2019-2023年河南省肺结核合并糖尿病患者治疗转归影响因素分析  

Analysis of factors influencing the treatment outcomes of patients with pulmonary tuberculosis and diabetes mellitus in Henan Province(2019-2023)

作　　者：吴璇 张艳秋[2] 徐吉英[2] 孟丹 孙定勇 Wu Xuan;Zhang Yanqiu;Xu Jiying;Meng Dan;Sun Dingyong(Department of Epidemiology,School of Public Health,Zhengzhou University,Zhengzhou 450001,China;Department of Tuberculosis Prevention and Control Center,Henan Center for Disease Control and Prevention,Zhengzhou 450016,China)

机构地区：[1]郑州大学公共卫生学院流行病学系,郑州450001 [2]河南省疾病预防控制中心结核病预防控制所,郑州450016

出　　处：《中国防痨杂志》2025年第4期425-431,共7页Chinese Journal of Antituberculosis

基　　金：河南省科技发展计划(242102311109);河南省医学科技攻关计划联合共建项目(LHGJ20210136)。

摘　　要：目的:探究河南省利福平敏感或耐药性未知肺结核合并糖尿病(PTB-DM)患者发生不良治疗结局的相关影响因素。方法:通过“中国疾病预防控制信息系统”子系统“结核病管理信息系统”,按照登记时间收集河南省2019年1月1日至2023年12月31日登记确诊的PTB-DM患者的病案信息,排除耐药结核病的患者,以及有严重并发症和合并症患者,最终纳入7354例患者作为研究对象。使用Kaplan-Meier法计算累积成功治疗率;利用Cox比例风险回归模型识别可能影响患者成功治疗的危险因素。结果:7354例研究对象中抗结核成功治疗者占86.1%(6329/7354),发生不良治疗结局者占13.9%(1025/7354);采用Kaplan-Meier函数估计累计成功治疗率为80.7%。多因素Cox比例风险回归分析表明,治疗2个月末痰检阴性(HR=0.388,95%CI:0.281~0.535)及痰检无结果(HR=0.251,95%CI:0.165~0.380)和采用6个月治疗方案(HR=0.129,95%CI:0.094~0.176)是PTB-DM患者抗结核治疗成功的保护因素;而≥65岁(HR=1.137,95%CI:1.002~1.290)、河南省本地户籍(HR=1.517,95%CI:1.072~2.148)、病原学阳性(HR=1.277,95%CI:1.105~1.476)和就诊延迟(HR=1.137,95%CI:1.005~1.287)是PTB-DM患者发生抗结核治疗不良治疗结局的危险因素。结论:针对PTB-DM患者优化早期痰菌监测、规范应用6个月短程抗结核治疗方案可明显降低不良治疗结局发生风险;同时,应警惕≥65岁老年患者、病原学阳性患者、就诊延迟患者及河南省本地患者发生不良治疗结局的风险。Objective:To identify the determinants of adverse treatment outcomes among patients with pulmonary tuberculosis and diabetes mellitus(PTB-DM)who have rifampicin-sensitive or unknown drug resistance status in Henan Province.Methods:Medical records of patients diagnosed with pulmonary tuberculosis and diabetes mellitus(PTB-DM)in Henan Province between January 1,2019,and December 31,2023,were retrieved from the Tuberculosis Management Information System,a subsystem of the China Disease Prevention and Control Information System.Patients with documented drug-resistant tuberculosis,as well as those with severe comorbidities or complications,were excluded.A total of 7354 eligible patients were included in the final analysis.The cumulative treatment success rate was estimated using the Kaplan-Meier method,while the Cox proportional hazards regression model was employed to identify risk factors associated with unsuccessful treatment outcomes.Results:Among the 7354 patients included in the study,86.1%(6329/7354)achieved successful tuberculosis treatment,while 13.9%(1025/7354)experienced adverse treatment outcomes.The cumulative treatment success rate,as estimated using the Kaplan-Meier method,was 80.7%.Multivariate Cox proportional hazards regression analysis identified several protective factors for successful anti-tuberculosis treatment in PTB-DM patients,including sputum smear negativity at the end of the second month of treatment(HR=0.388,95%CI:0.281-0.535),an unavailable sputum smear result(HR=0.251,95%CI:0.165-0.380),and the use of a six-month treatment regimen(HR=0.129,95%CI:0.094-0.176).Conversely,risk factors associated with adverse treatment outcomes included older age(≥65 years;HR=1.137,95%CI:1.002-1.290),local household registration in Henan Province(HR=1.517,95%CI:1.072-2.148),positive bacteriological findings(HR=1.277,95%CI:1.105-1.476),and delayed diagnosis(HR=1.137,95%CI:1.005-1.287).Conclusion:Optimizing early sputum monitoring and implementing a standardized six-month short-course anti-tuberculosis trea

关 键 词：结核 肺 糖尿病 共病现象 治疗结果 危险因素 

分 类 号：R52[医药卫生—内科学]