Analysis of clinical characteristics and factors influencing outcomes in elderly patients with drug-susceptible pulmonary tuberculosis

doi:10.19982/j.issn.1000-6621.20260078

Abstract

Abstract:

Objective: To investigate clinical characteristics and identify clinical determinants of treatment outcomes in elderly patients with drug-susceptible pulmonary tuberculosis (DS-PTB), with the aim of providing evidence to improve prognosis. Methods: A national multicenter retrospective cohort study was conducted, enrolling 2349 elderly DS-PTB patients aged ≥60 years admitted to five hospitals between January 1, 2020 and January 31, 2025. Clinical information throughout the entire treatment course and treatment outcome data were collected. Multivariate logistic regression models were employed to analyze clinical factors influencing treatment outcomes in these patients. Results: The successful treatment rate among the 2349 patients was 69.26% (1627/2349), comprising a cure rate of 40.95% (962/2349) and a treatment completion rate of 28.31% (665/2349). Treatment failure in 26.39% (620/2349), lost to follow-up in 3.36% (79/2349), and death in 0.98% (23/2349). Multivariate logistic regression analysis showed that retreatment (OR=1.352, 95%CI:1.037-1.764), malnutrition (OR=2.657, 95%CI: 1.588-4.444), involvement of three or more lung fields (OR=1.776, 95%CI:1.425-2.213), pulmonary cavitation (OR=1.436, 95%CI:1.173-1.757), and adverse drug reactions (OR=4.005, 95%CI:3.284-4.884) were identified as risk factors for unfavorable treatment outcomes in elderly patients with DS-PTB. Prolonged treatment duration (OR=0.937, 95%CI:0.913-0.962) and use of the 9H-Rpt-E-Lfx regimen (OR=0.649, 95%CI:0.498-0.846) emerged as protective factors associated with favorable treatment outcomes. Conclusion: Elderly DS-PTB patients showed a lower successful treatment rate. In clinical practice, priority attention should be given to patients with retreatment, malnutrition, extensive lesions with cavitation, and poor drug tolerance, and early intervention targeting these factors is helpful to improve prognosis in this population.

Key words: Tuberculosis, pulmonary, Treatment outcome, Aged, Factor analysis, statistical

CLC Number:

R521

Bai Yan, Chen Yu, Gao Xusheng, Liang Jianqin, Zeng Yi, Wang Yun, Fan Lin. Analysis of clinical characteristics and factors influencing outcomes in elderly patients with drug-susceptible pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2026, 48(9): 1266-1276. doi: 10.19982/j.issn.1000-6621.20260078

