云南省7县结核分枝杆菌／HIV联合感染患者抗结核疗效影响因素分析  

Effect of anti-tuberculosis treatment in tuberculosis patients co-infected with human immunodeficiency virus in seven counties, Yunnan

作　　者：许琳[1] 高小娇 李玲[1] 王芸[1] 

机构地区：[1]云南省疾病预防控制中心,昆明650022 [2]昆明医科大学公共卫生学院,昆明650022

出　　处：《中华流行病学杂志》2015年第2期128-131,共4页Chinese Journal of Epidemiology

基　　金：中国全球基金结核病项目（CHN-SSF-TB-30）

摘　　要：目的分析结核分枝杆菌／HIV联合感染患者（TB／HIV）抗结核疗效的影响因素。方法回顾性分析云南省7个中国全球基金结核病项目县2010年1月1日至2012年6月30日登记管理的445例TB／HIV的抗结核治疗结果，通过问卷收集一般人口学特征、患者来源、治疗分类等因素，并作为分组变量进行单因素X2检验。以抗结核治疗成功与否作为结局变量，采用多因素非条件logistic回归方法分析抗结核治疗效果的影响因素。结果445例TB／HIV经标准化抗结核治疗，397例（89．21％）治疗成功，其中影响患者疗效的5个危险因素包括就诊时有〉4个肺结核可疑症状（aOR=2．208）、在HIV／AIDS人群中主动筛查出的TB／HIV（aOR=5．856）、重症患者（aOR=4．607）、督导管理方式未采用全程督导（强化期督导方式aOR=4．129及全程管理方式aOR=8．090）和出现中断服药（aOR=21．517）。结论通过加强主动筛查尽早发现TB／HIV，及时提供标准化抗结核治疗和全程督导的随访管理措施，能有效改善抗结核治疗效果。Objective To understand the potential risk factors influencing the effect of standard anti-tuberculosis （TB） treatment for TB patients co-infected with human immunodeficiency virus （HIV） and provide evidence for the improvement of anti TB therapy. Methods A retrospective study was conducted among 445 TB/HIV patients diagnosed and registered in 7 counties in Yunnan province from January 2010 to June 2012. A structured questionnaire was used to collect the patients＇ demographic characteristics, diagnosis and treatment information after informed consent. Chi-square test was conducted to compare successful rate of anti TB treatment among the patients with different demographic characteristics. Multivariate logistic regression analysis was conducted to identify risk factors influencing the effect of anti TB treatment. Adjusted OR〉 1 means the risk factor of treatment failure. P value less than 0.05 was set as significant level. Results After standard anti TB treatment, 397 patients were cured. The five risk factors influencing treatment effect were the existing of 4 suspected TB symptoms when seeking medical care for the first time（adjusted OR=2.208）, TB/HIV patients detected in HIV/AIDS screening （adjusted OR=5.856）, severe case （adjusted OR=4.607） , non-full-course supervision during treatment （in intensive phase adjusted OR=4.129, full-course management adjusted OR=8.090） and interruption of therapy （adjusted OR=21.517）. Conclusion Early detection of TB/HIV patients and conducting full course supervision during treatment can improve the effect of anti TB treatment. It is necessary to strengthen the early detection of TB/HIV patients and standarded treatment in Yuunan province.

关 键 词：肺结核 人类免疫缺陷病毒 抗结核治疗 影响因素 

分 类 号：R52[医药卫生—内科学] R512.91[医药卫生—临床医学]