老年耐多药/利福平耐药肺结核患者的治疗转归及影响因素研究——全国多中心、回顾性队列研究  

Treatment outcomes and influencing factors in elderly patients with multidrug/rifampicin-resistant pulmonary tuberculosis: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9期1023-1029,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:分析老年耐多药/利福平耐药肺结核(multidrug/rifampicin-resistant pulmonary tuberculosis,MDR/RR-PTB)患者的治疗转归及影响因素。方法:采用全国多中心、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6家省级结核病专科医院收治的年龄≥60岁且诊断为MDR/RR-PTB的患者,共475例。记录患者的临床特征,随访全疗程的治疗相关信息,采用多因素logistic回归模型分析影响老年MDR/RR-PTB患者治疗转归的因素。结果:475例老年MDR/RR-PTB患者的治疗成功率为65.89%(313/475),其中治愈率为50.74%(241/475),完成治疗率为15.16%(72/475);治疗失败率为13.05%(62/475),失访率为17.05%(81/475),死亡率为4.00%(19/475)。多因素logistic回归分析结果显示,70~79岁[OR(95%CI)=1.560(1.001~2.431)]、≥80岁[OR(95%CI)=3.306(1.370~7.974)]、肺部出现空洞[OR(95%CI)=1.832(1.195~2.808)]是影响老年MDR/RR-PTB患者成功治疗的危险因素;治疗方案中含贝达喹啉[OR(95%CI)=0.193(0.044~0.841)]是老年MDR/RR-PTB患者成功治疗的保护因素。结论:老年MDR/RR-PTB患者治疗复杂、治疗难度较大,其治疗成功率较低,尤其应重视年龄≥70岁和肺部出现空洞的老年患者。Objective:To analyze treatment outcomes and influencing factors of multidrug/rifampicin-resistant pulmonary tuberculosis(MDR/RR-PTB)in elderly patients.Methods:A national multicenter retrospective cohort study was conducted to include 475 elderly(≥60 years)MDR/RR-PTB patients who were admitted to six provincial tuberculosis hospitals from January 1,2018 to December 31,2020.Clinical characteristics of those patients were recorded and full course treatment was followed up.Multivariable logistic regression model was used to analyze factors affecting treatment outcomes.Results:Successful treatment rate of 475 elderly MDR/RR-PTB patients was 65.89%(313/475),cure rate and treatment completion rate were 50.74%(241/475)and 15.16%(72/475)respectively.Treatment failure rate was 13.05%(62/475),loss of follow-up rate was 17.05%(81/475)and mortality rate was 4.00%(19/475).Multivariable logistic regression analysis showed that 70-79 years old(OR=1.560,95%CI:1.001-2.431),≥80 years old(OR=3.306,95%CI:1.370-7.974),lung cavities(OR=1.832,95%CI:1.195-2.808)were risk factors affecting MDR/RR-PTB treatment success in elderly patients.Inclusion of Bedaquiline in treatment regimen(OR=0.193,95%CI:0.044-0.841)was a protective factor for successful treatment.Conclusion:The treatment of elderly MDR/RR-PTB patients is complicated and difficult for which the successful treatment rate is low.Special attention should be paid to elderly patients aged≥70 years and those with pulmonary cavities.

关 键 词：结核 抗多种药物性 治疗结果 老年人 多中心研究(主题) 

分 类 号：R521[医药卫生—内科学]