2021年我国利福平耐药肺结核患者诊疗延迟及影响因素分析

doi:10.19982/j.issn.1000-6621.20250121

摘要/Abstract

摘要：

目的: 分析2021年我国利福平耐药肺结核患者诊疗延迟现状及影响因素,为优化耐药结核病诊疗流程提供循证依据。方法: 采用横断面研究方法,利用“中国疾病预防控制信息系统” 中2021年1月至2021年12月登记的利福平耐药肺结核患者数据,经完整性和逻辑性清理后,最终纳入9025例患者进行分析。采用中位数(四分位数)描述患者诊疗时间间隔分布,采用非参数秩和检验比较组间差异,多因素logistic回归分析影响患者诊疗延迟的影响因素。结果: 我国利福平耐药肺结核患者诊断时间间隔中位数(四分位数)为10(2,48)d,诊断延迟率为43.73%(3947/9025);治疗时间间隔中位数(四分位数)为5(0,21)d,治疗延迟率为43.42%(3919/9025)。多因素logistic回归分析结果显示,患者户口所在地为本省非本县(区)(OR=1.252,95%CI:1.024~1.530)、外省(OR=1.363,95%CI:1.097~1.693)、有既往抗结核治疗史(OR=1.743,95%CI:1.586~1.915)及非重点人群(OR=1.518,95%CI:1.165~1.979)是发生诊断延迟的危险因素;患者户口所在地为本省非本县(区)(OR=1.404,95%CI:1.148~1.717)、外省(OR=1.573,95%CI:1.266~1.956)、有既往抗结核治疗史(OR=1.669,95%CI:1.499~1.859)及接受短程化疗方案(OR=1.491,95%CI: 1.211~1.836)是发生治疗延迟的危险因素。结论: 我国利福平耐药肺结核患者存在不同程度的诊疗延迟,特别是流动人口、复治患者等发生延迟比例较高,建议进一步强化肺结核患者跨区域管理机制,提高二线抗结核药物可及性,从而缩短患者诊疗时间,提高患者诊疗质量。

关键词: 结核, 利福平, 诊断, 延迟, 危险因素

Abstract:

Objective: To analyze the current status and influencing factors of diagnosis and treatment delays in patients with rifampicin-resistant tuberculosis (RR-TB) in China in 2021, in order to provide evidence for optimizing the diagnosis and treatment process for drug-resistant tuberculosis. Methods: A cross-sectional study was conducted to collect the data of rifampicin-resistant TB patients registered in the “China Disease Prevention and Control Information System” from January 2021 to December 2021. After completeness and logic cleaning, a total of 9025 patients were ultimately included in the analysis. The distribution of patients’ diagnosis and treatment time was described using median (quartile). Non-parametric rank-sum tests were used to compare differences between groups, and multivariate logistic regression analysis was employed to identify factors influencing delays in diagnosis and treatment. Results: The median (quartile) of diagnostic interval was 10 (2, 48) days, and the diagnostic delay rate was 43.73% (3947/9025). The median (quartile) of treatment interval was 5 (0, 21) days, and the rate of treatment delay was 43.42% (3919/9025).The multivariate analysis revealed that patients having household registration in other counties (districts) within the same province (OR=1.252,95%CI:1.024-1.530), in other provinces (OR=1.363,95%CI:1.097-1.693), having previous history of anti-tuberculosis treatment (OR=1.743,95%CI:1.586-1.915) and belonging to non-key population (OR=1.518,95%CI:1.165-1.979) were risk factors for diagnostic delay. The risk factors for treatment delay included patients whose household registration was in the same province but not the same county/district (OR=1.404, 95%CI:1.148-1.717), in other provinces (OR=1.573,95%CI: 1.266-1.956), with a history of previous anti-tuberculosis treatment (OR=1.669,95%CI: 1.499-1.859), and those on short-course chemotherapy regimens (OR=1.491, 95%CI: 1.211-1.836). Conclusion: The rate of diagnosis and treatment delay in rifampicin-resistant TB patients was high in China. It is recommended to further strengthen the cross-regional management mechanism for tuberculosis patients and improve the accessibility of second-line anti-tuberculosis drugs, so as to shorten the diagnosis and treatment time and improve the quality of diagnosis and treatment of patients.

Key words: Tuberculosis, Rifampicin, Diagnosis, Delay, Risk factors

中图分类号:

R521

王涵飞, 李锦浩, 文雅欣, 徐彩红. 2021年我国利福平耐药肺结核患者诊疗延迟及影响因素分析[J]. 中国防痨杂志, 2025, 47(6): 738-745. doi: 10.19982/j.issn.1000-6621.20250121

Wang Hanfei, Li Jinhao, Wen Yaxin, Xu Caihong. Analysis of diagnosis and treatment delays and influencing factors of rifampicin-resistant tuberculosis patients in China, 2021[J]. Chinese Journal of Antituberculosis, 2025, 47(6): 738-745. doi: 10.19982/j.issn.1000-6621.20250121

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特征	患者例数	构成比(%)
性别
男性	6554	72.62
女性	2471	27.38
年龄(岁)
<25	967	10.71
25~44	2677	29.66
45~64	3639	40.32
≥65	1742	19.31
职业
学生及老师	461	5.11
工人	368	4.08
农民	4361	48.32
家务及待业	2432	26.95
其他	1403	15.54
户口所在地
本县(区)	8247	91.38
本省非本县(区)	415	4.60
外省	363	4.02
重点人群
是	719	7.97
否	8306	92.03
既往抗结核治疗史
无	2720	30.14
有	6305	69.86
治疗分类
初治	5121	56.74
复治	3904	43.26
药物敏感性检测方法
分子生物学	6897	76.42
传统药物敏感性试验	965	10.69
未知	1163	12.89
化疗方案
长疗程	8641	95.75
短疗程	384	4.25

