影响深圳市耐多药结核病患者治愈的相关因素的双向性队列研究  

Ambi-directional cohort study of risk factors for cure of multi-drug resistant pulmonary tuberculosis in Shenzhen

作　　者：吕德良[1] 谭卫国[1] 张乐平[1] 朱赛楠[2] 李蓉安 车晓玲[1] 杨应周[1] 

机构地区：[1]深圳市慢性病防治中心肺部疾病研究所,广东深圳518020 [2]北京大学第一医院医学统计室,北京100034

出　　处：《临床肺科杂志》2017年第7期1165-1168,1172,共5页Journal of Clinical Pulmonary Medicine

基　　金："十二五"国家科技重大专项项目(No.2012ZX10004903);深圳市科技计划项目(No.201302154);广东省医学科研基金立项项目(No.A2015050)

摘　　要：目的分析影响深圳市MDR-TB患者治愈的重要危险因素,确定临床治疗和管理的重点人群,为今后MDR-TB的治疗、管理和深入研究提供科学依据。方法采用双向性队列研究设计,以2006年10月-2013年10月在深圳登记治疗的MDR-TB患者作为研究队列,2008年前登记治疗患者的信息资料主要通过查看病历获得,2008年及以后登记治疗患者信息资料则通过问卷调查、临床检查和查看病历的方式获得。以因结核病死亡者、失败者、不良反应停药者组成疗效不佳组,与治愈患者比较,分析影响MDR-TB治愈的影响因素。采用多因素logistic回归确定影响治愈的重要因素,并估算因素的相对危险度。结果共165例MDRTB患者纳入项目治疗,其中99例(60.0%)治愈,10例完成治疗(6.1%),7例(4.2%)治疗失败,14例(8.5%)不良反应停药,7例(4.2%)丢失,17例(10.3%)迁出,10例(6.1%)拒治或拒复查,1例(0.6%)死亡。多因素logistic回归分析结果显示,年龄和合并乙型肝炎病毒(HBV)感染与MDR-TB个体化治疗效果密切相关,>40岁的中/老年人较40岁及以下的青年人的治疗失败或不良反应停药的危险性更高(OR=5.307,95%CI:1.660-16.963,P=0.005),合并HBV感染患者治疗失败或不良反应停药的危险性更高(OR=3.621,95%CI:1.026-12.787,P=0.046)。一些临床重要因素未纳入模型,如既往二线抗结核药物使用情况、疾病严重程度(病灶累及范围、空洞)等。结论治疗依从性和药物耐受性仍是MDR-TB治疗的重点关注内容,需做好适时评估。年龄和合并乙型肝炎病毒感染是影响MDR-TB治愈的重要危险因素,中老年人及合并HBV感染的患者是MDR-TB重点关注人群,应对中老年和合并HBV感染的MDR-TB患者探索和制定特殊治疗方案和管理措施,以提高他们的治疗效果。Objective To analyze the important risk factors for cure of multi-drug resistant pulmonary tuber-culosis （MDR-TB） in Shenzhen, in order to determine the key population of clinical treatment and management and provide scientific basis for the treatment, management and further study of MDR-TB in future. Methods Ambi-directional cohort study was used in this study. All patients diagnosed with MDR-TB in Shenzhen from October 2006 to October 2013 were included in the study. Prior to 2008,the information was collected from the medical records of MDR-TB patients. The information was collected through questionnaire survey, clinical examination and medical records since 2008. The poor curative effect （including death due to tuberculosis, treatment failure, stopped treatment for adverse drug reactions） and the cure were compared, and the factors that influencing the cure were analyzed. Logistic regression model was undertaken to determine important factors associated with the cure. Results In 165 MDR-TB patients treated with the project, 60% （99） cured, 6. 1% （10） completed the treatment, 4.2% （7） treatment failure, 8.5% （14） stopped treatment for adverse drug reactions （ADR） , 4. 2% （7） were lost to follow up, 10. 3% （17） moved out of Shenzhen, 6. 1% （ 10） refused further treatment or examination, and 1 case （0. 6% ） died. The multivariate logistic regression analysis indicated that age and hepatitis B vims （HBV） were as-sociated with the cure. Compared with the young people （ ≤40 years old ） ,patients of the middle-aged and elderly （〉40 years old） were at higher risk of failure or ADR discontinuation （OR= 5. 307, 95% CI： 1.660 -1 6 .9 6 3 , P = 0.005）. The risk of treatment failure or ADR discontinuation was higher in patients with HBV infection （OR =3. 621, 95% CI ： 1. 026 - 12. 787 , P = 0. 046） . In addition, the results showed that some clinical important factors were not included in logistic regression model, such

关 键 词：结核 肺 耐多药 治疗 治愈 影响因素 

分 类 号：R52[医药卫生—内科学]