92例久治未愈菌阳肺结核病例社会经济学状况调查分析  

Study on the socioeconomic factors of treatment failure among 92 bacillary-positive pulmonary tuberculosis patients

作　　者：李向群[1] 陈静[1] 张祖荣[1] 倪惠莉[1] 夏珍[1] 梅建[1] 

机构地区：[1]上海市疾病预防控制中心结防科,上海200336

出　　处：《中华疾病控制杂志》2010年第1期52-54,共3页Chinese Journal of Disease Control & Prevention

基　　金：第四轮中国全球基金结核病项目省级骨干学员实施性研究项目(2007.4)

摘　　要：目的对久治未愈菌阳肺结核病例进行社会经济学状况调查,为今后有效控制和减少久治未愈菌阳肺结核病的发生提供科学依据。方法选取2003-2004年上海市新登记疗程超过18个月仍未治愈的菌阳肺结核患者92例为病例组,按性别、年龄、初治、复治群体匹配同期上海市新登记完成治疗的菌阳肺结核患者85例为对照组,通过问卷调查的方法,对久治未愈菌阳肺结核病例社会经济学状况进行调查分析。结果初中以下文化程度、离异/丧偶、自费诊治、家庭负担重的病人更易造成久治未愈肺结核病例发生;由于该类病人病程长、病情复杂,造成诊疗费及个人费用支出较多,带来沉重的经济负担,因病致贫,因贫致病,形成恶性的疾病与经济循环链;肺结核知识知晓率对照组略高于病例组,职业分布中病例组学生的知晓率最高,对照组中干部的知晓率最高。结论对文化程度低、离异/丧偶、自费诊治、家庭负担重的病人要给予更多的关注,必须加大政府投入,特别是困难病人的生活补助和惠及耐药病人的二线抗结核药物的减免,提高政策保障力度;同时,进一步加强临床宣教和社区管理,减少耐药与不规律服药的发生,有效控制和减少久治未愈菌阳病例的形成。Objective To determine the socioeconomic factors and main causes of treatment failure among hacillary-positive pulmonary tuberculosis patients in Shanghai. Methods A 1 ： 1 matched case- control study was performed. Ninety two cases who were treated longer than 18 months, and 85 controls who completed treatment during 2003 - 2004 in Shanghai were selected. Cases and controls were matched by sex, age, and previous treatment. Results Adjusted by sex, age, and previous treatment, the associated factors of treatment failure among bacillary-positive pulmonary tuberculosis patients were drug resistance （χ^2=14.764, P〈0.001, OR=3.6, 95% CI： 1.9-7.0） and irregular treatment （χ^2 = 8. 373, P 〈 0.05, OR = 3.3,9596 CI ： 1.5 - 7.5）. Conclusions Regular treatment and appropriate regimen with first-line and second-line drugs based on drug susceptibility testing would be effective measures to decrease the treatment failure among bacillary-positive pulmonary tuberculosis patients.

关 键 词：结核 肺 社会经济学因素 广泛耐药结核 

分 类 号：R521[医药卫生—内科学]