Analysis of recurrence rate of pulmonary tuberculosis patients in Foshan and the influencing factors from 2014 to 2018

doi:10.19982/j.issn.1000-6621.20220023

Abstract

Abstract:

Objective: To investigate the recurrence rate of pulmonary tuberculosis patients in Foshan and its influencing factors,to provide scientific basis for preventing the recurrence of pulmonary tuberculosis. Methods: The medical record information of 15208 newly treated pulmonary tuberculosis patients who were reported and registered in Foshan City and whose treatment results were cured or the course of treatment was completed from January 2014 to December 2018 were collected from the “Tuberculosis Management Information System”, a subsystem of the “Chinese Disease Prevention and Control Information System”. Cox proportional hazards regression model was used to analyze the general data, clinical information, etiological results and treatment outcome of 161 patients with recurrent pulmonary tuberculosis. Results: A total of 15208 cases were included in this study. Of them, 161 cases (1.06%) relapse within 5 years. The cumulative recurrence rates were 0.40% (61/15208) after 1 year, 0.70% (106/15208) after 2 years, and 1.05% (159/15208) after 5 years. In the Cox proportional hazards regression model, local household registration (HR=1.56, 95%CI: 1.14-2.14, P=0.005), positive sputum smear at diagnosis (HR=2.92, 95%CI: 2.10-4.06, P<0.001), positive sputum smear after 2 months of treatment (HR=3.94, 95%CI: 2.41-6.47, P<0.001), abnormal blood urea nitrogen (HR=8.76, 95%CI: 5.00-15.36, P<0.001) were independent risk factors for the recurrence of pulmonary tuberculosis. Conclusion: The management of tuberculosis patients with local household registration, positive sputum smear at diagnosis, and abnormal blood urea nitrogen should be strengthened, and the quality of standardized treatment and management should be ensured. At the same time, targeted intervention measures should be carried out for this kind of high-risk population to reduce recurrence of pulmonary tuberculosis.

Key words: Tuberculosis, Recurrence, Risk factors, Regression analysis

ZHONG Qian-hong, MA Xiao-hui, ZHONG Yong-hui, ZHAO Zhi-meng, ZHANG Xi-lin, XU Bang, LUO Jie-ying, ZHONG Li-ping, DAI Lei. Analysis of recurrence rate of pulmonary tuberculosis patients in Foshan and the influencing factors from 2014 to 2018[J]. Chinese Journal of Antituberculosis, 2022, 44(7): 690-697. doi: 10.19982/j.issn.1000-6621.20220023

