脓肿分枝杆菌肺病治疗结局的影响因素分析:一项回顾性病例对照研究

doi:10.19982/j.issn.1000-6621.20260091

摘要/Abstract

摘要：

目的: 探讨影响脓肿分枝杆菌肺病(Mycobacterium abscessus pulmonary disease, MAB-PD)患者治疗结局的危险因素,为临床预后评估和个体化治疗提供证据。方法: 回顾性纳入2015年1月至2025年1月期间于首都医科大学附属北京胸科医院确诊的197例MAB-PD患者。收集患者人口学特征、基础疾病、实验室指标及治疗方案等资料。根据治疗结局分为良性结局组(治愈/完成治疗)和非良性结局组(治疗失败/死亡),采用单因素和多因素logistic回归模型分析治疗结局的危险因素。结果: 197例患者中,良性结局86例(43.6%),非良性结局62例(31.5%),失访49例(24.9%)。单因素分析显示,年龄(连续变量;OR=1.049,95%CI:1.022~1.077,P<0.001)和文化程度(以大专及以下为参照,大学及以上学历者为文化程度高,OR=0.307,95%CI:0.133~0.732,P=0.008)与治疗结局相关。多因素logistic回归分析显示,年龄是MAB-PD患者非良性结局的独立危险因素(OR=1.040,95%CI:1.011~1.070,P=0.007),年龄每增加1岁,出现非良性结局的风险增加4.0%。不良事件发生率为10.2%(20/197)。结论: 年龄增加是MAB-PD患者非良性治疗结局的独立危险因素,提示在临床实践中应加强对年龄较大患者的综合治疗管理和营养支持,以改善治疗预后。

关键词: 分枝杆菌感染, 非典型性细菌, 治疗结果, 因素分析, 统计学

Abstract:

Objective: To investigate the independent risk factors associated with treatment outcomes in patients with Mycobacterium abscessus pulmonary disease (MAB-PD) and provide evidence for clinical prognostic assessment and individualized therapy. Methods: This retrospective study included 197 patients diagnosed with MAB-PD at Beijing Chest Hospital, Capital Medical University between January 2015 and January 2025. Data on demographic characteristics, underlying diseases, laboratory parameters, and treatment regimens were collected. Patients were divided into a favorable outcome group (cured/treatment completed) and an unfavorable outcome group (treatment failure/death). Univariate and multivariate logistic regression models were employed to identify independent risk factors associated with treatment outcomes. Results: Among the 197 patients, 86 (43.6%) achieved favorable outcomes, 62 (31.5%) experienced unfavorable outcomes, and 49 (24.9%) were lost to follow-up. In univariable analysis, age (OR=1.049, 95%CI: 1.022-1.077; P<0.001) and educational level (university degree or above vs. junior college or below, OR=0.307, 95%CI: 0.133-0.732; P=0.008) were associated with treatment outcome. Multivariate logistic regression analysis revealed that age was the only independent risk factor for unfavorable outcomes in MAB-PD patients (OR=1.040, 95%CI: 1.011-1.070, P=0.007), with each additional year increase in age was associated with a 4.0% higher risk of unfavorable outcomes. The incidence of adverse events was 10.2% (20/197). Conclusion: Increased age is an independent risk factor for unfavorable treatment outcomes in MAB-PD patients, suggesting that comprehensive treatment management and nutritional support for older patients should be strengthened in clinical practice to improve prognosis.

Key words: Mycobacterium infections, Atypical bacterial forms, Treatment outcome, Factor analysis, statistical

中图分类号:

R563

程文, 聂文娟. 脓肿分枝杆菌肺病治疗结局的影响因素分析:一项回顾性病例对照研究[J]. 中国防痨杂志, 2026, 48(8): 1176-1183. doi: 10.19982/j.issn.1000-6621.20260091

Cheng Wen, Nie Wenjuan. Factors associated with treatment outcomes of Mycobacterium abscessus pulmonary disease: a retrospective case-control study[J]. Chinese Journal of Antituberculosis, 2026, 48(8): 1176-1183. doi: 10.19982/j.issn.1000-6621.20260091

