2005—2020年杭州市青少年肺结核病例不良转归的影响因素分析  

Influencing factors of the adverse outcome of pulmonary tuberculosis among adolescents in Hangzhou City between 2005 and 2020:a school-based retrospective cohort study

作　　者：赵刚[1] 程庆林[1] 谢立[1] 方子健 宋旭 Zhao Gang;Cheng Qinglin;Xie Li;Fang Zijian;Song Xu(Division of Tuberculosis Prevention and Therapy,Hangzhou Center for Disease Control and Prevention,Hangzhou 310021,China)

机构地区：[1]浙江省杭州市疾病预防控制中心结核病防治所,杭州310021

出　　处：《中华预防医学杂志》2023年第3期348-355,共8页Chinese Journal of Preventive Medicine

基　　金：浙江省基础公益计划项目(LGF21H260007);浙江省医药卫生科技计划项目(2020PY064,2021PY065);杭州市卫生科技计划项目(0020190783)。

摘　　要：目的分析2005—2020年杭州市青少年肺结核病例不良转归的影响因素。方法采用回顾性队列研究方法,从中国疾病预防控制传染病监测报告管理系统中,收集于杭州市12家肺结核定点医院发病时间为2005年1月1日至2020年12月31日的青少年肺结核病例信息,主要包括人口学、流行病学、临床表现和细菌学特征等数据,并对病例进行随访调查(随访终止时间为2021年12月31日),采用多因素Cox比例风险回归模型分析青少年肺结核不良转归的影响因素。结果4921例青少年肺结核病例年龄为(18.9±3.6)岁,男、女性病例分别为3074、1847例;不良转归病例占14.7%(725例)。多因素Cox比例风险回归模型分析结果显示,家属或自我肺结核管理方式[HR(95%CI):5.87(4.55~7.64)]、分子生物学检测阳性[HR(95%CI):4.62(2.98~7.19)]、痰涂片阳性次数≥1[HR(95%CI):3.72(2.87~4.83)]、非标准肺结核化疗方案[HR(95%CI):3.69(2.95~4.64)]、复治肺结核史[HR(95%CI):2.22(1.46~3.36)]、外来流动人员[HR(95%CI):1.89(1.54~2.34)]、胸部X线片检查次数越多[HR(95%CI):1.83(1.65~2.04)]、重症肺结核[HR(95%CI):1.38(1.02~2.05)],为青少年肺结核不良转归发生的危险因素;而年龄越大[HR(95%CI):0.94(0.92~0.96)]为青少年肺结核不良转归发生的保护性因素。结论杭州市青少年肺结核病例的管理方式、分子生物学检测、化疗方案、肺结核史、痰涂片检查、肺结核严重程度、户籍、胸部X线片检查、年龄与不良转归有关联。Objective To explore the influencing factors of the adverse outcome of pulmonary tuberculosis(PTB)among adolescents in Hangzhou City between 2005 and 2020.Methods A retrospective cohort study was used to collect the information of adolescent PTB patients with the onset of PTB occurring from January 1,2005 to December 31 in 12 designated tuberculosis hospitals in Hangzhou,mainly including demographic,epidemiological,clinical manifestations,bacteriological characteristics and other data,through the China Management Information System for Infectious Disease Surveillance and Reporting and the follow-up survey.All patients were followed up and the end time was December 31,2021.Multivariate Cox regression model was used to analyze the factors affecting the adverse outcome of these patients.Results The mean age of 4921 adolescent PTB patients was(18.9±3.6)years old,and the number of male and female patients were 3074 and 1847 respectively.The adverse outcome accounted for 14.7%(725)of all patients.Multivariate Cox regression model showed that eight risk factors,including management model from patients themselves or family members(HR=5.87,95%CI:4.55-7.64),molecular biology examination positive for PTB(HR=4.62,95%CI:2.98-7.19),the number of sputum smears-positive≥1(HR=3.72,95%CI:2.87-4.83),non-standardized therapy regimens of PTB(HR=3.69,95%CI:2.95-4.64),history of retreated PTB(HR=2.22,95%CI:1.46-3.36),migrant adolescents(HR=1.89,95%CI:1.54-2.34),the number of chest X-ray scan(HR=1.83,95%CI:1.65-2.04),and severe PTB(HR=1.38,95%CI:1.02-2.05),were associated with the adverse outcome of adolescent PTB patients.Age(HR=0.94,95%CI:0.92-0.96),as the only protective factor,was associated with the adverse outcome of these patients.Conclusion The management mode,molecular biological examination,chemotherapy program,history of tuberculosis,sputum smear examination,severity of tuberculosis,household residence,chest X-ray examination and age are associated with the adverse outcomes of adolescent PTB patients in Hangzhou.

关 键 词：青少年 肺结核 不良转归 影响因素 

分 类 号：R521[医药卫生—内科学]