关键词: 结核, 肺/治疗, 治疗失败, 危险因素, 深圳市

Abstract: Objective  To explore the risk factors associated with treatment failure in smear positive pulmo-nary tuberculosis (PTB) patients among floating population, and to provide a theoretical evidence for intervention measures development. Methods  4398 smear positive PTB patients among floating population that completed the treatment course with an outcome of failure or cure from January 2008 to December 2012 in Bao’an district, Shen-zhen city were enrolled in this study, among whom 4007 were cured and 391 were failed. The demographic, clinical, bacteriological information and management methods were compared by Chi-square test, Kruskal-Wallis test or Fisher’s test, and non-conditional logistic regression analysis was used to explore the influencing factors for treatment failure. Results  There were more males in treatment failure group (72.63%, 284/391) than cure group (62.27%, 2495/4007), and the difference was statistically significant（χ²=16.4636，P<0.0001）. Compared to cure group (56.66%,2271/4007), less cases were younger than 30 years in failure group (40.66%,159/391), and there was significant difference between the 2 groups (χ²=36.9359, P<0.0001). More patients in failure group had positive sputum at the end of 2 months’ treatment (48.69%, 186/382) than cure group (14.08%, 562/3992), and the difference was statistically significant (χ²=294.6323, P<0.0001). The proportion of patients treated with systematic management was 94.37% (369/391) in failure group, which was significantly lower than cure group (98.65%, 3953/4007) (χ²=38.4086, P<0.0001). Cavity presented more in failure group (48.59%, 190/391) than cure group (36.41%, 1459/4007), and the difference was statistically significant (χ²=22.5579, P<0.0001). The result of unconditional logistic regression analysis showed that female, aged 30 years and above, smear-positive at the end of 2 months’ treatment, the implementation of the systematic management and presence of cavity were significantly associated with treatment failure, and the OR (95%CI) values were 0.76 (0.60-0.97), 1.59 (1.27-1.99), 5.13 (4.10-6.43), 0.37 (0.19-0.72) and 1.36 (1.09-1.70), respectively. Conclusion  Female and the implementation of the systematic management are protective factors for treatment failure, and aged 30 years or above, smear-positive at the end of 2 months’ treatment and presence of cavity are risk factors for treatment failure. Paying close attention to risk factors associated with treatment failure and exploring effective management methods for PTB patients among floating population may help to reduce the incidence of treatment failure.

Key words: Tuberculosis, pulmonary/therapy, Treatment failure, Risk factors, Shenzhen city