复治耐多药/利福平耐药肺结核患者的治疗转归影响因素分析——全国多中心、回顾性队列研究  

Analysis of influencing factors of treatment outcomes of retreated multidrug-resistant/rifampicin-resistant pulmonary tuberculosis patients:a national multicenter retrospective cohort study

作　　者：叶智腾 任斐 王华 杨铭 陈禹[6] 陈晓红 王芸[1] 范琳 Ye Zhiteng;Ren Fei;Wang Hua;Yang Ming;Chen Yu;Chen Xiaohong;Wang Yun;Fan Lin(School of Public Health,the Key Laboratory of Environmental Pollution Monitoring and Disease Control,Ministry of Education,Guizhou Medical University,Guiyang 561113,China;Department of Tuberculosis,Shanghai Pulmonary Hospital Affiliated to Tongji University/Shanghai Tuberculosis Clinical Research Center/Shanghai Key Laboratory of Tuberculosis(Lung),Shanghai 200433,China;Department of Drug-resistant Tuberculosis,Xi’an Chest Hospital,Xi’an 710100,China;Department of Drug-resistant Tuberculosis,Anhui Chest Hospital,Hefei 230022,China;Department of Tuberculosis,Chengdu Public Health Clinical Medical Center,Chengdu 610061,China;Department of Children Tuberculosis,Shenyang Chest Hospital,Shenyang 110044,China;Fuzhou Pulmonary Hospital,Fuzhou 350008,China)

机构地区：[1]贵州医科大学公共卫生与健康学院,环境污染与疾病监控教育部重点实验室,贵阳561113 [2]同济大学附属上海市肺科医院结核科,结核病临床研究中心,上海市结核(肺)重点实验室,上海200433 [3]西安市胸科医院耐药结核科,西安710100 [4]安徽省胸科医院耐药结核病科,合肥230022 [5]成都市公共卫生临床医疗中心结核科,成都610061 [6]沈阳市胸科医院儿童结核科,沈阳110044 [7]福建省福州肺科医院,福州350008

出　　处：《中国防痨杂志》2024年第7期778-784,共7页Chinese Journal of Antituberculosis

基　　金：上海市科委医学创新研究项目(21Y11901000)。

摘　　要：目的:分析耐多药/利福平耐药肺结核(multidrug/rifampicin-resistant pulmonary tuberculosis,MDR/RR-PTB)复治患者治疗转归的影响因素。方法:采用多中心、回顾性队列研究方法,纳入2018年1月1日至2020年12月31日期间在全国六家省级结核病专科医院收治的2291例MDR/RR-PTB患者,随访患者的治疗信息,记录患者的临床特征,采用单因素、多因素logistic回归分析方法,分析影响复治MDR/RR-PTB患者治疗转归的因素。结果:2291例患者的治愈率为56.44%(1293/2291),完成疗程率为16.28%(373/2291),成功治疗率为72.72%(1666/2291);治疗失败率为11.39%(261/2291),死亡率为1.44%(33/2291),失访率为14.45%(331/2291)。多因素logistic回归分析结果显示,合并糖尿病[OR(95%CI)=1.739(1.315~2.301)]、合并肝脏疾病[OR(95%CI)=2.230(1.213~4.099)]及出现肺部空洞[OR(95%CI)=1.531(1.244~1.885)]是导致复治MDR/RR-PTB患者治疗失败的危险因素,方案中含贝达喹啉药物[OR(95%CI)=0.163(0.097~0.274)]和性别为女性[OR(95%CI)=0.713(0.571~0.890)]是患者成功治疗的保护因素。结论:复治MDR/RR-PTB患者的分类及治疗方案复杂,不同类型的复治患者治疗转归存在差异,应充分判断影响治疗转归的不利因素和有利因素,对患者实施个体化治疗。Objective:To analyze the influencing factors of treatment outcomes of retreated multidrug/rifampicin-resistant pulmonary tuberculosis(MDR/RR-PTB)patients.Methods:A multicenter retrospective cohort study was conducted to include 2291 MDR/RR-PTB patients admitted to six provincial tuberculosis designated hospitals from January 1,2018 to December 31,2020.Treatment information of those patients was followed up,clinical characteristics were recorded.Univariable and multivariable logistic regression were used to analyze the influencing factors of treatment outcomes of retreated MDR/RR-PTB patients.Results:Cure rate of 2291 patients was 56.44%(1293/2291),completion rate was 16.28%(373/2291),thus treatment success rate was 72.72%(1666/2291).Treatment failure rate was 11.39%(261/2291),mortality rate was 1.44%(33/2291),and loss of follow-up rate was 14.45%(331/2291).The analysis showed that combined with diabetes(OR(95%CI)=1.739(1.315-2.301)),combined with liver disease(OR(95%CI)=2.230(1.213-4.099))and pulmonary cavity(OR(95%CI)=1.531(1.244-1.885))were risk factors for treatment failure,while regimen containing bedaquiline(OR(95%CI)=0.163(0.097-0.274))and gender being female(OR(95%CI)=0.713(0.571-0.890))were protective factors.Conclusion:The classification and treatment regime of retreated MDR/RR-PTB patients are complicated,and treatment outcomes of different types of retreated patients differentiated.Adverse and favorable factors affecting treatment outcomes should be fully identified to perform individualized treatment on patients.

关 键 词：结核 抗多种药物性 治疗结果 因素分析 统计学 多中心研究(主题) 队列研究 

分 类 号：R521[医药卫生—内科学]