关键词: 结核, 肺, 抗药性, 方案评价, 治疗结果, 因素分析, 统计学

Abstract:

Objective: To explore the temporal trends of adverse treatment outcomes in patients with rifampicin-resistant pulmonary tuberculosis (RR-PTB) under different treatment regimens, and to analyze the influencing factors of adverse treatment outcomes. Methods: In this retrospective study, data were collected from the Tuberculosis Management Information System of China Information System for Disease Control and Provention on patients with RR-PTB who initiated second-line anti-tuberculosis treatment at designated tuberculosis hospitals in Yunnan Province between January 2020 and June 2023. The collected information included demographic characteristics, comorbidities, detailed diagnostic and treatment information, as well as prior treatment history. The cumulative incidence method was used to describe the temporal trends of adverse treatment outcomes, and the Cox proportional hazards regression model was employed to identify factors associated with these outcomes. Results: A total of 1380 RR-PTB patients were included, of whom 71.5% (987/1380) received long-course treatment regimens and 28.5% (393/1380) received short-course treatment regimens. Compared with long-course treatment regimens, short-course treatment regimens had a higher treatment success rate (81.4% (320/393) vs. 55.1% (544/987)), but the rate of adverse treatment outcomes occurred faster (the cumulative incidence of adverse treatment outcomes at 5 months was 64.4% (47/73) for short-course treatment regimens and 54.6% (242/443) for long-course treatment regimens). Multivariate Cox regression analysis revealed that short-course treatment regimens (aHR=0.588, 95%CI: 0.455-0.759), being female (aHR=0.778, 95%CI: 0.634-0.954), and being non-farmers (aHR=0.634, 95%CI: 0.487-0.825) were protective factors for adverse treatment outcomes in RR-PTB patients; whereas being older (aHR=1.024, 95%CI:1.018-1.030), being a floating population (aHR=2.282, 95%CI: 1.795-2.900), having more than one previous anti-tuberculosis treatment history (aHR=1.451, 95%CI: 1.110-1.897), and not using bedaquiline treatment (aHR=1.282, 95%CI:1.005-1.636) were risk factors for adverse treatment outcomes. Conclusion: The short-term regimen is preferentially recommended for RR-PTB patients in clinical practice. Clinicians should pay close attention to high risk populations, including those receiving long-term regimens, males, farmers, elderly individuals, migrant populations, patients with more than one previous history of anti-tuberculosis treatment, and those not receiving bedaquiline. Timely individualized interventions should be implemented in these populations to reduce the incidence of adverse treatment outcomes.

Key words: Tuberculosis, pulmonary, Drug resistance, Program evaluation, Treatment outcome, Factor analysis, statistical