北京市初治肺结核患者治疗成功后复发情况及危险因素分析  

Recurrence and risk factors to the pulmonary tuberculosis patients after successful initial treatment in Beijing

作　　者：张红伟[1] 陈曦[1] 孙闪华[1] 许琰[1] 李波[1] 赵鑫[1] 高志东[1] Zhang Hongwei;Chen Xi;Sun Shanhua;Xu Yan;Li Bo;Zhao Xin;Gao Zhidong(Beijing Institute of Tuberculosis Control,Beijing 100035,China)

机构地区：[1]北京结核病控制研究所,北京100035

出　　处：《疾病监测》2021年第8期818-823,共6页Disease Surveillance

基　　金：首都卫生发展科研专项基金(No.2011–1012–01);北京结核病控制研究所科研基金(No.JKS2021–01)。

摘　　要：目的分析北京市初治肺结核患者治疗成功后的复发情况及其影响因素。方法采用回顾性队列分析,从结核病管理信息系统中导出北京市2015—2017年登记并治疗成功的户籍初治肺结核患者为研究对象,匹配截至2020年12月31日的病案和报告卡,查找复发病例并进行生存分析,通过寿命表法估算肺结核复发情况,复发的单因素分析采用Kaplan-Meier法,组间比较采用log-rank法检验,多因素分析采用时依Cox回归模型。结果纳入研究的8503例成功治疗户籍初治结核病患者中,共有253例(2.98%)复发,复发率密度为8.14/1000人年,其中88.54%(224例)的患者3年内复发,5年累计复发率为3.57%。在单因素分析基础上进行的多因素分析发现,肺部空洞[调整后的风险比(aHR)为1.592,95%置信区间(CI):1.166~2.172,P=0.003]、时依变量中的年龄(aHR=1.004,95%CI:1.001~1.008,P=0.008)、被动就诊(aHR=1.200,95%CI:1.008~1.428,P=0.040)、病原学阳性(aHR=1.154,95%CI:1.034~1.289,P=0.011)是肺结核复发的独立危险因素。结论应加强结核病患者治疗成功后的随访和管理,对肺结核复发的高危人群开展针对性干预措施,加强对公众的健康教育,及早发现、尽快规范治疗,减少复发。Objective To analyze the recurrence and risk factors of pulmonary tuberculosis(TB)cases after successful initial treatment in Beijing.Methods A retrospective cohort study was conducted.The data of pulmonary TB cases with successful initial treatment in Beijing during 2015–2017 were collected from TB information management system.The medical records and Infectious Disease Report Cards registered or reported before December 31,2020 were collected to find recurrent TB cases and survival analysis was performed.The recurrence of TB was estimated by using life-table method,Kaplan-Meier method was used for univariate analysis of recurrence,log-rank method was used for comparison between groups,and timedependent Cox regression model was used for multivariate analysis.Results Among the 8503 TB cases with successful initial treatment enrolled in Beijing,253(2.98%)cases had recurrence,with a recurrence rate density of 8.14/1000 personyears,in which 88.54%(224 cases)had recurrence within 3 years,and 3.57%had recurrence within 5 years.Multivariate analysis based on univariate analysis showed that,lung cavity(adjusted Hazard ratio,aHR=1.592,95%CI:1.166–2.172,P=0.003),time-dependent covariates such as age(aHR=1.004,95%CI:1.001–1.008,P=0.008),passive treatment(aHR=1.200,95%CI:1.008–1.428,P=0.040),positive etiology(aHR=1.154,95%CI:1.034–1.289,P=0.011)were the independent risk factors for TB recurrence.Conclusion We should strengthen the follow-up and management of pulmonary TB patients after successful treatment,and conduct targeted intervention for groups at high-risk for TB recurrence.Public health education should be strengthened,and early detection and treatment should be performed to reduce TB recurrence.

关 键 词：结核 肺 复发 危险因素 生存分析 

分 类 号：R211[医药卫生—中医学] R521