Figures/Tables 8

因素	例数	成功治疗组 (1627例)	不良治疗转归组 (722例)	χ²值	P值
性别[例(构成比,%)]				0.989	0.320
女性	591	419(70.90)	172(29.10)
男性	1758	1208(68.71)	550(31.29)
年龄组[例(构成比,%)]				2.993	0.559
60~64岁	515	371(72.04)	144(27.96)
65~69岁	705	486(68.94)	219(31.06)
70~74岁	503	347(68.99)	156(31.01)
75~79岁	309	206(66.67)	103(33.33)
≥80岁	317	217(68.45)	100(31.55)
治疗类型[例(构成比,%)]				8.182	0.004
初治	2015	1418(70.37)	597(29.63)
复治	334	209(62.57)	125(37.43)
治疗方案[例(构成比,%)]				34.397	<0.001
2H-R-Z-E/4H-R	1022	699(68.40)	323(31.60)
9H-Rpt-E-Lfx	539	410(76.07)	129(23.93)
2H-Rpt-Z-E/4H-Rpt	282	210(74.47)	72(25.53)
9H-R-E-Lfx	347	218(62.82)	129(37.18)
其他^a	159	90(56.60)	69(43.40)
并发结核性胸膜炎[例(构成比,%)]				0.019	0.891
是	296	204(68.92)	92(31.08)
否	2053	1423(69.31)	630(30.69)
并发支气管结核[例(构成比,%)]				7.410	0.007
是	187	146(78.07)	41(21.93)
否	2162	1481(68.50)	681(31.50)
并发肺外结核[例(构成比,%)]				0.011	0.917
是	390	271(69.49)	119(30.51)
否	1959	1356(69.22)	603(30.78)
并发糖尿病[例(构成比,%)]				0.285	0.593
是	701	491(70.04)	210(29.96)
否	1648	1136(68.93)	512(31.07)
并发心脏疾病[例(构成比,%)]				0.226	0.635
是	320	218(68.13)	102(31.88)
否	2029	1409(69.44)	620(30.56)
并发脑血管疾病[例(构成比,%)]				0.742	0.389
是	213	142(66.67)	71(33.33)
否	2136	1485(69.52)	651(30.48)
并发恶性肿瘤[例(构成比,%)]				1.751	0.186
是	152	98(64.47)	54(35.53)
否	2197	1529(69.59)	668(30.41)
并发免疫性疾病[例(构成比,%)]				<0.001	0.989
是	75	52(69.33)	23(30.67)
否	2274	1575(69.26)	699(30.74)
并发慢性肺病[例(构成比,%)]				0.176	0.675
是	270	190(70.37)	80(29.63)
否	2079	1437(69.12)	642(30.88)
并发慢性肝病[例(构成比,%)]				0.364	0.546
是	291	206(70.79)	85(29.21)
否	2058	1421(69.05)	637(30.95)
并发慢性肾病[例(构成比,%)]				0.802	0.371
是	180	130(72.22)	50(27.78)
否	2169	1497(69.02)	672(30.98)
并发营养不良[例(构成比,%)]				20.840	<0.001
是	75	34(45.33)	41(54.67)
否	2274	1593(70.05)	681(29.95)
并发呼吸衰竭[例(构成比,%)]				3.969	0.046
是	32	17(53.12)	15(46.88)
否	2317	1610(69.49)	707(30.51)
肺部病灶范围[例(构成比,%)]				48.433	<0.001
<3个	1525	982(64.39)	543(35.61)
≥3个	824	645(78.28)	179(21.72)
出现空洞[例(构成比,%)]				25.616	<0.001
是	1066	682(63.98)	384(36.02)
否	1283	945(73.66)	338(26.34)
药物不良反应[例(构成比,%)]				190.153	<0.001
是	766	386(50.39)	380(49.61)
否	1583	1241(78.40)	342(21.60)
疗程(月)[M(Q₁,Q₃)]^b	-	12(10,14)	11(8,14)	-2.810	0.005

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方案类型	核心药物组合
治疗方案一	2H-R-Z-E/4H-R(标准治疗方案)
治疗方案二	9H-Rpt-E-Lfx
治疗方案三	2H-Rpt-Z-E/4H-Rpt
治疗方案四	9H-R-E-Lfx

变量	赋值
治疗转归	成功治疗=0,不良治疗转归=1
性别	女性=0,男性=1
年龄	60~64岁=0,65~69岁=1,70~74岁=2,75~79岁=3,≥80岁=4
并发支气管结核	否=0,是=1
并发恶性肿瘤	否=0,是=1
并发营养不良	否=0,是=1
并发呼吸衰竭	否=0,是=1
肺部病灶范围	<3个肺野=0,≥3个肺野=1
肺部空洞	无=0,有=1
治疗类型	初治=0,复治=1
治疗方案(月)	2H-R-Z-E/4H-R=0,9H-Rpt-E-Lfx=1,2H-Rpt-Z-E/4H-Rpt=2,其他=3
药物不良反应	未发生=0,发生=1
治疗疗程(月)	原值代入

