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摘要:
目的 基于结核病信息管理系统对新发肺结核病患者成功治疗后复发情况的观察跟踪研究,间接评价肺结核病患者的中长期治疗效果。 方法 基于全国结核病信息管理系统以某个县(区)2010年登记的所有新发肺结核病患者作为观察队列,通过系统搜寻10年期间(2010-2019年)观察队列的后续发病登记情况。 复发的单因素分析采用 Kaplan-Meier 法,多因素分析采用 Cox比例风险回归模型。 结果 第2年开始出现后续发病登记,第3年达到高峰(重新登记率为4.46%),第4~6年维持在3.00%以上的后续发病登记水平,往后逐年下降,降到第10年的0.23%。 历年均为男性更容易复发。 历次发病年龄偏向于50岁左右人群,职业偏向于农民。 Kaplan-Meier法和Cox比例风险回归模型分析显示新发肺结核病患者成功治疗后年龄偏大、农民、病原学初次菌阳、非主动就诊、诊断延误这类患者的后续复发风险相对较大。 平均发病间隔天数第一次重新登记最长,以后发病登记间隔呈缩短趋势。 结论 结核病防治是一项艰巨的系统工程,有条件的地方要结合健康中国行动,加强对新发肺结核病患者成功治疗后后续复发风险较高人群开展的后期随访,甚至实行全生命周期全人群健康管理。 Abstract:Objective To evaluate the medium and long-term treatment effects of tuberculosis (TB) based on the observation of the relapse of TB after successful treatment in newly registered patients. Methods Based on the national tuberculosis information management system, all the registered TB patients registered in a county in 2010 were selected as the observation cohort, and the follow-up for the cohort was conducted during 2010−2019. Kaplan-Meier method was used for univariate analysis on the relapse, and timedependent Cox regression model was used for multivariate analysis. Results The record of TB relapse started in the 2nd year after successful treatment, the relapse rate reached the peak of 4.46% in the 3rd year, remained >3.00% in the 4th−6th year, and then decreased year by year to 0.23% in the 10th year. Men were more likely to have TB relapse and more relapses occurred in age group 50 years in all the years. The relapse TB cases were mainly farmers. The Kaplan Meier method and Cox proportional risk regression model analysis showed that older age, being farmer, being bacterial positive for the first time, non-active medical care seeking and diagnosis delay were the risk factors for the relapse of TB after successful treatment in newly registered patients. The average interval before the relapse was longest after the first registration, then the interval gradually decreased. Conclusion TB prevention and control is a challenging project. If it is feasible, follow-up for newly diagnosed TB patients with high risk for relapse after successful treatment should be strengthened and, furthermore, life cycle health management in whole population can be conducted based on Health China Initiative. -
Key words:
- Tuberculosis /
- Newly registered tuberculosis case /
- Relapse
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表 1 观察队列874例新发肺结核病患者重新登记基本情况
Table 1. Basic situation of re-registration of 874 newly diagnosed pulmonary tuberculosis patients in the observation queue
项目 登记次数 χ2值 P值 首次 第2次 第3次 第4次 第5次 性别 3.401 0.334 男性 586 99 25 2 1 女性 288 35 8 1 0 年龄组(岁) 3.533 0.939 <15 5 1 0 0 0 15~ 272 35 8 1 0 35~ 179 25 7 1 0 50~ 418 73 18 1 1 年龄中位数(岁) 52 57 56 49 64 职业 7.726 0.562 农民 598 91 23 2 1 民工 199 23 2 1 0 工人 14 0 0 0 0 学生 24 3 1 0 0 其他 39 17 7 0 0 诊断结果 2.357 0.502 菌阳 280 44 8 0 0 菌阴 594 90 25 3 1 发病登记间隔时间
中位数(d)– 965 875 858 548 病例总数 874 134 33 3 1 注:发病登记间隔时间计算指二次登记日期的间隔天数;–. 首次登记不存在间隔天数 表 2 观察队列不同年份肺结核患者后续发病重新登记情况表
Table 2. Re-registration of subsequent pulmonary tuberculosis cases in different years of the observation queue
登记次数 2010年 2011年 2012年 2013年 2014年 2015年 2016年 2017年 2018年 2019年 总计 首次 874 874 第2次 9 39 27 17 17 13 5 5 2 134 第3次 4 9 8 5 3 4 33 第4次 1 1 1 3 第5次 1 1 重新登记合计 – 9 39 31 27 27 18 8 10 2 – 重新登记率(%) 1.03 4.46 3.55 3.09 3.09 2.06 0.92 1.14 0.23 – 注:–. 2010年为首次登记,不存在重新登记 表 3 后续肺结核发病登记患者痰菌状况
Table 3. Status of sputum bacteria in patients with subsequent pulmonary tuberculosis incidence registration
痰涂片 结核分枝杆菌核酸检测阳性(例) 结核分枝杆菌核酸检测阴性(例) 无结果
(例)培养阳性 培养阴性 无结果 培养阳性 培养阴性 无结果 培养阳性 培养阴性 无结果 涂阳 6 0 0 0 0 0 23 0 0 涂阴 5 0 0 0 9 0 18 110 0 合计 11 0 0 0 9 0 41 110 0 表 4 新发肺结核病患者成功治疗后首次复发的多因素分析结果
Table 4. Multifactor analysis results of the first relapse of newly diagnosed pulmonary tuberculosis patients after successful treatment
变量 β值 ${ s_{\overline x} } $ Wald χ2值 HR值(95%CI) P值 性别 女性 1.000 男性 0.017 0.245 0.005 1.017(0.63~1.643) 0.945 年龄组(岁) <15 1.000 15~ −0.228 1.300 0.031 0.796(0.062~10.184) 0.861 35~ 0.193 0.379 0.259 1.213(0.577~2.552) 0.611 50~ 0.125 0.254 0.240 1.133(0.688~1.865) 0.624 职业 农民 1.000 民工 0.466 0.473 0.970 1.593(0.631~4.024) 0.325 工人 −1.372 0.818 2.812 0.254(0.051~1.261) 0.044 学生 −0.448 1.133 0.156 0.639(0.069~5.886) 0.693 其他 −0.232 0.720 0.104 0.793(0.193~3.251) 0.747 诊断结果 菌阳 1.000 菌阴 −0.267 0.197 1.834 0.766(0.52~1.127) 0.176 患者来源 转诊 1.000 主动就诊 0.198 0.209 0.897 1.219(0.809~1.837) 0.343 户籍 流动人口 1.000 本地人口 −1.415 0.789 3.216 0.243(0.052~1.141) 0.043 诊断延误 延误 1.000 未延误 −1.561 0.923 3.933 0.923(0.623~1.368) 0.039 注:β. 偏回归系数;HR. 风险比;CI. 置信区间 -
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