复治菌阳肺结核患者治疗成功后再次复发的危险因素分析  

Analysis of risk factors for recurrence of pulmonary tuberculosis after successful completion of treatment of relapsed smear positive tuberculosis

作　　者：杜建[1] 韩喜琴[1] 舒薇[1] 陈梓 谢仕恒 吕晓亚[1] 戈启萍[1] 马艳[1] 刘宇红[1] 李亮[1] 高微微[1] DU Jian;HAN Xi-qin;SHU Wei;CHEN Zi;XIE Shi-heng;LYU Xiao-ya;GE Qi-ping;MA Yan;LIU Yu-hong;LI Liang;GAO Wei-wei(Beijing Chest Hospital,Capital Medical University/Clinical Center on Tuberculosis,China Center for Disease Control and Prevention,Beijing 101149,China)

机构地区：[1]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,101149

出　　处：《中国防痨杂志》2019年第6期624-631,共8页Chinese Journal of Antituberculosis

摘　　要：目的探讨复治菌阳肺结核治疗成功后再次复发患者的相关危险因素。方法采取多中心、随机、开放、平行、对照的前瞻性队列研究,联合国内22家结核病防治机构共同参与。对复治肺结核满疗程治疗成功后的300例患者,在2013年3月至2019年1月进行了近6年的随访,共发现有23例治疗成功后的肺结核患者再次复发(复发组),治疗成功后有277例未复发者(未复发组)。对两组在既往(初治时和复治时)累计用药时间、此次治疗前是否存在耐药、此次复治方案、此次治疗时服用利福平或利福喷丁(简称“利福类药物”)剂量,以及治疗成功时胸片显示的空洞情况进行分析,探讨其治疗成功后再次复发的危险因素。统计方法采用SPSS19.0软件进行数据的统计学分析,计数资料采用χ^2检验或Fisher确切概率法;两组患者的临床指标与复发间的关系采用logistic回归分析,以P<0.05为差异有统计学意义。结果复发组胸片显示空洞闭合率[7.1%(1/14)]明显低于未复发组[49.2%(90/183)],差异具有统计学意义(χ^2=9.246,P=0.002)。单因素分析复发与未复发两组在既往(此次治疗前)累计使用一线抗结核药物时间≥7个月者分别为60.9%(14/23)和29.1%(80/275),差异具有统计学意义(χ^2=9.926,P=0.002)。在此次治疗前药物敏感性试验结果存在耐药者复发组占63.6%(14/22),与未复发组[35.8%(93/260)]比较,差异也具有统计学意义(χ^2=6.690,P=0.010)。多因素分析既往累计用药时间和此次复治前是否存在耐药与再次复发有相关性,OR值(95%CI值)分别为4.911(1.885~12.792)和3.085(1.204~7.902)(P=0.001和P=0.019);另外发现此次复治方案中使用低剂量利福类药物对再次复发有影响,OR值(95%CI值)为3.499(1.302~9.404)(P=0.013)。结论既往累计抗结核用药时间≥7个月、此次复治前存在耐药、此次复治方案中使用低剂量利福类药物,以及治疗结束时胸片仍显示有空洞者是复治�Objective This study is to identify and analyze the risk factors of recurrence of pulmonary tuberculosis after successful completion of treatment of relapsed smear positive tuberculosis.Methods This was a multi-centered open-label randomized controlled prospective cohort study which recruited patients from 22 TB specialized clinical centers across China. From March 2013 to January 2019, 300 relapsed pulmonary TB patients after completion of anti-TB retreatment had been followed-up for 6 consecutive years. Twenty-three of those who had completed retreatment relapsed again formed the recurrent cohort, the rest 277 patients who remained clear of TB formed the control cohort. Indicators including past accumulated time of anti-TB medication including initial treatment and retreatment, the presence of drug resistance prior initiation of retreatment, retreatment chemo-regimens, dosages of rifampicin or rifapentine (in short rifamycins)of retreatment regimens as well as cavitation on chest X-ray after successful completion of retreatment were investigated and analyzed by using mono-factor or multi-factor analysis for further TB recurrence. SPSS 19.0 was used for statistical analysis, collected data were verified using χ^2 test;a logistical regression was utilized to analyze the correlation between clinical characteristics of both cohorts and TB recurrence, P<0.05 was considered statistically significant difference.Results 7.1%(1/14) of patient from recurrent cohort having his or hers lung cavity closed which was much lower than control with 49.2%(90/183)of patients having their lung cavities closed, the difference was statistically significant(χ^2=9.246,P=0.002). Using mono-factor analysis, percentages of patients who received ≥7 months of past accumulated time of administration of first-line anti-TB drugs from both recurrent and control cohort were 60.9%(14/23)and 29.1%(80/275) respectively, difference between 2 cohorts was statistically significant (χ^2=9.926, P=0.002). Presence of drug resistance prior to initiat

关 键 词：结核 肺 再治疗 复发 危险因素 因素分析 统计学 

分 类 号：R521[医药卫生—内科学]