2016—2022年贵州省利福平耐药结核病患者治疗延迟现状及影响因素分析  

Status and influencing factors of treatment delay of rifampicin resistant tuberculosis patients,Guizhou,2016-2022

作　　者：王大福 郭雪丽 马晓雪 王芸[1] 周姣姣 周建 李福栋 李进岚[2,1] WANG Da-fu;GUO Xue-li;MA Xiao-xue;WANG Yun;ZHOU Jiao-jiao;ZHOU Jian;LI Fu-dong;LI Jin-lan(School of Public Health,the Key Laboratory of Environmental Pollution Monitoring and Disease Control,Ministry of Education,Guizhou Medical University,Guiyang,Guizhou 561113,China;不详)

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,贵州贵阳561113 [2]贵州省疾病预防控制中心

出　　处：《现代预防医学》2024年第18期3410-3415,共6页Modern Preventive Medicine

基　　金：贵州省发改委省级基本建设前期工作项目(2020-181-131);贵州省科技计划项目(黔科合基础-ZK[2022]一般389);国家自然科学基金(81860591);贵州医科大学博士科研启动基金(2020-070)。

摘　　要：目的 分析贵州省2016—2022年利福平耐药结核病(rifampicin-resistant tuberculosis,RR-TB)患者治疗延迟现状及其影响因素,为贵州省制定RR-TB防控措施提供依据。方法 从“中国疾病预防控制信息系统”子系统“结核病管理信息系统”中导出贵州省2016—2022年RR-TB患者病案信息,治疗延迟率随时间变化趋势采用趋势χ^(2)检验,采用logistic回归模型分析其影响因素。结果 贵州省2016—2022年RR-TB发生治疗延迟患者513例,治疗延迟率为23.29%。2016-2019年患者治疗延迟率呈下降趋势(趋势χ^(2)=9.099,P=0.003),2018年治疗延迟率最低,为10.53%;2020-2022年患者治疗延迟率呈上升趋势(趋势χ^(2)=5.937,P=0.015),2021年最高为31.62%。在地区分布上,黔南州(50.00%)和毕节市(47.26%)的非流动患者的治疗延迟率位居前列;而遵义市(28.70%)的流动患者治疗延迟率最高。多因素分析结果显示,与流动人口、初治失败、使用分子生物学药敏检测的患者相比,非流动患者(OR=1.496,95%CI=1.198~1.867)、新患者(OR=1.774,95%CI=1.344~2.342)、复发(OR=1.494,95%CI=1.110~2.011)、使用传统药敏检测方法(OR=2.985,95%CI=2.323~3.834)是治疗延迟的危险因素。结论 贵州省2016—2022年RR-TB患者治疗延迟率总体呈下降趋势,但受新型冠状病毒疫情影响仍然较高。建议进一步加强对毕节市等重点地区的防治工作,加强对耐药患者的健康教育,实施以患者为中心的耐药患者关怀服务体系;扩大医保报销范围等,降低患者经济负担;进一步扩大分子生物学检测技术应用,达到全覆盖水平,为患者诊治提供有利条件。Objective This study assesses the status and determinants of treatment delays among patients with rifampicin-resistant tuberculosis(RR-TB) in Guizhou Province,2016-2022,aiming to inform the development of RR-TB control strategies in the region.Methods Data on RR-TB patients from 2016 to 2022 were extracted from the "Tuberculosis Management Information System," a subsystem of the "China Disease Prevention and Control Information System." The trend in treatment delay rates over time was analyzed using Trend chi-square test,while logistic regression models were used to examine the factors influencing these delays.Results From 2016 to 2022,Guizhou Province reported 513 cases of treatment delays among patients with rifampicin-resistant tuberculosis(RR-TB),resulting in a treatment delay rate of 23.29%.The rate of treatment delays decreased from 2016 to 2019(Trend chi-square test=9.099,P=0.003),reaching its lowest in 2018 at 10.53%.However,from 2020 to 2022,the rate of treatment delays exhibited an upward trend(Trend chi-square test=5.937,P=0.015),peaking in 2021 at 31.62%.Multivariable analysis indicated that compared to migrant populations,patients undergoing initial treatment,and those tested with molecular biological drug sensitivity tests,non-migrant patients(OR=1.496,95%CI=1.198 to 1.867),new patients(OR=1.774,95%CI =1.344 to 2.342),patients with relapse(OR=1.494,95%CI=1.110 to 2.011),and those tested using traditional drug sensitivity methods(OR=2.985,95%CI=2.323 to 3.834) were at higher risk for treatment delays.Conclusion From 2016 to 2022,the overall trend of treatment delays in rifampicin-resistant tuberculosis(RR-TB) patients in Guizhou Province showed a decline.However,there was an increasing trend during the COVID-19 pandemic.This suggests a need to enhance the prevention and control of drug-resistant tuberculosis in key areas such as Bijie City.There is also a need to intensify health education for patients with drug resistance,implement patient-centered care systems for those patients,expand the applicat

关 键 词：利福平耐药结核病 治疗延迟 影响因素 贵州省 

分 类 号：R521[医药卫生—内科学]