新发涂阳肺结核治疗失败的影响因素研究  

Factors affecting treatment failure of new smear positive pulmonary tuberculosis patients

作　　者：陈其琛[1] 谭守勇[1] 郭婉如 刘建雄[1] 薛植强[1] 

机构地区：[1]广州市胸科医院,广州510095 [2]广州市黄埔区慢性病防治站,广州510725

出　　处：《中国防痨杂志》2011年第4期219-226,共8页Chinese Journal of Antituberculosis

基　　金：广东省科技计划资助项目(2008B030301009)

摘　　要：目的探讨影响新发涂阳肺结核治疗失败的危险因素,为减少新发涂阳肺结核治疗失败提供建议。方法选择2003—2009年广州市367例户籍新发涂阳肺结核治疗失败病例,按同区、同性别、年龄相差不超过2岁、与治疗日期最接近的治愈病人进行1∶1的病例对照研究;采用单因素和多因素条件logistic回归分析。结果单因素分析有22项因素差异有统计学意义(P<0.05),其中OR值较高的前10位依次为不规则服药(19.54)、减量治疗(7.92)、3个月末痰涂阳性(7.88)、药物不良反应中的肝功能损害(7.79)、肺外结核中的支气管结核(6.05)、2个月末痰涂阳性(5.17)、初治耐药(4.26)、低蛋白血症(3.01)、服药管理中的自服药(2.91)、合并糖尿病(1.84);多因素分析有有13项因素被选入回归方程。其中OR值较高的因素有不规则服药(15.93)、减量治疗(8.91)、初始耐药(5.02)、3月末涂片仍阳性(3.21)、药物不良反应(2.30)、2月末涂片仍阳性(2.70),其中自觉经济状况(1.51)较好是保护因素。结论不规则服药、减量治疗、初始耐药、2、3个月末痰仍阳性、药物不良反应等因素是治疗失败的主要影响因素,经济状况好是保护因素;在新发涂阳肺结核的临床治疗中,针对危险性因素采取相应的干预措施,对减少治疗失败具有重要意义。Objective To explore the risk factors affecting treatment failure of new smear positive pulmonary tuberculosis in order to provide recommendations for reducing treatment failure. Methods This is a 1∶1 case-control study.367 treatment failure cases of new smear positive pulmonary tuberculosis registered from 2003 to 2009 in Guangzhou City were selected in the case group;control cases are matched on living district,gender,and age and treatment completion date.Univariate and multiple conditional Logistic regressions were made for analysis. Results 22 significantly different factors are identified through univariate analysis,among which,the top ten factors with higher OR value are irregular medication（19.54）,doseager eduction（7.92）,smear-positive at the end of 3 months（7.88）,liver function damage（7.79）,endobronchial tuberculosis（6.05）,smear-positive at the end of 2 months（5.17）,primary drug-resistant（4.26）,hypoalbuminemia（3.01）,self management（2.91）,diabetes（1.84）;Thirteen factors are selected into the regression equation.Among them,factors with higher OR value are irregular medication（15.93）,dosage reduction（8.91）,primary drug-resistant（5.02）,smear-positive at the end of 3 months（3.21）,adverse drug response（2.30）,smear-positive at the end of 2 months（2.70）,Among them,economic status（1.51） is a protective factor. Conclusion irregular medication,dosage reduction,primary drug resistance,smear positive at the end of 2,3 month,adverse drug response are the main factors of treatment failure,the economic situation is protective factor.It is important to adopt corresponding intervention measures against the risk factors in order to reduce treatment failure.

关 键 词：结核 肺/药物疗法 治疗失败 危险因素 病例对照研究 

分 类 号：R521[医药卫生—内科学]