2158例MTB/HIV双重感染患者治疗转归及影响因素分析

doi:10.3969/j.issn.1000-6621.2021.03.014

摘要/Abstract

摘要：

目的分析MTB/HIV双重感染患者治疗转归情况及影响因素,为有效防控MTB/HIV双重感染疫情提供科学依据。方法收集2017—2019年四川省结核病定点医疗机构诊断并登记为MTB/HIV双重感染且接受治疗的2249例患者。排除无原因及时间停止治疗、诊断变更、单耐药或耐多药的情况,最后纳入2158例。收集患者的人口学特征(性别、年龄、民族、职业)、患者发现方式(患者来源、首诊机构级别)与患病特征(有无并发其他结核、是否重症、HIV阳性检查时间、病原学检查结果、耐药情况、治疗分类、确诊AIDS年限)等,分析患者的治疗转归情况及影响因素。结果 2158例患者中,治愈442例、完成疗程1505例,治疗成功率为90.22%(1947/2158),不良结局率为9.78%(211/2158),包括非结核死亡134例(6.21%)、丢失22例(1.02%)、因结核死亡16例(0.74%)、因药物不良反应停止治疗13例(0.60%)、失败7例(0.32%)、转入耐多药治疗1例(0.05%)、其他18例(0.83%)。多因素分析结果显示,与首诊机构为市级的患者相比,到县级就诊的患者发生不良结局的风险较小(OR=0.525,95%CI:0.288~0.955);与病原学检查结果为阴性及无病原学结果的患者相比,病原学检查为阳性的患者发生不良结局的风险是其1.433倍(OR=1.433,95%CI:1.053~1.951)。结论 MTB/HIV双重感染患者中以市级为首诊机构、病原学检查阳性的患者不良结局发生率较高,应加强对到市级医疗机构首诊、病原学检查为阳性的患者的健康教育、疗效观察,并及时调整治疗方案,以提高MTB/HIV双重感染患者的治疗成功率,改善患者的预后。

关键词: HIV感染, 结核, 共病现象, 治疗结果, 因素分析,统计学

Abstract:

Objective To analyze the outcomes of anti-tuberculosis treatment in MTB/HIV co-infection patients, and to explore risk factors affecting the success of the treatment, and to provide scientific evidence for effective control of MTB/HIV co-infection. Methods A total of 2249 TB patients diagnosed and registered as MTB/HIV co-infection and receiving treatment at the TB designated hospitals from 2017 to 2019 were enrolled into this study. Patients with no cause or time to discontinue treatment, changes in diagnosis, single drug resistance or multidrug resistance were excluded, and 2158 cases were included. The data of the patients were collected, which included demographic characteristics (gender, age, nationality, occupation), patients detection methods (source of patients, institutional level of first seeking) and disease characteristic (complicated with other TB, severe disease, time of HIV positive test, etiological test results, drug resistance, treatment classification, years of AIDS diagnosis) and treatment outcomes. The factors affecting patients’ treatment outcomes were analyzed. Results Among 2158 MTB/HIV patients, 442 cases were cured and 1505 cases completed therapy, and the treatment success rate was 90.22% (1947/2158). The adverse outcome rate was 9.78% (211/2158), including 134 cases (6.21%) died from non-tuberculosis disease, 22 cases (1.02%) lost, 16 cases (0.74%) died from TB, 13 cases (0.60%) discontinued therapy due to adverse reactions, 7 cases (0.32%) of failure, 1 case (0.05%) conversed to multidrug-resistant TB treatment, and 18 cases (0.83%) of other treatment outcome. Multivariate analysis indicated that the risk factors affecting the success of the anti-TB therapy in patients were associated with first seeking institution level and TB diagnosis results of different categories of MTB/HIV patients. Compared with patients whose first seeking institution at municipal level, those who visited county level had a lower risk of adverse outcomes (OR=0.525, 95%CI: 0.288-0.955).Positive TB patients had a 1.433-fold higher risk of adverse outcome than negative TB patients and those without etiological results (OR=1.433, 95%CI:1.053-1.951). Conclusion The adverse outcomes rate of MTB/HIV patients with positive etiology tests and fist diagnosed in municipal medical institutions are relatively higher. It is necessary to strengthen the health education and curative effect observation of the patients who are first diagnosed in municipal medical institutions and have positive etiological examination results, and adjust the treatment regimen in time, so as to improve the treatment success rate of the patients with MTB/HIV and improve the prognosis of the patients.

