Analysis of influencing factors of tuberculosis recurrence among primary treated pulmonary tuberculosis patients in Kashgar, Xinjiang

doi:10.3969/j.issn.1000-6621.2021.11.013

Abstract

Abstract:

Objective To understand the influencing factors of tuberculosis (TB) recurrence among primary treated pulmonary TB patients in Kashgar, Xinjiang from 2011 to 2020, and provide scientific evidence for formulating and improving intervention strategies to reduce local TB recurrence rate. Methods From January 2011 to December 2020, medical records of 100699 primary treated TB patients registered in Kashgar were derived from TB Information Management System which was a subsystem of the “China Disease Prevention and Control Information System”. Cox proportional hazard regression model was used to analyze the general information, clinical data, etiological results, and treatment outcomes of 15730 patients with recurrent TB. Results Among 100699 primary treated pulmonary TB patients registered and successfully treated, 15730 patients recurrent with a recurrence density of 4.13/100 person-years. The 3-year cumulative recurrence accounted for 69.69% (10962/15730) of all recurrences, and the 5-year cumulative recurrence accounted for 89.04% (14006/15730). The Cox proportional hazards regression model showed that: 15-64 years old (aHR=2.37, 95%CI: 1.50-3.76), ≥65-year-old (aHR=2.44, 95%CI: 1.54-3.87), Miao ethnic group (aHR=3.46, 95%CI: 2.20-5.44), Uyghur ethnic group (aHR=2.39, 95%CI: 2.01-2.84), farmers (aHR=1.98, 95%CI: 1.70-2.31), unemployed (aHR=1.51, 95%CI: 1.28-1.77), sputum smear positive at the end of fifth month after treatment (aHR=1.59, 95%CI: 1.18-2.14) were independent risk factors for TB recurrence. Conclusion The risk of recurrence for primary treated TB patients in Kashgar was relatively high. We should focus on providing standardized treatment and follow-up management for patients over 65 years old, patients who were farmers or unemployed, and patients with sputum smear positive results at the end of fifth month of anti-TB treatment. Targeted intervention measures should be imposed on these high-risk groups at early stage.

Key words: Tuberculosis, Recurrence, Epidemiological characteristics, Influencing factors

Diermulati ·Tusun, Maiweilanjiang ·Abulimiti, LIU Zhen-jiang, Xirizhati ·Mamuti, LI Guan-zhen, LI Tao, CHEN Jin-ou, Liwayiding ·Aersila, ZHAO Yan-lin, ZHANG Li-jie, OU Xi-chao. Analysis of influencing factors of tuberculosis recurrence among primary treated pulmonary tuberculosis patients in Kashgar, Xinjiang[J]. Chinese Journal of Antituberculosis, 2021, 43(11): 1176-1182. doi: 10.3969/j.issn.1000-6621.2021.11.013

