治患者、营养状况不佳的患者,同时提倡规律运动,提高患者治疗依从性,从而增加患者治疗成功率。 Abstract:Objective To understand the treatment outcome of multidrug-resistant tuberculosis (TB) and analyze the influencing factors. Methods Information related to treatments and outcomes of 1 165 patients with multidrug-resistant TB registered and reported in the Tuberculosis Reporting System of Henan Province were collected through a questionnaire survey in 2022 for a retrospective analysis. Software SPSS 27.0 was used for the descriptive epidemiological analysis, and the influencing factors for treatment outcome were analyzed by univariate and multivariate analyses. Results Of the 1165 patients with multidrug-resistant TB, 54.7% had benign outcomes (successful treatment). Multivariate Logistic regression analysis showed that the risk for adverse outcome was 2.380 times higher in age group ≥65 years than in age group ≤25 years [odds ratio (OR)=0.390, 95% confidence interval (CI): 1.220−4.643], the risk for adverse outcome in patients with body mass index (BMI) ≥24.0 kg/m2 was 39.0% higher than that in those with a BMI ≤18.4 kg/m2 (OR=0.390, 95%CI: 0.182 to 0.834), the risk for adverse outcomes was 1.149 times higher in patients with repeated treatment than that in newly detected patients (OR=1.149, 95%CI: 1.026 to 1.287), the risk for adverse outcome was 1.709 times higher in patients without regular exercise than in patients with regular exercise (OR=1.709, 95%CI: 1.128 to 2.589), and the risk for adverse outcome was 3.762 times higher in patients with more than 14 days of treatment interruption for multidrug-resistant therapy than in patients without treatment interruption (OR=3.762, 95%CI: 2.100 to 6.739). Conclusion The treatment success rate of multidrug-resistant TB patients in Henan was moderate in China, but the number of patients was high. It is necessary to pay attention to the patients with older age, retreatment and poor nutritional status, promote regular exercise and improve patient compliance with treatment to increase the success rate of TB treatment. -
表 1 耐多药结核病患者治疗结局影响因素的单因素分析
Table 1. Univariate analysis on factors influencing treatment outcomes in patients with multidrug-resistant tuberculosis
变量 良性结局 不良结局 χ2值 P值 变量 良性结局 不良结局 χ2值 P值 病例数(例) 构成比(%) 病例数(例) 构成比(%) 病例数(例) 构成比(%) 病例数(例) 构成比(%) 性别 3.476 0.062 登记分类 11.523 <0.001 男性 489 76.9 428 81.4 新患者 330 63.6 241 52.9 女性 147 23.1 98 18.6 复治患者 189 36.4 215 47.1 不详 1 2 不详 118 72 年龄组(岁) 58.725 <0.001 0月痰涂片检查结果 1.562 0.211 ≤25 114 17.9 59 11.2 涂阳 481 77.7 415 80.7 26~ 254 39.9 133 25.2 涂阴 138 22.3 99 19.3 46~ 190 29.8 206 39.0 不详 18 14 ≥65 79 12.4 130 24.6 影像学空洞 0.396 0.529 不详 0 0 有 295 56.6 227 54.6 体质指数(kg/m2) 10.052 0.007 无 226 43.4 189 45.4 <18.4 63 10.5 75 16.8 不详 116 112 18.4~ 396 66.3 288 64.4 粟粒肺结核 0.042 0.838 ≥24.0 139 23.2 84 18.8 有 35 6.7 29 6.9 不详 39 81 无 485 93.3 381 93.1 职业 11.019 <0.001 不详 117 118 农民 434 68.1 406 76.9 结核菌素试验结果 6.036 0.049 非农民 203 31.9 122 23.1 强阳性 209 56.3 136 52.1 不详 0 0 一般阳性 151 40.7 145 44.7 户籍类型 4.186 0.242 阴性 11 3.0 10 3.2 本地(县区) 355 55.7 266 50.4 不详 266 237 市内流动 197 30.9 177 33.5 药敏确诊结果 18.384 <0.001 市间流动(省内) 63 9.9 67 12.7 耐多药 380 73.6 277 60.7 省间流动 22 3.5 18 3.4 广泛耐药 136 26.4 179 39.3 不详 0 0 不详 121 181 文化程度 38.067 <0.001 治疗史 0.798 0.671 文盲或半文盲 41 6.9 49 10.9 未使用过抗结核药 98 15.5 82 15.6 小学 104 17.4 128 28.4 仅使用一线药 320 50.4 252 48.0 初中 208 34.8 135 29.9 使用过一二线药 216 34.1 191 36.4 高中及同等学历 129 21.5 97 21.5 不详 3 3 大专及以上 116 19.4 42 9.3 中断治疗 98.853 <0.001 不详 39 77 有 39 6.2 145 28.3 婚姻状况 4.348 0.114 无 598 93.8 383 71.7 已婚 442 73.8 347 75.7 不详 0 0 未婚 129 21.5 80 17.5 治疗方案 18.666 <0.001 离异/丧偶 28 4.7 31 6.8 一线标准方案 25 3.9 19 3.8 不详 38 70 二线标准方案 363 57.1 289 56.1 诊断为肺结核前是否吸烟 8.621 0.003 二线个性化方案 227 35.7 169 34.1 是 192 32.5 184 41.3 未形成有效方案 21 3.3 49 6.0 否 399 67.5 261 58.7 不详 1 2 不详 46 83 中药应用 2.188 0.139 诊断为肺结核前是否饮酒 0.821 0.365 有 129 20.3 89 16.9 是 137 23.2 114 25.6 无 508 79.7 439 83.1 否 454 76.8 331 74.4 不详 0 0 不详 46 83 诊断为肺结核前是否规律运动 10.521 0.005 是 255 43.5 151 33.9 否 332 56.5 295 66.1 不详 50 82 注:“不详”的数据不计入构成比 表 2 多因素logistic回归分析变量赋值表
Table 2. Variable assignment table for multivariate logistic regression analysis
变量 赋 值 年龄(岁) 1=≤25,2=26~,3=46~,4=≥65 体质指数(kg/m2) 1=<18.4,2=18.4~,3=≥24.0 登记分类 1=新患者,2=复治患者 规律运动 1=有规律运动,2=无规律运动 14 d以上中断治疗 1=未中断治疗,2=中断治疗 表 3 患者治疗结局危险因素的多因素分析
Table 3. Multivariate analysis on risk factors for patient treatment outcomes
变量 β Wald χ2值 OR值 95% 置信区间 P值 年龄(岁) ≤25 − − 1.000 − − 26~ −0.376 1.465 0.687 0.374~1.262 0.226 46~ 0.474 2.462 1.607 0.889~2.906 0.117 ≥65 0.867 6.467 2.380 1.220~4.643 0.011 体质指数(kg/m2) <18.4 − − 1.000 − − 18.4~ −0.416 1.686 0.660 0.352~1.236 0.194 ≥24.0 −0.942 5.903 0.390 0.182~0.834 0.015 复治患者 0.139 5.750 1.149 1.026~1.287 0.016 无规律运动 0.536 6.399 1.709 1.128~2.589 0.011 中断治疗 1.325 19.835 3.762 2.100~6.739 <0.001 常量 –2.648 20.083 0.071 − <0.001 注:−. 没有该项数据 -
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