Figures/Tables 3

变量			复发						未复发					HR(95%CI)值	P值
变量			例数			构成比(%)			例数			构成比(%)		HR(95%CI)值	P值
性别															0.004
男			129			1.2			10457			99.8		1.00
女			32			0.7			4590			99.3		0.57(0.39~0.84)
年龄(岁)															0.007
≤50			96			0.9			10405			99.1		1.00
>50			65			1.4			4642			98.6		1.54(1.12~2.11)
少数民族															0.506
否			156			1.1			14443			98.9		1.00
是			5			0.8			604			99.2		0.74(0.30~1.80)
本地户籍															0.010
否			71			0.9			8148			99.1		1.00
是			90			1.3			6899			98.7		1.50(1.10~2.05)
患者来源
健康检查			4			0.4			914			99.6		1.00
接触者检查			0			0.0			82			100.0		-	0.994
因症就诊			20			1.1			1841			98.9		2.44(0.84~7.15)	0.103
转诊			106			1.1			9527			98.9		2.45(0.90~6.64)	0.079
追踪			31			1.2			2650			98.8		2.56(0.91~7.22)	0.076
其他			0			0.0			33			100.0		-	0.996
就诊间隔大于14d															0.001
否			54			1.6			3311			98.4		1.00
是			107			0.9			11736			99.1		0.59(0.42~0.81)
空洞															<0.001
否			94			0.8			10972			99.2		1.00
是			67			1.6			4075			98.4		1.91(1.40~2.61)
变量	复发						未复发						HR(95%CI)值		P值
变量	例数			构成比(%)			例数			构成比(%)			HR(95%CI)值		P值
诊断时痰检结果															<0.001
涂阴	67			0.6			10311			99.4			1.00
涂阳	94			2.0			4689			98.0			3.07(2.24~4.20)
治疗2个月末痰检结果															<0.001
涂阴	130			0.9			14164			99.1			1.00
涂阳	12			3.3			349			96.7			3.77(2.09~6.81)
培养结果															0.005
培阴	3			0.2			1559			99.8			1.00
培阳	17			1.1			1486			98.9			5.92(1.73~20.2)
合并其他结核															0.144
否	151			1.1			13515			98.9			1.00
是	10			0.6			1532			99.4			0.62(0.33~1.18)
合并症															0.006
否	142			1.0			14025			99.0			1.00
是	19			1.8			1022			98.2			1.95(1.21~3.15)
糖尿病															<0.001
否	145			1.0			14410			99.0			1.00
是	16			2.5			637			97.5			2.57(1.53~4.30)
患者诊断分型
原发性肺结核	0			0.0			1			100.0			-		-
血行播散性肺结核	0			0.0			18			100.0			-		-
继发性肺结核	161			1.1			15028			98.9			-		-
重症															0.184
否	136			1.0			13226			99.0			1.00
是	25			1.4			1821			98.6			1.34(0.87~2.05)
治疗管理方式															<0.001
全程督导	98			1.4			6710			98.6			1.00
全程管理	0			0.0			24			00.0			0(0~inf)		0.993
强化期督导	60			0.7			8286			99.3			0.47(0.34~0.65)		<0.001
自服药	3			10.0			27			90.0			6.90(2.19~21.78)		<0.001
系统管理															0.001
否	4			5.3			71			94.7			1.00
是	157			1.0			14976			99.0			0.19(0.07~0.51)
白细胞计数															0.007
正常	126			1.0			12892			99.0			1.00
异常	35			1.6			2155			98.4			1.67(1.15~2.43)
红细胞计数															0.274
正常	117			1.1			10264			98.9			1.00
异常	44			0.9			4783			99.1			0.82(0.58~1.17)
血红蛋白计数															0.002
正常	117			0.9			12346			99.1			1.00
异常	44			1.6			2701			98.4			1.72(1.21~2.43)
变量		复发						未复发					HR(95%CI)值		P值
变量		例数			构成比(%)			例数			构成比(%)		HR(95%CI)值		P值
血小板计数															0.406
正常		148			1.0			14076			99.0		1.00
异常		13			1.3			971			98.7		1.27(0.72~2.24)
中性粒细胞百分比															0.728
正常		147			1.1			13617			98.9		1.00
异常		14			1.0			1430			99.0		0.91(0.52~1.57)
淋巴细胞百分比															0.021
正常		130			1.0			13077			99.0		1.00
异常		31			1.5			1970			98.5		1.58(1.07~2.34)
单核细胞百分比															0.720
正常		114			1.0			10839			99.0		1.00
异常		47			1.1			4208			98.9		1.06(0.76~1.49)
丙氨酸氨基转移酶															0.332
正常		143			1.1			12977			98.9		1.00
异常		18			0.9			2070			99.1		0.78(048~1.28)
天冬氨酸氨基转移酶															0.001
正常		122			0.9			12784			99.1		1.00
异常		39			1.7			2263			98.3		1.81(1.26~2.60)
总胆红素															0.552
正常		148			1.0			14014			99.0		1.00
异常		13			1.2			1033			98.8		1.19(0.67~2.09)
直接胆红素															0.043
正常		136			1.0			13450			99.0		1.00
异常		25			1.5			1597			98.5		1.55(1.01~2.38)
间接胆红素															0.172
正常		4			0.1			13048			99.9		1.00
异常		2			0.1			1999			99.9		3.26(0.60~17.81)
尿素氮															<0.001
正常		91			0.8			11427			99.2		1.00
异常		70			1.9			3620			98.1		2.43(1.78~3.32)
空腹血糖															0.229
正常		123			1.0			12061			99.0		1.00
异常		38			1.3			2986			98.7		1.25(0.87~1.80)
尿酸															<0.001
正常		104			1.5			6885			98.5		1.00
异常		57			0.7			8162			99.3		0.47(0.34~0.64)
肌酐															0.614
正常		114			1.0			10904			99.0		1.00
异常		47			1.1			4143			98.9		1.09(0.78~1.53)

变量	β值	s $x ¯$ 值	Wald χ²值	aHR(95%CI)值	P值
性别(以男性为参照)
女	-0.37	0.200	1.840	0.69(0.47~1.02)	0.066
本地户籍(以否为参照)
是	0.45	0.161	2.789	1.56(1.14~2.14)	0.005
就诊间隔大于14天(以否为参照)
是	-0.58	0.170	3.416	0.56(0.40~0.78)	<0.001
诊断时痰检结果(以涂阴为参照)
涂阳	1.07	0.168	6.379	2.92(2.10~4.06)	<0.001
治疗2个月末痰检结果(以涂阴为参照)
涂阳	1.37	0.252	5.439	3.94(2.41~6.47)	<0.001
其他	0.61	0.323	1.945	1.83(1.00~3.39)	0.052
是否合并糖尿病(以否为参照)
是	0.47	0.272	1.743	1.61(0.94~2.73)	0.081
血红蛋白计数(以正常为参照)
异常	1.02	0.378	2.702	2.78(1.32~5.83)	0.007
直接胆红素(以正常为参照)
异常	1.78	0.328	5.444	5.94(3.13~11.79)	<0.001
天冬氨酸氨基转移酶(以正常为参照)
异常	0.65	0.353	1.839	1.91(0.96~3.82)	0.070
尿素氮(以正常为参照)
异常	2.17	0.286	7.579	8.76(5.00~15.36)	<0.001
尿酸(以正常为参照)
异常	-3.66	0.321	11.390	0.03(0.01~0.05)	<0.001

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