Figures/Tables 3

变量		复发			未复发		HR(95%CI)		P值
变量		例数		构成比(%)	例数	构成比(%)	HR(95%CI)		P值
性别									<0.01
女		7789		15.46	42585	84.54	1.00
男		7941		15.78	42384	84.22	1.08(1.04~1.11)		<0.01
年龄(岁)									<0.01
<15		19		5.00	361	95.00	1.00
15~64		8857		15.56	48060	84.44	3.402(2.17~5.34)		<0.01
≥65		6854		15.79	36548	84.21	3.528(2.25~5.53)		<0.01
民族									<0.01
汉族		140		7.34	1768	92.66	1.00
苗族		22		25.29	65	74.71	4.04(2.57~66.35)		<0.01
塔吉克族		27		8.85	278	91.15	1.41(0.92~2.16)		0.117
维吾尔族		15522		15.80	82749	84.20	2.68(2.27~3.18)		<0.01
民族不详		19		14.84	109	85.16	2.37(1.45~3.87)		0.001
变量	复发				未复发			HR(95%CI)	P值
变量	例数		构成比(%)		例数	构成比(%)		HR(95%CI)	P值
职业									<0.01
学生或教师	186		8.00		2138	92.00		1.00
服务业	20		15.87		106	84.13		1.57(0.99~2.49)	0.056
医务人员	9		6.92		121	93.08		0.77(0.39~1.50)	0.439
工人	48		9.25		471	90.75		1.00(0.72~1.39)	0.984
农民	13974		16.32		71661	83.68		2.13(1.84~2.47)	<0.01
干部职员	61		8.27		677	91.73		0.88(0.65~1.18)	0.394
离退人员	348		14.41		2067	85.59		1.52(1.27~1.82)	<0.01
待业	1034		12.90		6983	87.10		1.59(1.36~1.86)	<0.01
其他或不详	50		6.29		745	93.71		1.03(0.75~1.41)	0.872
患者来源									<0.01
转诊追踪	8298		18.95		35493	81.05		1.00
因症就诊或推荐	5197		21.04		19499	78.96		1.20(1.16~1.24)	<0.01
体检或接触者筛查	2182		6.93		29316	93.07		0.73(0.70~0.77)	<0.01
登记不详	53		7.42		661	92.58		0.67(0.51~0.88)	0.004
诊断结果									<0.01
病原学阴性	12439		15.73		66623	84.27		1.00
病原学阳性	3263		15.91		17246	84.09		1.24(1.19~1.29)	<0.01
单纯结核性胸膜炎	12		1.23		963	98.77		0.21(0.11~0.37)	<0.01
无病原学结果或肺外结核	16		10.46		137	89.54		0.65(0.39~1.08)	0.095
耐药情况									<0.01
敏感	714		8.38		7804	91.62		1.00
单耐药	65		14.44		385	85.56		1.38(1.06~1.79)	0.015
耐多药	11		14.29		66	85.71		0.72(0.38~1.34)	0.297
无耐药结果	14940		16.30		76714	83.70		0.88(0.82~0.96)	0.002
2个月末痰涂片结果									<0.01
涂阴	14441		15.69		77622	84.31		1.00
涂阳	205		24.85		620	75.15		1.69(1.46~1.94)	<0.01
未查痰	1084		13.88		6727	86.12		0.86(0.80~0.91)	<0.01
5个月末痰涂片结果									<0.01
涂阴	13996		15.78		74694	84.22		1.00
涂阳	47		31.13		104	68.87		1.80(1.33~2.42)	<0.01
未查痰	1687		14.23		10171	85.77		0.93(0.88~0.98)	0.005
总延迟(d)
<30	5693		13.36		36904	86.64		1.00
≥30	10037		17.27		48065	82.73		1.20(1.16~1.24)	<0.01

变量		β值		s $x -$ 值	Wald χ²值	aHR(95%CI)值	P值
性别(以男性为参照)
女性		-0.08		0.02	25.96	0.92(0.89~0.95)	<0.01
年龄[(岁),以<15岁为参照]
15~64		0.86		0.24	13.49	2.37(1.50~3.76)	<0.01
≥65		0.89		0.24	14.33	2.44(1.54~3.87)	<0.01
民族(以汉族为参照)
苗族		1.24		0.23	28.96	3.46(2.20~5.44)	<0.01
维吾尔族		0.87		0.09	97.76	2.39(2.01~2.84)	<0.01
民族不详		0.88		0.25	12.36	2.42(1.48~3.96)	<0.01
职业(以学生或教师为参照)
农民		0.68		0.08	78.73	1.98(1.70~2.31)	<0.01
离退人员		0.40		0.09	17.52	1.49(1.23~1.79)	<0.01
待业		0.41		0.08	24.47	1.51(1.28~1.77)	<0.01
患者来源(以转诊追踪为参照)
因症就诊或推荐		0.16		0.02	79.66	1.18(1.14~1.22)	<0.01
健康或接触者检查		-0.47		0.03	319.01	0.63(0.59~0.66)	<0.01
变量	β值		s $x -$ 值		Wald χ²值	aHR(95%CI)值	P值
诊断结果(以病原学阴性为参照)
病原学阳性	0.24		0.02		112.70	1.27(1.22~1.33)	<0.01
单纯结核性胸膜炎	-1.64		0.30		29.53	0.19(0.11~0.35)	<0.01
耐药情况(以敏感为参照)
未获得耐药信息	0.11		0.04		5.91	1.11(1.02~1.21)	0.015
2个月末痰涂片结果(以涂阴为参照)
涂阳	0.30		0.07		16.56	1.35(1.17~1.57)	<0.01
未查痰	-0.11		0.04		9.76	0.89(0.83~0.96)	0.002
5个月末痰涂片结果(以涂阴为参照)
涂阳	0.46		0.15		9.07	1.59(1.18~2.14)	0.003
总延迟[(d),以<30d为参照]
≥30	0.24		0.02		190.34	1.27(1.23~1.31)	<0.01

