Abstract:

Objective:To analyze the risk factors of recurrence in cured patients with multidrug-resistant pulmonary tuberculosis (MDR-PTB). Methods:A retrospective study was conducted in 600 MDR-PTB patients who were cured by long-term (18-24 months) chemotherapy (6Am-Lfx-P-Z-Pto/18Lfx-P-Z-Pto; Am: amikacin, Lfx: levofloxacin, P: sodium p-aminosalicylate, Z: pyrazinamide, Pto: prothionamide) and followed up for 3 years from 18 hospitals in 15 provinces between January 2013 and December 2017. The basic information, clinical information and laboratory test results of the subjects were collected, including gender, age, body mass index, history of chronic disease, history of tuberculosis (before receiving this long-term chemotherapy regimen), treatment and medication status, as well as sputum smear, sputum culture, drug sensitivity test, chest CT scan, routine blood test, erythrocyte sedimentation rate, routine urine test, liver and kidney function, etc. The risk factors of recurrence in cured MDR-PTB patients were analyzed, and the predictive value of recurrence risk factors for MDR-PTB recurrence was evaluated by receiver operating characteristic curve. Results:The 3-year recurrence rate of the 600 MDR-PTB patients was 6.7% (40/600; 95%CI: 4.9%-9.1%). Logistic multivariate regression analysis showed that elevated erythrocyte sedimentation rate (OR (95%CI)=2.705 (1.136-6.444)), elevated total bilirubin (OR (95%CI)=5.329 (1.408-20.170)), elevated urinary protein (OR (95%CI)=5.642 (1.650-19.292)), elevated urine glucose (OR (95%CI)=5.333 (1.357-20.954)), usage of cycloserine (OR (95%CI)=11.771 (3.920-35.347)), the time from the initial diagnosis of pulmonary tuberculosis to the initial diagnosis of MDR-PTB ≥1 year (OR (95%CI)=8.730 (2.710-28.119)), and cavity (OR (95%CI)=32.806 (6.096-176.557)) were independent risk factors for MDR-PTB recurrence. The receiver operating characteristic curve analysis showed that when the logistic regression analysis overall model was used as the test variable, the area under the curve was the largest (0.932). Conclusion:Attention should be paid to the erythrocyte sedimentation rate, total bilirubin level, urine protein level and urine sugar level when they higher than the normal levels, as well as the treatment and follow up of MDR-PTB patients with the initial diagnosis of PTB to the initial diagnosis of MDR-PTB ≥1 year, and MDR-PTB patients with cavities, furthermore, the use of cycloserine should be reasonable and standardized.

Key words: Tuberculosis,pulmonary, Drug resistance,multiple, Recurrence, Risk factors