Recurrence influencing factors and active case-finding efficacy analysis among pulmonary tuberculosis patients after successful initial treatment in Jinshan District, Shanghai

doi:10.19982/j.issn.1000-6621.20260051

Abstract

Abstract:

Objective: To know the recurrence and influencing factors of pulmonary tuberculosis (PTB) after patients finished a successful initial treatment, and explore the implementation efficacy of active case-finding screening strategy. Methods: Using retrospective cohort study method, data of new PTB cases registered in Jinshan District between January 1, 2015 and August 31, 2024 with successful treatment was collected from “The Tuberculosis Information Management System”, a subsystem of the “China Disease Prevention and Control Information System”. These patients were then matched against all PTB patients registered in Jinshan District during 2016 to 2025 to identify relapse cases. The recurrence of PTB and its influencing factors were analyzed. Active case-finding was conducted for PTB patients who have been registered between January 1, 2022 and August 31, 2024 in seven towns participating in “Zero Tuberculosis Community” project, to assess the efficacy of active screening. Results: A total of 1579 successfully treated PTB patients were included in this study. After comparison with all registered tuberculosis cases in Jinshan District during 2016—2025, a total of 44 recurrent cases were observed, the recurrent rate was 2.79%. The proportion of recurrence within 2 years, 3 years were 61.36% (27/44) and 84.09% (37/44), and the cumulative recurrence rates within 1 year, 3 years, 5 years, and 10 years were 0.51%, 2.45%, 2.51% and 2.94%, respectively. Multivariable Cox regression analysis showed that ≥60 age group (HR=9.832, 95%CI: 1.323-73.054, P=0.026), comorbid diabetes (HR=2.241, 95%CI: 1.149-4.365, P=0.018) were independent risk factors for PTB recurrence. Active case-finding was conducted on 117 patients with previously successfully treated PTB, identifying 8 etiologically positive cases among whom 4 patients were confirmed with recurrent PTB (including 2 cases within 1 year and 2 cases within 2 years). The detection rate of active screening was 3.42%. Conclusion: Recurrence in successfully treated PTB patients mainly occurs within 3 years, with age over 60 and comorbid diabetes being the main risk factors for recurrence. It is recommended to strengthen follow-up efforts and increase pathogenic examination frequency for PTB patients within 3 years after their initial treatment completion, especially for those who aged over 60 or have comorbid diabetes, make active screening one of the methods for determining whether a recurrence has occurred.

Key words: Tuberculosis, pulmonary, Recurrence, Diagnostic services, Factor analysis, statistical, Intervention studies, Outcome assessment (health care)

CLC Number:

Zhang Rui, Hao Yanxing, Song Canlei, Zhu Weitao, Zhu Shiyu. Recurrence influencing factors and active case-finding efficacy analysis among pulmonary tuberculosis patients after successful initial treatment in Jinshan District, Shanghai[J]. Chinese Journal of Antituberculosis, 2026, 48(10): 1590-1596. doi: 10.19982/j.issn.1000-6621.20260051

Figures/Tables 5

References 31

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特征	例数	构成比(%)	特征	例数	构成比(%)
性别			合并糖尿病
女性	462	29.26	否	1390	88.03
男性	1117	70.74	是	189	11.97
年龄组(岁)			患者来源
2~29	273	17.29	追踪及转诊	470	29.77
30~59	623	39.45	直接就诊	1094	69.28
60~100	683	43.26	主动筛查	15	0.95
户籍			职业
外省市	465	29.45	离退人员	435	27.55
上海市	1114	70.55	家务及待业	312	19.76
病原学结果			工人及农民	527	33.37
阴性及无结果	558	35.34	其他	305	19.32
阳性	1021	64.66	合计	1579	100.00

随访时间	期初例数	期内截尾例数	校正观察例数	期内复发例数	期内复发率(%)	累积复发率(%)
第1年	1579	46	1556	8	0.51	0.51
第2年	1525	40	1505	19	1.26	1.77
第3年	1466	23	1454.5	10	0.69	2.45
第4年	1433	22	1422	1	0.07	2.51
第5年	1410	10	1405	0	0.00	2.51
第6年	1400	9	1395.5	1	0.07	2.58
第7年	1390	8	1386	0	0.00	2.58
第8年	1382	2	1381	3	0.22	2.80
第9年	1377	2	1376	1	0.07	2.87
第10年	1374	0	1374	1	0.07	2.94

变量	复发例数 (复发率,%)	复发(44例)		未复发(1535例)		HR(95%CI)值	P值
变量	复发例数 (复发率,%)	例数	构成比(%)	例数	构成比(%)	HR(95%CI)值	P值
性别
女性	7(1.52)	7	15.91	455	29.64	1.000
男性	37(3.31)	37	84.09	1080	70.36	2.272(1.013~5.096)	0.046
年龄组(岁)
2~29	1(0.37)	1	2.27	272	17.72	1.000
30~59	15(2.41)	15	34.09	608	39.61	6.727(0.889~50.923)	0.065
60~100	28(4.10)	28	63.64	655	42.67	12.806(1.742~94.129)	0.012
户籍
外省市	5(1.08)	5	11.36	460	29.97	1.000
上海市	39(3.50)	39	88.64	1075	70.03	0.655(0.252~1.700)	0.384
病原学结果
阴性及无结果	14(2.51)	14	31.82	544	35.44	1.000
阳性	30(2.94)	30	68.18	991	64.56	2.317(1.126~4.764)	0.022
合并糖尿病
否	32(2.30)	32	72.73	1358	88.47	1.000
是	12(6.35)	12	27.27	177	11.53	2.900(1.494~5.631)	0.002
患者来源
追踪及转诊	9(1.91)	9	20.45	461	30.03	1.000
直接就诊	34(3.11)	34	77.27	1060	69.06	0.615(0.295~1.282)	0.195
主动筛查	1(6.67)	1	2.27	14	0.91	2.091(0.286~15.276)	0.467
职业
离退人员	19(4.37)	19	43.18	416	27.10	1.000
家务及待业	8(2.56)	8	18.18	304	19.80	1.743(0.763~3.981)	0.188
工人及农民	11(2.09)	11	25.00	516	33.62	0.728(0.253~2.098)	0.557
其他	6(1.97)	6	13.64	299	19.48	0.783(0.315~1.948)	0.559

变量	β值	s${}_{\overline{x}}$值	Wald χ²值	HR(95%CI)值	P值
性别
女性				1.000
男性	0.586	0.414	2.000	1.797(0.798~4.046)	0.157
年龄组(岁)
2~29				1.000
30~59	1.702	1.037	2.694	5.486(0.719~41.831)	0.101
60~100	2.286	1.023	4.989	9.832(1.323~73.054)	0.026
合并糖尿病
否				1.000
是	0.807	0.341	5.613	2.241(1.149~4.365)	0.018
病原学结果
阴性及无结果				1.000
阳性	0.021	0.0327	0.004	1.021(0.537~1.939)	0.950

街镇	纳入患者例数	筛查[例(筛查率,%)]	可疑症状例数	病原学阳性例数	确诊患者例数
漕泾镇	7	6(85.71)	0	0	0
枫泾镇	15	9(60.00)	0	2	1
廊下镇	10	9(90.00)	0	2	2
吕巷镇	18	17(94.44)	0	1	0
山阳镇	39	28(71.79)	0	1	0
石化街道	24	24(100.00)	1	2	1
亭林镇	31	24(77.42)	0	0	0
合计	144	117(81.25)	1	8	4