Key words: HIV infection, Tuberculosis, Comorbidity, Treatment outcome, Factor analysis,statistics

杨妮, 苏茜, 肖月, 逯嘉, 宋杨, 饶正远, 夏岚, 何金戈, 陈闯, 张灵麟. 2158例MTB/HIV双重感染患者治疗转归及影响因素分析[J]. 中国防痨杂志, 2021, 43(3): 274-279. doi: 10.3969/j.issn.1000-6621.2021.03.014

YANG Ni, SU Qian, XIAO Yue, LU Jia, SONG Yang, RAO Zheng-yuan, XIA Lan, HE Jin-ge, CHEN Chuang, ZHANG Ling-lin. Analysis on treatment outcomes and influencing factors of 2158 patients with MTB/HIV co-infection[J]. Chinese Journal of Antituberculosis, 2021, 43(3): 274-279. doi: 10.3969/j.issn.1000-6621.2021.03.014

图/表 4

表1

表2

MTB/HIV双重感染患者治疗转归影响因素的单因素分析

影响因素	患者例数	治疗成功		不良结局		χ²值		P值
影响因素	患者例数	例数	构成比(%)	例数	构成比(%)	χ²值		P值
性别						0.759		0.384
女	406	371	91.38	35	8.62
男	1752	1576	89.95	176	10.05
年龄组(岁)						17.949		0.000
0~15	23	21	91.30	2	8.70
16~45	1217	1120	92.03	97	7.97
46~60	572	514	89.86	58	10.14
61~90	346	292	84.39	54	15.61
民族						7.471		0.006
汉族	1294	1149	88.79	145	11.21
少数民族	864	798	92.36	66	7.64
职业						2.600		0.457
家政家务及待业	210	188	89.52	22	10.48
学生及儿童	25	23	92.00	2	8.00
农民	1763	1586	89.96	177	10.04
其他	160	150	93.75	10	6.25
患者来源						5.006		0.082
因症推荐、因症就诊	745	677	90.87	68	9.13
转诊、追踪	1314	1175	89.42	139	10.58
健康检查、其他	99	95	95.96	4	4.04
首诊机构级别						9.723		0.008
市级	84	70	83.33	14	16.67
县级	2047	1856	90.67	191	9.33
乡级	27	21	77.78	6	22.22
是否并发其他结核						3.890		0.049
无	1927	1747	90.66	180	9.34
有	231	200	86.58	31	13.42
是否重症						1.100		0.294
否	1965	1777	90.43	188	9.57
是	193	170	88.08	23	11.92
HIV阳性检查时间						0.006		0.939
已知阳性	1642	1481	90.19	161	9.81
新确诊阳性	516	466	90.31	50	9.69
病原学检查结果						9.305		0.010
阴性及无病原学结果	1513	1384	91.47	129	8.53
阳性	584	511	87.50	73	12.50
单纯结核性胸膜炎及其他肺外结核	61	52	85.25	9	14.75
治疗分类						0.238		0.626
初治	2031	1834	90.30	197	9.70
复治	127	113	88.98	14	11.02
影响因素	患者例数	治疗成功		不良结局			χ²值	P值
影响因素	患者例数	例数	构成比(%)	例数	构成比(%)		χ²值	P值
确诊AIDS年限(年)							3.668	0.300
<1	1566	1407	89.85	159	10.15
1~5	424	389	91.75	35	8.25
6~9	140	128	91.43	12	8.57
≥10	28	23	82.14	5	17.86

表2

表3

表4

MTB/HIV双重感染患者治疗转归影响因素的多因素logistic回归分析

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
首诊机构级别
市级			7.467	0.024	1.000
县级	-0.644	0.305	4.450	0.035	0.525(0.288~0.955)
乡级	0.224	0.556	0.162	0.687	1.251(0.421~3.720)
年龄组(岁)
0~15			15.022	0.002	1.000
16~45	-0.070	0.752	0.009	0.926	0.933(0.213~4.075)
46~60	0.160	0.758	0.044	0.833	1.173(0.265~5.184)
61~90	0.640	0.760	0.710	0.399	1.897(0.428~8.414)
病原学检查结果
阴性及无病原学结果			6.347	0.042	1.000
阳性	0.360	0.157	5.242	0.022	1.433(1.053~1.951)
单纯结核性胸膜炎及其他肺外结核	0.526	0.380	1.920	0.166	1.692(0.804~3.561)

表4

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