初治菌阳肺结核患者治疗失败影响因素分析  

Analysis of influencing factors on treatment failure in initially treated patients with bacterial positive pulmonary tuberculosis

作　　者：姜若溪 钟达[1] 窦小洁 Jiang Ruoxi;Zhong Da;Dou Xiaojie(Department of Outpatient,Tianjin Tuberculosis Control Center,Tianjin 300041,China)

机构地区：[1]天津市结核病控制中心门诊部,天津300041

出　　处：《结核与肺部疾病杂志》2024年第3期236-243,共8页Journal of Tuberculosis and Lung Disease

摘　　要：目的:分析初治菌阳肺结核患者治疗失败的影响因素,为提高患者成功治疗率提供依据。方法:采用回顾性研究方法,参照入组标准从天津市结核病控制中心“医院信息管理系统”中收集2020年1—12月天津市结核病控制中心收治且完成1年随访的392例初治菌阳肺结核患者临床资料(包括性别、年龄、婚姻、职业、文化程度、收入情况、居住情况、烟酒史、体质量指数、基础疾病、因症就诊、是否定期体检、就诊延迟、诊断延迟、药物不良反应、是否规律用药、结核分枝杆菌耐药及影像学检查结果等),采用单因素和多因素logistic回归模型分析患者治疗转归情况及治疗失败的影响因素。结果:392例肺结核患者的治疗失败率为8.16%(32/392)。多因素logistic回归模型分析结果显示,存在药物不良反应(OR=3.109,95%CI:1.186~8.151)、就诊延迟(OR=2.028,95%CI:1.742~5.541)、诊断延迟(OR=3.231,95%CI:1.213~8.604)、结核分枝杆菌耐药(OR=8.478,95%CI:2.111~34.055)和不规律用药(OR=1.825,95%CI:1.185~2.810)均是初治菌阳患者治疗失败的危险因素,而定期健康检查(OR=0.568,95%CI:0.357~0.904)是初治菌阳患者治疗成功的保护因素。结论:提高人群定期检查以尽早发现潜在患者、发现疑似肺结核症状应积极就医并及时进行诊断、开展耐药性检测自我管理意识、积极处理治疗过程中的药物不良反应并加强用药安全指导、引导患者改善自身生活习惯和用药依从性,均可提高初治菌阳肺结核患者治疗成功率。Objective:To analyze the influencing factors of treatment failure in initially treated patients with bacterial positive pulmonary tuberculosis,and provide evidence for improving the treatment success rate.Methods:A retrospective study was conducted to collect the clinical data of 392 new patients with positive bacteria results,who were registered from January to December 2020 in Tianjin Tuberculosis Control Center and completed a one-year follow-up.The data was extracted from Hospital Information System of Tianjin Tuberculosis Control Center.The data included sex,age,marriage,occupation,education level,income,living conditions,smoking and alcohol history,body mass index,basic diseases,symptomatic visits,whether regular physical examination,delayed visits,delayed diagnosis,adverse drug reactions,whether regular drug use,drug resistance of Mycobacterium tuberculosis,and imaging examination results.Single-and multi-variable logistic regression models were used to analyze the factors associated with treatment failure.Results:Among 392 patients,the failure rate of pulmonary tuberculosis treatment was 8.16%(32/392).The multivariate logistic regression analysis showed that the presence of adverse drug reactions(OR=3.109,95%CI:1.186-8.151),delayed visits(OR=2.028,95%CI:1.742-5.541),delayed diagnosis(OR=3.231,95%CI:1.213-8.604),Mycobacterium tuberculosis resistance(OR=8.478,95%CI:2.111-34.055),and irregular medication use(OR=1.825,95%CI:1.185-2.810)were risk factors for treatment failure,while regular health examinations(OR=0.568,95%CI:0.357-0.904)was protective factor for treatment failure in new bacterial positive patients.Conclusion:Improving regular health examinations to detection of potential patients as early as possible,promoting of patients with suspected tuberculosis symptoms to seek medical service and receiving timely diagnosis,carrying out self-management awareness of drug resistance testing,active handling of adverse drug reactions during treatment,strengthening medication safety guidance,guiding patients to

关 键 词：结核 肺 治疗结果 因素分析 统计学 天津 

分 类 号：R521[医药卫生—内科学]