含利奈唑胺方案治疗耐多药肺结核患者的疗效观察及不良结局预测模型的构建与评价  

Observation of curative effect and construction and evaluation of adverse outcome prediction model of linezolid-containing regimen in the treatment of multidrug-resistant pulmonary tuberculosis

作　　者：唐浩杰 杨子龙 俞朝贤 冯治宇 汪敏 张宏 吴迪[2] 袁园 陈泽莹 黄显林 邝浩斌 TANG HaoJie;YANG Zilong;YU Zhaoxian;FENG Zhiyu;WANG Min;ZHANG Hong;WU Di;YUAN Yuan;CHEN Zeying;HUANG Xianlin;KUANG Haobin(Intensive Care Medicine,State Key Laboratory of Respiratory Disease,Guangzhou Key Laboratory of Tuberculosis Research,Intensive Care Unit,Guangzhou Chest Hospital,Institute of Tuberculosis,Guangzhou Medical University,Guangzhou,Guangdong 510095,China;Tuberculosis Internal Medicine,State Key Laboratory of Respiratory Disease,Guangzhou Key Laboratory of Tuberculosis Research,Intensive Care Unit,Guangzhou Chest Hospital,Institute of Tuberculosis,Guangzhou Medical University,Guangzhou,Guangdong 510095,China)

机构地区：[1]呼吸疾病全国重点实验室,广州市结核病研究重点实验室,广州医科大学结核病防治研究院,广州市胸科医院重症医学科,广东广州510095 [2]呼吸疾病全国重点实验室,广州市结核病研究重点实验室,广州医科大学结核病防治研究院,广州市胸科医院.结核内科,广东广州510095

出　　处：《临床肺科杂志》2024年第9期1309-1314,共6页Journal of Clinical Pulmonary Medicine

基　　金：广东市科技计划基金资助项目(No.2023B03J1303);广州市医学重点学科(2021-2023)结核病学。

摘　　要：目的观察含利奈唑胺方案治疗耐多药肺结核患者的临床疗效,并构建不良结局的预测模型。方法选取广州市胸科医院耐药结核科2019年7月至2022年9月纳入治疗的113例耐多药或利福平耐药肺结核患者,所有患者治疗方案的制定参照指南的治疗原则,住院2周以上,出院转耐多药专科门诊全程治疗管理,记录年龄、性别、治疗史、基础疾病、肺部病灶、痰菌检测结果等临床特征。采用χ^(2)检验进行组间比较分析治疗成功组和不良结局组的临床特征。将纳入病例的临床特征作为自变量,以治疗成功(治愈、完成治疗)及不良结局(失败、丢失、死亡)为因变量,对可能影响不良结局的因素采用Logistic回归分析,计算各因素的P值、比值比(OR)及其95%可信区间(95%CI)。结果纳入的113例含利奈唑胺方案治疗的MDR/RR-TB患者中治疗成功率为79.65%,不良结局发生率为20.35%,肺部病灶吸收有效率为88.35%,空洞变化有效率为73.24%,治疗2个月及6个月痰菌阴转率分别为:47.79%、87.61%。Logistic回归分析显示:复治(OR=3.987,95%CI:1.089~14.590,P=0.037)、合并空洞(OR=15.760,95%CI:1.518~163.667,P=0.021)、年龄≥65岁(OR=9.438,95%CI:1.136~78.396,P=0.038)可能是影响患者发生不良结局的危险因素。预测模型ROC曲线下面积AUC为0.772,当约登指数为0.448时,其敏感度为0.870,特异度为0.578,截断值为0.156。结论利奈唑胺治疗耐多药肺结核疗效可观,但仍存在一定比例的不良结局发生率,临床治疗及随访中可使用该模型对患者进行不良转归风险分类,通过对合并复治、空洞、年龄≥65岁的人群重点管治、加强督导,并采取有针对性的、有效的方案,从而提高治疗成功率。Objective To observe the clinical efficacy of linezolid regimen in the treatment of MDR/RR-TB patients,and establish a prediction model of adverse outcomes.Methods 113 patients with multidrug-resistant pulmonary tuberculosis who received a linezolid-containing regimen in Guangzhou Chest Hospital from July 2019 to September 2022 were included.The treatment regimens of all patients adhere to the treatment principles of the guideline,such as hospitalization for more than 2 weeks,and transfer to a multidrug-resistant specialist clinic for total treatment management after discharge.Clinical characteristics such as age,gender,treatment history,underlying diseases,lung lesions,sputum test results,and adverse reactions were recorded.The χ^(2) test was used to compare and analyze the clinical characteristics of the successful treatment group and the adverse outcome group.Logistic regression analysis was performed for factors that might affect adverse outcomes,and the P-value,odds ratio(OR),and 95%confidence interval(95%CI)of each factor were calculated.Results Among the 113 MDR/RR-TB patients included in the treatment with the linezolid regimen,the treatment success rate was 79.65%,the incidence of adverse outcomes was 20.35%,the effective rate of lung lesion absorption was 88.35%,the effective rate of cavity change was 73.24%,and the sputum negative conversion rate after 2 months and 6 months of treatment was as follows:47.79%,87.61%.There were statistically significant differences in combined cavities(P=0.004)and baseline sputum smears(P=0.008)between the successful treatment group and the adverse outcome group.Logistic regression analysis showed that retreatment(OR=3.987,95%CI:1.089~14.590,P=0.037),merged cavity(OR=15.760,95%CI:1.518~163.667,P=0.021),age≥65years old(OR=9.438,95%CI:1.136~78.396,P=0.038)were independent risk factors for adverse outcomes.The area under the ROC curve of the prediction model was 0.772,When the Youden index was 0.448,the sensitivity was 0.870,the specificity was 0.578,and the cutoff value

关 键 词：利奈唑胺 肺结核 耐多药 疗效 不良结局 预测模型 

分 类 号：R521[医药卫生—内科学]