1 165例耐多药和广泛耐药肺结核患者治疗结局及影响因素分析

王硕; 何梦雅; 张艳秋; 李栋梁; 谢春雨; 孟澜涛; 孙定勇

doi:10.3784/jbjc.202303170106

1 165例耐多药和广泛耐药肺结核患者治疗结局及影响因素分析

doi: 10.3784/jbjc.202303170106

王硕^1,,
何梦雅²,
张艳秋²,
李栋梁²,
谢春雨²,
孟澜涛²,
孙定勇^{1, 2, ,}

1.
郑州大学, 河南郑州 450001
2.
河南省疾病预防控制中心, 河南郑州 450016

基金项目: 河南省科技发展计划（No. 212102310156）；河南省医学科技攻关计划联合共建项目

详细信息

作者简介:
王硕，男，安徽省阜阳市人，公共卫生在读硕士，从事结核病防治方面的研究，Email：1419040457@qq.com

通讯作者:
孙定勇，Tel：13703865596，Email: 508712946@qq.com

中图分类号: R211；R183.3
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- 被引次数: 0
出版历程
- 收稿日期: 2023-03-17
- 网络出版日期: 2023-09-19

Treatment outcomes of 1165 patients with multidrug-resistant and extensively drug-resistant pulmonary tuberculosis and influencing factors

1.
Zhengzhou University, Zhengzhou 450001, Henan, China
2.
Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, Henan, China

Funds: This study was supported by fund for Henan Province Science and Technology Development Program (No. 212102310156) and Henan Province Medical Science and Technology Tackling Program Joint Common Construction Project (No. LHGJ20200131)

摘要

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。
- 耐多药肺结核 /
- 危险因素分析 /
- 回顾性研究
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.
- Multidrug-resistant tuberculosis /
- Influencing factors analysis /
- Retrospective research

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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
变量	病例数（例）	构成比（%）	病例数（例）	构成比（%）	χ²值	P值	变量	病例数（例）	构成比（%）	病例数（例）	构成比（%）	χ²值	P值
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

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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

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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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