饮酒对肺结核患者治疗两个月末痰菌阴转及治疗转归的影响  

Effect of alcohol drinking on sputum conversion at the end of second month and outcome of smear-positive pulmonary tuberculosis patients

作　　者：马艳[1] 杜建[1] 舒薇 谢仕恒 王红红[1] 谭守勇[2] 李向群[3] 傅衍勇 马丽萍[5] 张联英[6] 刘飞鹰[7] 胡代玉 张艳玲[9] 刘宇红[1] 李亮[1] Ma Yan;Du Jian;Shu Wei;Xie Shiheng;Wang Honghong;Tan Shouyong;Li Xiangqun;Fu Yanyong;Ma Liping;Zhang Lianying;Liu Feiying;Hu Daiyu;Zhang Yanling;Liu Yuhong;Li Liang(Center Office, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Clinical Center on Tuberculosis, China CDC, Beijing 101149,China;Department of TB Control, Guangzhou Chest Hospital, Guangzhou 510095,China;Department of TB Prevention and Treatment, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China;Department of TB Control, Tianjin Centers for Disease Control and Prevention, Tianjin 300041, China;Department of TB Prevention and Treatment, Henan Center for Disease Control and Prevention, Zhengzhou 450016,China;Department of TB Prevention and Treatment, Hebei Center for Disease Control and Prevention, Shijiazhuang 050021, China;Department of TB Prevention and Treatment,, Guangxi Center for Disease Control and Prevention, Nanning 530021,China;Department of TB Control, Chongqing Anti-tuberculosis Institute, Chongqing 400050, China;Department of TB Prevention and Treatment, Yunnan Center for Disease Control and Prevention, Kunming 650022, China)

机构地区：[1]北京市结核病胸部肿瘤研究所首都医科大学附属北京胸科医院中国疾病预防控制中心结核病防治临床中心,北京101149 [2]广州市胸科医院结核科,广州510095 [3]上海市疾病预防控制中心结核病防治科,上海200336 [4]天津市结核病控制中心结核科,天津300041 [5]河南省疾病预防控制中心结核病防治科,郑州450016 [6]河北省疾病预防控制中心结核病防治科,石家庄050021 [7]广西壮族自治区疾病预防控制中心结核病防治科,南宁530021 [8]重庆市结核病防治所结核科,重庆400050 [9]云南省疾病预防控制中心结核病防治科,昆明650022

出　　处：《中华医学杂志》2019年第14期1090-1094,共5页National Medical Journal of China

摘　　要：目的探讨饮酒对涂阳肺结核患者治疗2个月末痰菌阴转及治疗转归的的影响。方法根据我国结核病疫情及地域分布情况,2008—2011年选择我国8个省自治区、直辖市共49个实施单位确诊的年龄≥18岁的2 067例涂阳肺结核患者基本情况及治疗效果进行分析,根据患者饮酒情况分为不饮酒、戒酒及现在饮酒3组,比较不饮酒、戒酒及现在饮酒3组患者在不良反应、病灶吸收、空洞闭合、2个月末痰培养及治疗转归方面的差异,分析饮酒对肺结核疗效的影响。结果在2 067例涂阳肺结核患者中,不饮酒组占55.2%(1 140/2 067),戒酒组占36.5%(755/2 067),现在饮酒组占8.3%(172/2 067);不饮酒、戒酒及现在饮酒3组患者2个月末痰菌阴转率分别为86.1%、81.3%及83.0%(χ^2=6.782,P=0.033);治疗转归差异有统计学意义(χ^2=13.620,P=0.034),治疗成功率分别为83.9%、81.1%及79.7%,治疗失败率分别为6.4%、10.3%及9.9%,病死率分别为2.1%、2.3%及4.1%。多因素Logistic回归分析结果显示,戒酒组患者2个月末痰培养未阴转率及病死率分别是不饮酒组患者的1.431及1.668倍,现在饮酒组患者2个月末痰培养未阴转率是不饮酒组患者的1.256倍。结论饮酒可影响肺结核疗效,增加患者2个月末痰菌未阴转率及死亡的风险。Objective To explore the effect of alcohol drinking on sputum culture conversion at the end of second month and outcome of smear-positive pulmonary tuberculosis (PTB) patients. Methods Total 2 067 patients aged 18 years and above diagnosed and treated from 2008 to 2011 in 49 TB institutions from 8 provinces, antonomous regions and municipalities were enrolled, according to tuberculosis situation and regional distribution in China. Those patients were divided into three groups according to alcohol drinking, including never alcohol drinker group, ever-alcohol drinker group and current alcohol drinker group, respectively. Chi-square test was used to compare the following variables among the three groups: adverse action, lesions absorption, cavity size, sputum-culture results at the end of the 2nd month of treatment, and treatment outcome. Multivariate Logistic regression was used to explore that whether alcohol drinking was risk factor of poor treatment effect. Results Among the 2 067 smear-positive PTB patients, never drinkers, ex-drinkers and current drinkers account for 55.2%(1 140/2 067), 36.5%(755/2 067), 8.3%(172/2 067), respectively. Among patients of never drinkers, ex-drinkers and current drinkers groups, sputum-culture conversion rate at the end of the 2nd month of treatment were 86.1%, 81.3% and 83.0%, respectively (χ^2=6.782, P=0.033);the difference in treatment outcome was significant (χ^2=13.620, P=0.034). Treatment success rate were 83.9%, 81.1% and 79.7%, respectively;failure rate was 6.4%, 10.3% and 9.9%, respectively, and fatality rate were 2.1%, 2.3% and 4.1%, respectively. Multivariate Logistic regression analysis showed that non-sputum conversion of the end of 2nd month and fatality rate of ex-drinkers were 1.431 and 1.668 times higher than never drinkers, respectively;non-sputum conversion of the end of 2nd month of current drinkers was 1.256 times higher than never drinkers. Conclusion Alcohol drinking affects the treatment effectiveness of tuberculosis, which increased risk of culture-posit

关 键 词：结核 肺 饮酒 细菌培养 治疗结果 

分 类 号：R521[医药卫生—内科学]