308例耐多药肺结核患者的治疗转归及影响因素分析  

Analysis of treatment outcome and influencing factors of 308 patients with multidrug-resistant pulmonary tuberculosis

作　　者：薛剑航 曹红 李露 刘洵锐 马桂林[1] 郑蓉蓉[1] 柯然[1] Xue Jianhang;Cao hong;Li Lu;Liu Xunrui;Ma Guilin;Zheng Rongrong;Ke Ran(Tuberculosis and AIDS Prevention and Control Division,Xiamen Center for Disease Control and Prevention,Xiamen 361000,China)

机构地区：[1]厦门市疾病预防控制中心结核病与艾滋病预防控制处,厦门3610001

出　　处：《结核与肺部疾病杂志》2024年第1期44-50,共7页Journal of Tuberculosis and Lung Disease

摘　　要：目的:筛选和评估影响耐多药肺结核(MDR-PTB)患者治疗转归的因素。方法:通过“中国疾病预防控制信息系统”的子系统“结核病信息管理系统”收集厦门市2010—2019年308例MDR-PTB患者的治疗转归资料进行分析,分析影响治疗转归的危险因素,并构建预测模型。结果:308例MDR-PTB患者中,治疗成功226例(73.38%);发生不良转归82例(26.62%),其中治疗失败52例(16.88%),死亡17例(5.52%),其他原因13例(4.22%)。影响治疗转归的因素有:男性(OR=2.877,95%CI:1.356~6.104)、年龄≥50岁(OR=1.833,95%CI:1.011~3.323)、家务及待业(OR=0.352,95%CI:0.196~0.631)、复治患者(OR=6.357,95%CI:1.842~21.944)、3个月末痰培养阴性(OR=0.162,95%CI:0.063~0.416)。基于联合预测因子预测MDR-TB患者治疗转归的预测模型ROC曲线下面积为0.909(95%CI:0.871~0.938)。结论:男性、年龄≥50岁、复治患者、3个月末痰培养阳性是MDR-PTB患者发生不良转归的危险因素,家务及待业是MDR-PTB患者发生不良转归的保护因素。联合预测因子模型拥有较强的对MDR-PTB患者治疗后不良转归的预测能力。Objective:To screen and evaluate the factors affecting treatment outcomes in patients with multidrug-resistant pulmonary tuberculosis(MDR-PTB).Methods:Treatment outcome data of 308 patients with MDR-PTB in Xiamen from 2010 to 2019 were collected through the“Tuberculosis Information Management System”,a subsystem of the“China Disease Prevention and Control Information System”,then risk factors affecting the treatment outcome were analyzed,and the prediction model was built.Results:Of 226(73.38%)out of these 308 patients were successfully treated.There were 82 cases(26.62%)getting adverse outcomes,including 52 cases(16.88%)with treatment failure,17 cases(5.52%)died,and 13 cases(4.22%)getting adverse outcome with other causes.Factors influencing the treatment outcome were:male(OR=2.877,95%CI:1.356-6.104),age≥50 years old(OR=1.833,95%CI:1.011-3.323),housewife/without a job(OR=0.352,95%CI:0.196-0.631),retreatment(OR=6.357,95%CI:1.842-21.944),sputum culture negative at 3 month(OR=0.162,95%CI:0.063-0.416).The area under ROC curve of the predictive model was 0.909(95%CI:0.871-0.938)based on combined predictors to predict the outcome of MDR-TB patients.Conclusion:Male,age≥50 years old,retreatment patients and sputum culture positive at month 3 were risk factors for adverse outcomes in MDR-PTB patients,housewife/without a job were protective factor for adverse outcomes in MDR-PTB patients.The combined predictor model had fairly strong ability to predict adverse outcomes in patients with MDR-PTB after treatment.

关 键 词：结核 肺 结核 抗多种药物性 危险因素 治疗结果 ROC曲线 

分 类 号：R521[医药卫生—内科学] R181.22[医药卫生—临床医学]