2019-2023年江苏省苏州市18~65岁利福平敏感肺结核患者不良转归影响因素的回顾性队列研究

Factors associated with unfavorable outcomes in rifampicin-susceptible pulmonary tuberculosis cases aged 18-65 years in Suzhou, Jiangsu, 2019−2023: a retrospective cohort study

  • 摘要:
    目的 分析2019—2023年江苏省苏州市18~65岁肺结核患者不良转归的流行特征并揭示其影响因素,进而为降低该年龄组肺结核患者的不良转归发生率提供新的科学依据。
    方法 从中国疾病预防控制信息系统结核病管理系统收集数据,采用回顾性队列分析其特征,构建Cox风险模型分析转归的影响因素。
    结果 2019年1月至2023年6月,苏州市18~65岁男、女性肺结核病例分别是6365例(占比68.05%)和2989例(占比31.95%);全部患者发生不良转归的比例为4.75%。 不良转归组和良好转归组年龄分别为(41.90 ± 13.66)岁和(38.21 ± 13.24)岁,差异有统计学意义(P<0.001)。 多因素Cox模型表明:复治肺结核风险比(HR)=2.37, 95%CI: 1.78~3.14、非标准的治疗方案(HR=1.42, 95%CI:1.15~1.75)、患者的年龄越大(HR=1.01, 95%CI: 1.00~1.02)、患者自主服药(HR=9.82, 95%CI:7.10~13.57)、病原学结果阳性(HR=3.54, 95%CI:2.62~4.78)、常居住地为城镇(HR=1.32, 95%CI:1.05~1.64)是18~65岁患者发生不良转归的危险因素。
    结论 研究期内,苏州市18~65岁肺结核患者治疗的良好转归率是95.25%,略高于中国2022年新发和复发患者的平均成功治疗率。 但治疗管理方式、治疗方案、患者的居住环境、大龄患者等因素是防治的困难和挑战,应重点关注上述影响因素的患者群体。

     

    Abstract:
    Objective To analyze the epidemiological characteristics of unfavorable treatment outcomes in rifampicin-sensitive pulmonary tuberculosis (TB) patients aged 18−65 years in Suzhou, Jiangsu province, identify influencing factors, and provide evidence to reduce the incidence of unfavorable outcomes of rifampicin-sensitive pulmonary TB patients in this age group.
    Methods Data were extracted from the Tuberculosis Management System of the China Disease Control and Prevention Information System for a retrospective cohort analysis to understand the epidemiological characteristics of unfavorable treatment outcomes in rifampicin-sensitive pulmonary TB patients aged 18−65 years, and Cox proportional hazards model was constructed to identify factors associated with treatment outcomes.
    Results During the period from January 2019 to June 2023, among the pulmonary tuberculosis cases aged 18-65 years in Suzhou city, there were 6 365 male cases (68.05%) and 2 989 female cases (31.95%), respectively. The proportion of those with unfavorable treatment outcomes was 4.75%. Significant differences were observed in age between the unfavorable outcome group and the favorable outcome group (41.90 ± 13.66 vs. 38.21 ± 13.24 years, P<0.001). Multivariate Cox proportional hazards model analysis revealed that retreatment hazard ratio (HR)=2.37 95%CI: 1.78–3.14, non-standard treatment regimen (HR=1.42, 95%CI: 1.15–1.75), older age (HR=1.01, 95%CI: 1.00–1.02), self-medication (HR=9.82, 95%CI: 7.10–13.57), positive etiological results (HR=3.54, 95% CI: 2.62–4.78), and urban residence (HR=1.32, 95%CI: 1.05–1.64) were significant factors associated with unfavorable treatment outcomes in pulmonary TB patients aged 18−65 years in Suzhou.
    Conclusion During the study period, the rate of favorable treatment outcome in pulmonary TB patients aged 18−65 years was 95.25% in Suzhou, slightly higher than the average successful treatment rate (2022) for newly diagnosed and relapsed pulmonary TB patients in China in 2022. However, challenges still exist in TB prevention and treatment due to factors such as suboptimal treatment management, non-standardized regimens, patients' residential environment, and older age. It is necessary to conduct targeted interventions in the pulmonary TB patients affected by these risk factors to improve the clinical treatment outcomes.

     

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