特征	患者例数	诊断时间间隔 [d,M(Q₁,Q₃)]	统计检验值	P值	治疗时间间隔 [d,M(Q₁,Q₃)]	统计检验值	P值
性别			Z=-1.373	0.170		Z=1.727	0.084
男性	6554	10(2,49)			5(0,21)
女性	2471	9(2,44)			6(0,21)
年龄(岁)			H=5.808	0.121		H=7.494	0.058
<25	967	8(2,45)			5(0,20)
25~44	2677	9(2,45)			6(0,22)
45~64	3639	10(2,49)			4(0,22)
≥65	1742	11(2,51)			5(0,21)
职业			H=23.050	0.001		H=147.117	0.001
学生及老师	461	8(2,47)			5(0,20)
工人	368	12(2,57)			6(0,25)
农民	4361	11(2,56)			6(0,25)
家务及待业	2432	8(2,38)			2(0,15)
其他	1403	10(2,41)			6(0,23)
户口所在地			H=8.411	0.015		H=25.052	<0.001
本县(区)	8247	10(2,46)			5(0,21)
本省非本县(区)	415	13(2,61)			7(1,24)
外省	363	14(2,64)			8(1,29)
重点人群			Z=-2.372	0.018		Z=-0.238	0.812
是	719	8(2,39)			5(0,18)
否	8306	10(2,49)			5(0,21)
既往抗结核治疗史			Z=-13.356	<0.001		Z=-7.534	<0.001
无	2720	6(1,28)			4(0,15)
有	6305	13(2,57)			6(0,24)
治疗分类			Z=1.548	0.122		Z=-4.327	<0.001
初治	5121	10(2,46)			6(0,23)
复治	3904	10(2,50)			4(0,20)
药物敏感性检测方法			H=1584.796	<0.001		H=3.465	0.177
分子生物学	6897	10(2,47)			5(0,21)
传统药物敏感性试验	965	56(29,90)			6(0,29)
未知	1163	2(0,6)			5(0,18)
化疗方案			-	-		Z=2.211	0.137
长疗程	-	-			5(0,21)
短疗程	-	-			9(2,23)

特征	患者例数	诊断延迟 [例,率(%)]	χ²值	P值	治疗延迟 [例,率(%)]	χ²值	P值
性别			0.308	0.579		2.041	0.153
男性	6554	2878(43.91)			2816(42.97)
女性	2471	1069(43.26)			1103(44.64)
年龄(岁)			2.013	0.570		5.824	0.121
<25	967	407(42.09)			406(41.90)
25~44	2677	1158(43.26)			1202(44.90)
45~64	3639	1606(44.13)			1538(42.26)
≥65	1742	776(44.55)			773(44.37)
职业			19.749	<0.001		91.524	<0.001
学生及老师	461	193(41.87)			197(42.73)
工人	368	173(47.01)			171(46.47)
农民	4361	1988(45.59)			2056(47.15)
家务及待业	2432	981(40.34)			861(35.40)
其他	1403	612(43.62)			634(45.19)
户口所在地			8.681	0.013		18.089	<0.001
本县(区)	8247	3568(43.26)			3526(42.75)
本省非本县(区)	415	200(48.19)			204(49.16)
外省	363	179(49.31)			189(52.07)
重点人群			7.288	0.007		1.618	0.203
是	719	280(38.94)			296(41.17)
否	8306	3667(44.15)			3623(43.62)
既往抗结核治疗史			138.590	<0.001		35.166	<0.001
无	2720	935(34.38)			1053(38.71)
有	6305	3012(47.77)			2866(45.46)
治疗分类			0.107	0.744		25.701	<0.001
初治	5121	2232(43.59)			2342(45.73)
复治	3904	1715(43.93)			1577(40.39)
药物敏感性检测方法			2146.183	<0.001		5.789	0.055
分子生物学	6897	2982(43.24)			2963(42.96)
传统药物敏感性试验	965	965(100.00)			454(47.05)
未知	1163	0.00(0.00)			502(43.16)
化疗方案			-	-		17.058	<0.001
长疗程	-	-			3713(42.97)
短程疗	-	-			206(53.65)

变量	赋值情况	变量	赋值情况
性别	男性=1;女性=2	重点人群	是=1;否=2
年龄(岁)	<25=1;25~44=2;45~64=3;≥65=4	既往抗结核治疗史	无=1;有=2
职业	学生及老师=1;工人=2;农民=3;家务及待业=4;其他=5	化疗方案	长疗程=1;短疗程=2
户口所在地	本县(区)=1;本省非本县(区)=2;外省=3	治疗分类	初治=1;复治=2

变量	β值	$s_{\bar{x}} $值	Wald χ²值	P值	OR值	95%CI值
职业
学生及老师					1.000
工人	-0.284	0.195	2.115	0.146	0.753	0.513~1.104
农民	-0.350	0.167	4.413	0.036	0.705	0.509~0.977
家务及待业	-0.556	0.169	10.891	0.001	0.574	0.412~0.798
其他	-0.388	0.168	5.357	0.021	0.678	0.488~0.942
户口所在地
本县(区)					1.000
本省非本县(区)	0.225	0.102	4.812	0.028	1.252	1.024~1.530
外省	0.310	0.111	7.845	0.005	1.363	1.097~1.693
既往抗结核治疗史
无					1.000
有	0.555	0.048	133.666	<0.001	1.743	1.586~1.915
重点人群
是					1.000
否	0.418	0.135	9.528	0.002	1.518	1.165~1.979