关键词: 结核, 肺, 小地区分析, 治疗结果, 结果评价(卫生保健), 因素分析, 统计学

Abstract:

Objective This study aimed to understand the normalization of the sputum smear monitoring during anti-tuberculosis treatment, and to investigate treatment outcomes and associated factors among smear-positive pulmonary tuberculosis patients in two counties (Feng County and Pei County) of Xuzhou (Jiangsu Province) and Urumqi (Xinjiang Uygur Autonomous Region).Methods A prospective cohort study was conducted to collect the follow-up information and treatment outcomes of smear-positive tuberculosis patients diagnosed from 2014 to 2016 in Feng County and Pei County of Xuzhou and Urumqi. All statistical analyses were performed using SPSS software 22.0. The categorical data was described using proportions. Differences of two groups were compared using Pearson chi-square test or Fisher’s exact test. Multivariable analysis was conducted using binary logistic regression. A two-sided P value <0.05 was considered statistically significant. A total of 574 smear-positive pulmonary tuberculosis patients were included in this study, with an average age of (46±20.8) years old. Among all the subjects, 420 (73.2%) were males, 265 (46.2%) were from two counties of Xuzhou and 309 (53.8%) were from Urumqi.Results The treatment success proportion for 574 study participants was 88.2% (506/574), including 391 patients who were cured and 115 patients who completed the treatment, and the proportion in Feng County and Pei County of Xuzhou was significantly higher than in Urumqi (Feng County and Pei County: 92.8%, 246/265, Urumqi: 84.1%, 260/309, χ ²=10.310, P=0.001). A total of 48 (8.4%, 48/574) smear-positive patients missed at least one sputum smear test during treatment. Univariate analysis indicated that the proportions of adverse treatment outcomes among males (χ ²=4.342, P=0.037), non-local residents (χ ²=5.646, P=0.017) and patients with smear non-conversion after 2-month treatment (Fisher’s exact test: P=0.000) were significantly higher than females, local residents and patients with smear conversion after 2-month treatment. Multivariable analysis indicated that the risk for adverse treatment outcomes of smear-positive pulmonary tuberculosis among males and patients with smear non-conversion after 2-month treatment (OR=6.892, 95%CI=3.218-14.762, P=0.000) was significantly higher than females (OR=0.329, 95%CI=0.121-0.898, P=0.030) and patients with smear conversion after 2-month treatment. Conclusion The treatment success proportion among smear-positive tuberculosis patients was higher in two counties of Xuzhou than in Urumqi. Males and smear non-conversion after 2-month treatment will increase the risk of adverse treatment outcomes.

Key words: Tuberculosis, pulmonary, Small-area analysis, Treatment outcome, Outcome assessment (Health care), Factor analysis, statistical