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中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (6): 593-598.doi: 10.3969/j.issn.1000-6621.2018.06.009

• 论著 • 上一篇    下一篇

208例耐多药肺结核患者治疗转归及影响因素分析

苏伟,李仁忠,阮云洲,徐彩红,陈明亭()   

  1. 102206 北京,中国疾病预防控制中心结核病预防控制中心
  • 收稿日期:2018-03-13 出版日期:2018-06-20 发布日期:2018-07-24
  • 基金资助:
    中国疾病预防控制中心礼来基金会耐多药结核病防治项目(18193)

Analysis of treatment outcomes and influencing factors of 208 multidrug-resistant pulmonary tuberculosis patients

Wei SU,Ren-zhong LI,Yun-zhou RUAN,Cai-hong XU,Ming-ting. CHEN()   

  1. National Center for Tuberculosis Control and Prevention,Chinese Centers for Disease Control and Prevention, Beijing 102206,China
  • Received:2018-03-13 Online:2018-06-20 Published:2018-07-24

摘要: 目的

了解并明确我国耐多药肺结核患者诊治基本免费的情况下,影响耐多药肺结核患者治疗效果的相关因素。

方法

收集2009—2010年全球基金项目实施期间湖北省武汉市、江苏省镇江市、山东省聊城市纳入治疗的208例耐多药肺结核患者,对其治疗转归情况进行回顾性调查,分析治疗转归的影响因素。

结果

纳入治疗的208例患者中,治疗成功103例(49.5%),失访47例(22.6%),失败32例(15.4%),死亡26例(12.5%);治疗满12个月的患者有72.1%(150例)在治,治疗满18个月的患者有61.1%(127例)在治;失访的主要原因是患者自行停药24例(51.1%)和外出打工10例(21.3%);年龄≥60岁(OR=5.964;95%CI=2.517~14.133)、农民(OR=2.871;95%CI=1.530~5.389)、既往使用过二线抗结核药物(OR=2.158;95%CI=1.156~4.028)是影响耐多药肺结核治疗成功的危险因素。

结论

在耐多药肺结核患者基本免费诊疗的情况下,治疗成功率并不高,存在较高的失访率;提示探索缩短耐多药肺结核疗程和诊断时间等防治策略十分必要,并应重视对老年人、农民等特殊人群的治疗管理,规范二线抗结核病药物使用。

关键词: 结核, 肺, 结核, 抗多种药物性, 治疗结果, 因素分析, 统计学

Abstract: Objective

To analyze the factors that affect the treatment outcomes of multidrug-resistant tuberculosis (MDR-TB) patients based on the free treatment of MDR-TB patients.

Methods

From 2009 to 2010, 208 multidrug-resistant pulmonary tuberculosis patients were enrolled as research subjects from Wuhan City, Hubei Province, Zhenjiang City, Jiangsu Province, and Liaocheng City, Shandong Province during the implementation of the Global Fund Project. A retrospective survey was conducted to analyze the outcomes of treatment and its influencing factors.

Results

Of the 208 patients, 103 (49.5%) were successful, 47 (22.6%) were lost to follow-up, 32 (15.4%) failed and 26 (12.5%) died; 72.1%(150 cases) of patients were remained after 12 months of treatment and 61.1% (127 cases) of patients were remained after 18 months of treatment; patients lost from treatment were mainly due to self-discontinued (51.1%, 24/47) and working elsewhere (21.3%, 10/47); Age ≥60 years old (OR=5.964,95%CI=2.517-14.133), farmers (OR=2.871,95%CI=1.530-5.389), used second-line antituberculosis drugs (OR=2.158,95%CI=1.156-4.028) were the risk factors for successful treatment of MDR-TB.

Conclusion

Based on the free treatment for MDR-TB patients, the successful rate of treatment is not high, there is a high rate of tracking loss during treatment. The suggestion is that it is necessary to explore strategies to shorten the course of treatment and diagnostic time for MDR-TB and pay attention to the treatment and management of special groups such as the elderly and farmers as well as regulate the use of second-line anti-tuberculosis drugs.

Key words: Tuberculosis, pulmonary, Tuberculosis, multidrug-resistant, Treatment outcome, Factor analysis, statistics