福建省县级结核病定点医疗机构抗结核固定剂量复合制剂使用情况及其影响因素分析  

Analysis of the use of anti-tuberculosis fixed-dose combination and influencing factors in county-level tuberculosis designated hospital in Fujian Province

作　　者：陈代权[1] 林淑芳[1] 戴志松[1] 周银发[1] 陈堃 林勇明[1] Chen Daiquan;Lin Shufang;Dai Zhisong;Zhou Yinfa;Chen Kun;Lin Yongming(Department of Tuberculosis and Leprosy Prevention and Control,Fujian Provincial Center for Disease Control and Prevention,Fuzhou 350012,China)

机构地区：[1]福建省疾病预防控制中心结核病麻风病防治所,福州350012

出　　处：《中国防痨杂志》2024年第11期1365-1372,共8页Chinese Journal of Antituberculosis

基　　金：福建省引导性科技计划项目(2023Y0044);福建省疾病预防控制中心软课题(2023RK02)。

摘　　要：目的:分析福建省县级结核病定点医疗机构抗结核固定剂量复合制剂(fixed-dose combination,FDC)使用情况及其影响因素,为进一步推广抗结核FDC和规范全省抗结核治疗方案提供理论依据。方法:采用典型抽样法从福建省9个设区市和平潭综合实验区共抽取18家结核病定点医院作为研究现场,调查各研究现场2020年1月1日至2021年12月31日登记并治疗且符合入组标准的980例利福平敏感肺结核患者FDC使用及替换情况,采用两水平logistic模型分析影响FDC使用的因素。结果:980例患者初始治疗方案的FDC使用率为80.41%(788/980)。两水平logistic模型分析结果显示,年龄为60~90岁和有并发症/合并症均为未使用FDC的危险因素(OR=1.499,95%CI:1.000~2.247,P=0.049;OR=1.844,95%CI:1.231~2.761,P=0.003),而体质量为38~54kg、55~70kg和71~90kg的患者未使用FDC的风险均降低(OR=0.297,95%CI:0.123~0.721,P=0.007;OR=0.334,95%CI:0.136~0.823,P=0.017;OR=0.217,95%CI:0.065~0.722,P=0.013)。有16.50%(130/788)使用FDC治疗的患者在后续的治疗中使用“散药”替换FDC。FDC方案替换率在不同地区[2.96%(4/135)~32.00%(24/75)]、60~90岁[20.45%(54/264)]与13~59岁[14.50%(76/524)]患者间的差异均有统计学意义(χ^(2)=50.752,P<0.001;χ^(2)=4.513,P=0.034)。结论:福建省抗结核FDC使用率约为80%,不同地区FDC使用率存在较大差异。患者年龄、体质量及有并发症/合并症均是使用FDC的影响因素。Objective:To analyze the use of anti-tuberculosis fixed-dose combinations(FDC)in Fujian Province and its influencing factors,so as to provide evidence for expanding FDC adoption and promoting standardized tuberculosis treatment.Methods:A total of 18 tuberculosis designated hospitals were selected from 9 cities and Pingtan comprehensive experimental area in Fujian Province based on typical sampling method.A total of 980 patients with rifampicin-susceptible pulmonary tuberculosis who met the enrollment criteria and were registered and treated from January 1,2020 to December 31,2021 were enrolled.The use or replacement of FDC were analyzed.A two-level logistic model was used to analyze the factors affecting the use of FDC.Results:Among 980 tuberculosis patients,80.41%(788/980)used FDC as initial treatment drugs.The two-level logistic model analysis showed that patients aged 60-90 years and with complications/comorbidities were risk factors for not using FDC(OR=1.499,95%CI:1.000-2.247,P=0.049;OR=1.844,95%CI:1.231-2.761,P=0.003),while patients with body mass 38-54 kg,55-70 kg and 71-90 kg were more likely using FDC(OR=0.297,95%CI:0.123-0.721,P=0.007;OR=0.334,95%CI:0.136-0.823,P=0.017;OR=0.217,95%CI:0.065-0.722,P=0.013).16.50%(130/788)of patients who initially treated with FDC switched to single-drug formulations in subsequent treatment.The replacement rate of FDC was significantly different between variable regions(2.96%(4/135)-32.00%(24/75),χ^(2)=50.752,P<0.001).The replacement rate was also significantly different between 60-90 years group(20.45%(54/264))and 13-59 years group(14.50%(76/524))(χ^(2)=4.513,P=0.034).Conclusion:The usage rate of anti-tuberculosis FDC in Fujian Province is about 80%,and there are significant differences between different regions.Age,body weight,and complications/comorbidities are factors associated with the use of FDC.

关 键 词：结核 肺 固定剂 因素分析 统计学 

分 类 号：R521[医药卫生—内科学] R183.3[医药卫生—临床医学]