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中国防痨杂志 ›› 2021, Vol. 43 ›› Issue (3): 274-279.doi: 10.3969/j.issn.1000-6621.2021.03.014

• 论著 • 上一篇    下一篇


杨妮, 苏茜, 肖月, 逯嘉, 宋杨, 饶正远, 夏岚, 何金戈(), 陈闯, 张灵麟   

  1. 610041 成都,四川省疾病预防控制中心结核病预防控制所
  • 收稿日期:2020-12-04 出版日期:2021-03-10 发布日期:2021-03-03
  • 通信作者: 何金戈

Analysis on treatment outcomes and influencing factors of 2158 patients with MTB/HIV co-infection

YANG Ni, SU Qian, XIAO Yue, LU Jia, SONG Yang, RAO Zheng-yuan, XIA Lan, HE Jin-ge(), CHEN Chuang, ZHANG Ling-lin   

  1. Institute for Tuberculosis Control and Prevention,Sichuan Provincial Center for Disease Control and Prevention,Chengdu 610041, China
  • Received:2020-12-04 Online:2021-03-10 Published:2021-03-03
  • Contact: HE Jin-ge


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


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