因素	β值	s${}_{\overline{\mathit{x}}}$值	P值	OR(95%CI)值
年龄组(60~64岁为参照组)
65~69岁	0.057	0.138	0.677	1.059(0.808~1.387)
70~74岁	0.050	0.150	0.736	1.052(0.784~1.411)
75~79岁	0.248	0.171	0.148	1.281(0.916~1.792)
≥80岁	0.073	0.178	0.681	1.076(0.760~1.524)
并发支气管结核	-0.323	0.202	0.110	0.724(0.488~1.076)
并发恶性肿瘤	0.218	0.194	0.262	1.243(0.850~1.819)
并发营养不良	0.977	0.262	<0.001	2.657(1.588~4.444)
并发呼吸衰竭	0.486	0.390	0.213	1.627(0.757~3.495)
≥3个肺野	0.574	0.112	<0.001	1.776(1.425~2.213)
出现肺部空洞	0.362	0.103	<0.001	1.436(1.173~1.757)
复治	0.302	0.136	0.026	1.352(1.037~1.764)
治疗方案(2H-R-Z-E/4H-R为参照组)
9H-Rpt-E-Lfx	-0.432	0.135	0.001	0.649(0.498~0.846)
2H-Rpt-Z-E/4H-Rpt	-0.272	0.163	0.096	0.762(0.553~1.049)
9H-R-E-Lfx	0.154	0.142	0.277	1.167(0.884~1.540)
其他^a	0.221	0.191	0.247	1.247(0.858~1.813)
发生药物不良反应	1.387	0.101	<0.001	4.005(3.284~4.884)
疗程(月)	-0.065	0.013	<0.001	0.937(0.913~0.962)

治疗方案	分类	60~64岁 (515例)	65~69岁 (705例)	70~74岁 (503例)	75~79岁 (309例)	≥80岁 (317例)	χ²值	P值
2H-R-Z-E/4H-R	方案使用率	55.53(286/515)	49.22(347/705)	42.15(212/503)	33.01(102/309)	23.66(75/317)	104.710	<0.001
	成功治疗率	71.68(205/286)	69.45(241/347)	65.57(139/212)	65.69(67/102)	62.67(47/75)	3.876	0.423
9H-Rpt-E-Lfx	方案使用率	13.79(71/515)	17.59(124/705)	22.27(112/503)	30.42(94/309)	43.53(138/317)	121.770	<0.001
	成功治疗率	81.69(58/71)	70.16(87/124)	82.14(92/112)	74.47(70/94)	74.64(103/138)	6.167	0.187
2H-Rpt-Z-E/4H-Rpt	方案使用率	10.10(52/515)	10.78(76/705)	12.92(65/503)	13.59(42/309)	14.83(47/317)	6.302	0.178
	成功治疗率	80.77(42/52)	72.37(55/76)	76.92(50/65)	66.67(28/42)	74.47(35/47)	2.813	0.590
9H-R-E-Lfx	方案使用率	13.79(71/515)	16.03(113/705)	15.90(80/503)	14.89(46/309)	11.67(37/317)	4.217	0.378
	成功治疗率	60.56(43/71)	69.91(79/113)	60.00(48/80)	56.52(26/46)	59.46(22/37)	3.821	0.431
其他^a	方案使用率	6.80(35/515)	6.38(45/705)	6.76(34/503)	8.09(25/309)	6.31(20/317)	1.129	0.890
	成功治疗率	65.71(23/35)	53.33(24/45)	52.94(18/34)	60.00(15/25)	50.00(10/20)	2.037	0.729

因素	复治	治疗方案[n/、2H-R-Z-E/4H-R为参照组]
因素	复治	9H-Rpt-E-Lfx	2H-Rpt-Z-E/4H-Rpt	9H-R-ELfx	其他^a
主效应分析	1.352(1.037~1.764)	0.649(0.498~0.846)	0.762(0.553~1.049)	1.167(0.884~1.540)	1.247(0.858~1.813)
剔除单位1	1.367(1.008~1.855)	0.852(0.617~1.176)	0.812(0.552~1.194)	1.052(0.752~1.472)	1.259(0.814~1.945)
剔除单位2	1.476(1.069~2.039)	0.633(0.447~0.896)	0.880(0.592~1.306)	1.262(0.869~1.832)	1.470(0.879~2.460)
剔除单位3	1.372(1.043~1.804)	0.676(0.517~0.886)	0.723(0.518~1.009)	1.142(0.859~1.518)	1.224(0.833~1.799)
剔除单位4	1.260(0.950~1.670)	0.621(0.471~0.820)	0.787(0.566~1.093)	1.154(0.866~1.539)	1.103(0.749~1.625)
剔除单位5	1.232(0.893~1.700)	0.585(0.435~0.788)	0.681(0.471~0.986)	1.304(0.964~1.764)	1.350(0.897~2.031)