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特征		例数	构成比(%)
人口学特征
性别	男性	68	34.5
	女性	129	65.5
体质量指数	低体质量^a	56	28.4
	非低体质量	141	71.6
民族	汉族	188	95.4
	少数民族	9	4.6
婚姻	未婚	17	8.6
	已婚	174	88.3
	离异/丧偶	2	1.0
	其他^b	4	2.1
文化程度	大学及以上	36	18.3
	大专及以下	112	56.9
	其他^c	49	24.8
职业	非脑力劳动者	90	45.7
	脑力劳动者	107	54.3
临床特征
免疫系统疾病	否	188	95.4
	是	9	4.6
奥马环素	否	187	94.9
	是	10	5.1
治疗结局	非良性结局	62	31.5
	良性结局	86	43.6
	失访	49	24.9
不良反应	否	177	89.8
	是	20	10.2

影响因素	赋值说明	β值	s${}_{\overline{\mathit{x}}}$值	Wald χ²值	OR(95%CI)值	P值
性别
男性		0.030	0.177	0.028	1.061(0.531~2.122)	0.867
女性	参照组				1.000
年龄	连续变量	0.048	0.013	12.885	1.049(1.022~1.077)	<0.001
婚姻
未婚		―4.356	133.300	0.001	0.364(0.020~6.187)	0.974
已婚		―2.899	133.300	0.001	1.562(0.138~17.656)	0.983
离异/丧偶^a		10.600	400.000	0.001	NA	0.980
其他^b	参照组				1.000
文化程度
大学及以上		―0.591	0.222	7.103	0.307(0.133~0.732)	0.008
大专及以下	参照组				1.000
民族
汉族		―0.443	0.375	1.396	0.412(0.095~1.793)	0.237
少数民族	参照组				1.000
职业
非脑力劳动者		0.115	0.115	0.169	1.260(0.650~2.440)	0.468
脑力劳动者	参照组				1.000
免疫疾病
是	参照组				1.000
否		―0.543	0.364	2.228	0.337(0.081~1.405)	0.136
体质量指数
低体质量		―0.069	0.185	0.138	0.872(0.423~1.797)	0.710
非低体质量	参照组				1.000
糖化血红蛋白	连续变量	0.004	0.168	0.001	1.004(0.722~1.397)	0.979
奥马环素
是	参照组				1.000
否		―0.173	0.364	0.227	0.707(0.170~2.944)	0.634

影响因素	赋值说明	β值	s${}_{\overline{\mathit{x}}}$值	Wald χ²值	调整后OR(95%CI)值	P值
年龄	连续变量	0.039	0.015	7.290	1.040(1.011~1.070)	0.007
性别
男性	参照组				1.000
女性		―0.249	0.436	0.325	0.780(0.332~1.833)	0.569
文化程度
大学及以上		―0.462	0.553	0.621	0.630(0.213~1.863)	0.457
大专及以下	参照组				1.000

影响因素	赋值说明	β值	s${}_{\overline{\mathit{x}}}$值	Wald χ²值	调整后OR(95%CI)值	P值
性别
男性		―0.409	0.290	1.985	0.441(0.141~1.377)	0.159
女性	参照组				1.000
年龄	连续变量	0.005	0.016	0.101	1.005(0.974~1.038)	0.751
婚姻
未婚		―10.418	325.000	0.001	<0.001	0.974
已婚		2.399	108.300	0.001	0.346(0.034~3.505)	0.982
离异/丧偶		4.559	108.400	0.002	3.000(0.084~107.447)	0.966
其他^a	参照组				1.000
文化程度
大学及以上		0.078	0.401	0.038	1.100(0.274~4.423)	0.846
大专及以下		―0.060	0.318	0.036	0.958(0.314~2.922)	0.850
其他^b	参照组				1.000
民族
汉族		6.112	217.900	0.001	>999.999	0.978
少数民族	参照组				1.000
职业
非脑力劳动者		―0.510	0.269	3.592	0.361(0.126~1.035)	0.058
脑力劳动者	参照组				1.000
免疫疾病
是	参照组				1.000
否		6.112	217.900	0.001	>999.999	0.978
体质量指数
低体质量		0.292	0.243	1.435	1.792(0.690~4.651)	0.231
非低体质量	参照组				1.000
糖化血红蛋白	连续变量	―0.908	0.762	1.421	0.403(0.091~1.795)	0.233
奥马环素
是	参照组				1.000
否		―0.719	0.580	1.538	0.487(0.127~1.235)	0.215

影响因素	赋值说明	β值	s${}_{\overline{\mathit{x}}}$值	Wald χ²值	调整后OR(95%CI)值	P值
年龄	连续变量	0.003	0.016	0.038	1.003(0.973~1.034)	0.084
职业
脑力劳动者	参照组				1.000
非脑力劳动者		-0.507	0.269	3.542	0.363(0.126~1.043)	0.060