2013-2020年江苏省南通市初治结核病患者成功治疗后复发情况及其影响因素分析  

Relapse of pulmonary tuberculosis after successful initial treatment and influencing factors in Nantong,Jiangsu,2013-2020

作　　者：孙晴 王小平[1] 符剑[1] 杨小梅[1] 陈骥 张荣荣[1] Sun Qing;Wang Xiaoping;Fu Jian;Yang Xiaomei;Chen Ji;Zhang Rongrong(Chronic Infectious Disease Prevention and Control Department of Nantong Center for Disease Control and Prevention,Nantong 226000,Jiangsu,China)

机构地区：[1]南通市疾病预防控制中心慢性传染病防制科,江苏南通226000

出　　处：《疾病监测》2024年第10期1270-1275,共6页Disease Surveillance

摘　　要：目的分析2013—2020年江苏省南通市肺结核复发率及影响肺结核复发的可能因素,为完善南通市肺结核防控策略提供参考依据。方法采用回顾性队列研究的方法,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2013—2020年南通市定点医疗机构登记的成功治疗的初治活动性肺结核患者病案信息,匹配2013—2021年登记的复发病例,采用寿命表法计算各观察年度复发率和n年的累积复发率。采用Cox比例风险回归模型分析肺结核复发有关影响因素。结果纳入研究的19176例成功治疗的患者中,截至观察终点共有906例(4.72%)患者复发,复发率为0.99/100人年,中位复发时间为1.25(0.58,2.58)年,其中42.49%的复发病例发生在成功治疗后1年内,80.79%发生在成功治疗后3年内,93.27%发生在成功治疗后5年内。多因素Cox回归分析结果显示,男性[风险比(HR)=1.53,95%置信区间(CI):1.30~1.80,P<0.001]、农民(HR=3.04,95%CI:2.30~4.01,P<0.001)、病原学阳性(HR=1.53,95%CI:1.23~1.89,P<0.001)、2个月末痰涂片阳性(HR=1.52,95%CI:1.02~2.27,P=0.039)、糖尿病患者(HR=3.54,95%CI:2.48~5.06,P<0.001)是肺结核复发的独立危险因素。20~39岁(HR=0.60,95%CI:0.36~1.00,P=0.048)、因症就诊(HR=0.68,95%CI:0.57~0.80,P<0.001)、全程管理(HR=0.68,95%CI:0.55~0.84,P<0.001)是肺结核复发的保护因素。结论南通市肺结核患者绝大部分的复发出现在成功治疗后5年内,应加强对初治结核病患者停药后,特别是成功治疗后5年内的定期随访工作;治疗过程中要加强对合并糖尿病的初治肺结核患者、病原学阳性及2个月末痰检阳性患者的血糖、痰菌及耐药监测,结合患者意愿和临床病情及时调整治疗方案,以减少高危人群中肺结核的复发风险。Objective To understand the incidence of relapse of pulmonary tuberculosis(TB)and the possible influencing factors in Nantong,Jiangsu Province,from 2013 to 2020,and provide reference for further improvement of the prevention and control strategies of pulmonary TB in Nantong.Methods A retrospective cohort study was conducted,the medical record information of active pulmonary TB patients registered in Nantong from 2013 to 2021were collected from National Tuberculosis Management Information System for the analysis combined with the incidence data of relapse of pulmonary TB from 2014 to 2021,and the annual incidence rate of the relapse and the cumulative incidence rate of the relapse in n years were calculated by using the life table method.Cox proportional hazards regression model was used to analyze the influencing factors associated with the relapse of pulmonary TB.Results In the 19176 successfully treated pulmonary TB patients included in the study,a total of 906(4.72%)relapse cases were observed at the end of the observation,with the incidence rate of 0.99/100 person years and within a median time of 1.25(0.58,2.58)years.In the relapse cases,42.49%occurred within 1year after successful treatment,80.79%occurred within 3 years after successful treatment,and 93.27%occurred within 5 years after successful treatment.Multivariate Cox regression analysis showed that being man[hazard ratio(HR)=1.53,95%confidence interval(CI):1.30-1.80,P<0.001],being farmer(HR=3.04,95%CI:2.30-4.01,P<0.001),being positive in etiological test(HR=1.53,95%CI:1.23-1.89,P<0.001),being positive in sputum smear test at the end of month 2(HR=1.52,95%CI:1.02-2.27,P=0.039),being diabetes patients(HR=3.54,95%CI:2.48-5.06,P<0.001)were the independent risk factors for the relapse of pulmonary TB.Age 20-39 years(HR=0.60,95%CI:0.36-1.00,P=0.048),medical care seeking due to symptom(HR=0.68,95%CI:0.57-0.80,P<0.001),and comprehensive management(HR=0.68,95%CI:0.55-0.84,P<0.001)were protective factors for the relapse of pulmonary TB.Conclusion The incidence

关 键 词：复发 结核分枝杆菌 寿命表 COX比例风险模型 

分 类 号：R211[医药卫生—中医学] R521