上海市松江城区结核病登记死亡患者特征及影响因素分析  

The characteristics and analysis of influencing factors of tuberculosis registered dead patients in Songjiang City,Shanghai

作　　者：秦楠 徐春泽[2] 关颖[2] 路丽苹[2] 王伟炳 姜永根[2] QIN Nan;XU Chun-ze;GUAN Ying;LU Li-ping;WANG Wei-bing;JIANG Yong-gen(Department of Epidemiolgy,School of Public Health.Fudan Unirersity,Shanghai 200032,China)

机构地区：[1]复旦大学公共卫生学院流行病学教研室,上海200032 [2]上海市松江区疾病预防控制中心结核病防治科

出　　处：《中国防痨杂志》2020年第4期345-352,共8页Chinese Journal of Antituberculosis

基　　金：“十三五”国家科技重大专项(2017ZX10201302,2018ZX10722302-005);国家自然科学基金(81673233)。

摘　　要：目的 探讨结核病患者死亡危险因素,为降低结核病患者死亡率提供科学参考.方法 根据中国疾病预防控制中心《结核病管理信息系统》,获得上海市松江区城区在2004年1月1日至2008年12月31日间登记确诊的782例活动性结核病患者.剔除农村地区、外来流动人口及失访患者,总计765例患者纳入研究.研究终点为2019年6月1日,平均随访时间为(9.7±3.2)年.采用回顾性队列研究方法,收集患者基本人口学信息、生存时间和生存状况等信息.结核病患者全死因死亡及因结核死亡危险因素分析采用Cox比例风险回归模型分析,以P<0.05为差异有统计学意义.结果 2004-2008年结核病登记患者中,因结核病死亡32例,病死率为4.2%;全死因死亡233例,病死率为30.5%.诊断后第1年全死因病死率和结核病病死率最高(x2趋势值分别为20.16、3.00,P值均<0.05).Cox多因素分析显示,结核病患者全死因死亡的危险因素为男性[调整风险比(aHR)=0.12,95%CI=0.03~0.77],41~岁年龄组(aHR=1.52,95%CI=1.23~1.88),≥61岁年龄组(aHR=1.60,95%CI=1.37~1.73),有肺空洞(aHR=2.12,95%CI=1.57~2.83),痰涂片阳性(aHR=1.76,95 %CI=1.52~1.91)及并发其他基础疾病(并发糖尿病:aHR=1.35,95%CI=1.26~1.47;并发肿瘤:aHR=1.78,95%CI=1.48~1.96).因结核死亡的危险因素包括≥61岁年龄组(aHR=1.34,95 %CI=0.08~1.85),有肺空洞(aHR=2.95,95 %CI=1.26~6.71),复治(aHR=1.43,95%CI=0.18~1.85),痰涂片阳性(aHR=1.17,95% CI=0.48~2.15),耐多药结核病(aHR=1.20,95% CI=1.01~1.56),并发其他基础疾病(并发糖尿病:aHR=1.23,95%CI=1.04~1.25;并发肿瘤:aHR=13.72,95%CI=1.78~95.75).结论 医疗卫生机构应关注年龄>40岁、男性、有肺空洞、痰涂片阳性、并发糖尿病和肿瘤等因素对结核病患者全死因死亡的影响;对因结核死亡的影响应关注年龄≥61岁、有肺空洞、复治、痰涂片阳性、耐多药结核病,以及并发糖尿病和肿瘤等因素.要特别关注患者诊断第一年后的治疗�Objective To explore the risk factors of death in tuberculosis patients and to provide a scientific reference for reducing the mortality of tuberculosis patients.Methods According to the Tuberculosis Information Management System of Chinese Center for Disease Control and Prevention,782 patients with active tuberculosis were registered and diagnosed in Songjiang District of Shanghai from January 1,2004 to December 31,2008.A total of 765 patients were included in the study,excluding rural areas,floating population and patients who lost their visits.The end point of this study was June 1,2019,with an average follow-up time of(9.7±3.2)years.A retrospective cohort study was used to collect basic demographic information,survival time and survival status of patients.Risk factors of all-cause death of tuberculosis patients and TB-caused deaths were analyzed by Cox proportional hazard regression model.P<0.05 was considered statistically significant.Results From 2004 to2008,32 cases died of tuberculosis,with a mortality rate of 4.2%.Two hundred and thirty-three cases died of all causes,with a mortality rate of 30.5%.The mortality rate of all causes and TB-caused deaths in the first year after diagnosis were the highest(χtrend2=20.16 and 3.00,respectively,P values were all<0.05).Cox multivariate analysis showed that the risk factors of patients who died from all causes of death were male(aHR=0.12,95%CI=0.03-0.77),41-60 years old group(aHR=1.52,95%CI=1.23-1.88),≥61 years old group(aHR=1.60,95%CI=1.37-1.73),lung cavity(aHR=2.12,95%CI=1.57-2.83),sputum smear positive(aHR=1.76,95%CI=1.52-1.91)and other underlying diseases(diabetes:aHR=1.35,95%CI=1.26-1.47;tumor:aHR=1.78,95%CI=1.48-1.96).The risk factors of death due to tuberculosis included age which over 61 years old(aHR=1.34,95%CI=0.08-1.85),lung cavity(aHR=2.95,95%CI=1.26-6.71),retreatment(aHR=1.43,95%CI=0.18-1.85),sputum smear positive(aHR=1.17,95%CI=0.48-2.15),multidrug-resistant tuberculosis(aHR=1.20,95%CI=1.01-1.56),and other underlying diseases(diabetes:aHR=1.23,95%

关 键 词：结核 肺 死亡原因 危险因素 因素分析 统计学 小地区分析 

分 类 号：R52[医药卫生—内科学]