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中国防痨杂志 ›› 2022, Vol. 44 ›› Issue (7): 698-703.doi: 10.19982/j.issn.1000-6621.20220017

• 论著 • 上一篇    下一篇


高丽, 庞学文, 张国钦, 李敬新, 张帆()   

  1. 天津市结核病控制中心研究室,天津 300000
  • 收稿日期:2022-01-28 出版日期:2022-07-10 发布日期:2022-07-06
  • 通信作者: 张帆

Analysis of risk factors for recurrence within 2 years after successful treatment of newly treated active pulmonary tuberculosis in Tianjin

GAO Li, PANG Xue-wen, ZHANG Guo-qin, LI Jing-xin, ZHANG Fan()   

  1. Research Room of Tianjin Center for Tuberculosis Control and Prevention,Tianjin 300000, China
  • Received:2022-01-28 Online:2022-07-10 Published:2022-07-06
  • Contact: ZHANG Fan

摘要: 目的 探讨天津市初治活动性肺结核患者成功治疗后2年内复发的影响因素。 方法 从“中国疾病预防控制信息系统”的子系统“结核病管理信息系统”中,收集2016年1月1日至2019年12月31日登记成功治疗的天津市户籍的8115例初治活动性肺结核患者病案信息,采用Cox比例风险模型对患者的一般资料、临床信息、病原学结果及治疗转归信息等情况进行分析。 结果 8115例患者中,307例(3.78%)患者在2年内复发,复发密度为0.85/100人年(307/36104),6个月内复发患者占35.83%(110/307),6~12个月占29.00%(89/307),1~2年内占35.17%(108/307);2016—2019年登记且完成疗程的初治肺结核患者2年内复发比例分别为4.20%(102/2427),4.03%(96/2383),3.53%(86/2433),2.64%(23/872),呈逐年下降趋势( χ 趋势 2=4.517, P=0.034)。Cox比例风险回归模型显示,男性(aHR=1.321,95%CI:1.021~1.710),40~59岁组(aHR=2.220,95%CI:1.224~4.025)和≥60岁组(aHR=1.935,95%CI: 1.066~3.513),工人/民工/牧民(aHR=2.303, 95%CI: 1.233~4.303),家务/待业(aHR=2.340,95%CI: 1.322~4.143),病原学阳性(aHR=1.785,95%CI:1.407~2.265),非利福平耐药患者(aHR=1.968,95%CI: 1.389~2.789),2个月末痰涂片阳性(aHR=1.517,95%CI: 1.033~2.228),合并糖尿病(aHR=1.382,95%CI: 1.028~1.857)是复发的独立危险因素。 结论 天津市初治活动性肺结核患者复发风险较高,应重点关注40岁以上人群、工人/民工/牧民、家务/待业、病原学阳性、非利福平耐药和治疗2个月末痰涂片阳性患者和合并糖尿病人群的规范治疗与随访管理,早期对这些高危人群开展针对性的干预措施。

关键词: 结核, 肺, 复发, 流行病学研究, 危险因素, 天津市

Abstract: Objective: To investigate the influencing factors of recurrence within 2 years after successful treatment of newly treated active tuberculosis in Tianjin. Methods: Medical records of 8115 newly treated active tuberculosis patients registered in Tianjin City from January 1, 2016 to December 31, 2019 were retrieved from Tuberculosis Management Information System, a sub-system of Chinese Disease Control and Prevention Information System. Cox proportional risk model was used to analyze the general information, clinical information, etiological results and treatment outcomes of them. Results: Among the 8115 patients, 307 patients recurred within 2 years, the recurrence rate was 3.78%. The recurrence density was 0.85 per 100 person-years (307/36104),the proportion of recurrence within 6 months was 35.83% (110/307), 29.00% (89/307) within 6-12 months, and 35.17% (108/307) in 1-2 years. Among subjects enrolled from 2016 to 2019, the recurrence rates within 2 years were 4.20% (102/2427),4.03% (96/2383),3.53% (86/2433),2.64% (23/872) respectively, which decreased year by year ( χ trend 2=4.517, P=0.034).Cox proportional risk regression model showed that male (aHR=1.321,95%CI:1.021-1.710), 40-59 years old (aHR=2.220,95%CI:1.224-4.025), ≥60 years old (aHR=1.935,95%CI: 1.066-3.513), worker/migrant worker/herdsmen (aHR=2.303, 95%CI: 1.233-4.303), houseworker/unemployment (aHR=2.340,95%CI: 1.322-4.143), positive etiological result (aHR=1.785,95%CI:1.407-2.265), resistance to non-rifampicin drugs (aHR=1.968, 95%CI: 1.389-2.789), sputum smear positive after 2 months’ treatment (aHR=1.517,95%CI:1.033-2.228), complicated with diabetes mellitus (aHR=1.382, 95%CI: 1.028-1.857) were independent risk factors for recurrence. Conclusion: The risk of recurrence of newly treated active tuberculosis patients in Tianjin City was relatively high. We should focus on the standardized treatment and follow-up management of people over 40 years old, workers/farmers/herdsmen/unemployed patients, and patients with positive etiological results/non-rifampicin resistance/positive sputum smear results after 2 months’treatment/diabetes. Specialized intervention measures should be put on these high-risk groups in early stages.

Key words: Tuberculosis, pulmonary, Recurrence, Epidemiologic studies, Risk factors, Tianjin