References 13

[1]	World Health Organization. Global tuberculosis report 2020. Geneva:World Health Organization, 2020.
[2]	彭红, 虞浩, 姜洁, 等. 江苏省初治结核病复发流行病学特征及影响因素. 江苏预防医学, 2019, 30(4):355-359. doi: 10.7666/d.y1963563. doi: 10.7666/d.y1963563
[3]	邱玉冰, 许琳, 杨蕊, 等. 云南省成功治疗肺结核患者5年复发情况及影响因素研究. 预防医学, 2020, 32(6):559-562. doi: 10.19485/j.cnki.issn2096-5087.2020.06.005. doi: 10.19485/j.cnki.issn2096-5087.2020.06.005
[4]	Diermulati T, Maiweilanjiang A, Xirizhati M, et al. The Epidemiological Characteristics of Pulmonary Tuberculosis-Kashgar Prefecture, Xinjiang Uygur Autonomous Region, China, 2011—2020. China CDC Weekly, 2021, 3(26):557-561. doi: 10.46234/ccdcw2021.144. doi: 10.46234/ccdcw2021.144
[5]	麦维兰江·阿不力米提, 地尔木拉提·吐孙, 刘振江, 等. 2016—2018年喀什地区初治涂阳肺结核患者治疗效果及其影响因素分析. 中国防痨杂志, 2021, 43(4):391-397. doi: 10.3969/j.issn.1000-6621.2021.04.016. doi: 10.3969/j.issn.1000-6621.2021.04.016
[6]	World Health Organization. Definitions and reporting framework for tuberculosis—2013 revision (updated December 2014). Geneva:World Health Organization, 2013.
[7]	田攀, 文富强. 肺结核复发危险因素的研究进展. 中华肺部疾病杂志(电子版), 2013, 6(2):52-54. doi: 10.3877/cma.j.issn.1674-6902.2013.02.015. doi: 10.3877/cma.j.issn.1674-6902.2013.02.015
[8]	Crofts JP, Andrews NJ, Barker RD, et al. Risk factors for recurrent tuberculosis in England and Wales,1998—2005. Thorax, 2010, 65(4):310-314. doi: 10.1136/thx.2009.124677. doi: 10.1136/thx.2009.124677
[9]	E1 Sahly HM, Wright JA, Soini H, et al. Recurrent tuberculosis in Houston,Texas: a population-based study. Int J Tuberc Lung Dis, 2004, 8(3):333-340.
[10]	张屹立, 郑晓宇, 吴悦. 某市2008—2017年结核患者复发因素调查研究. 中国医药指南, 2021, 19(11):121-122. doi: 10.15912/j.cnki.gocm.2021.11.055. doi: 10.15912/j.cnki.gocm.2021.11.055
[11]	Folkvardsen DB, Norman A, Rasmussen EM, et al. Recurrent tuberculosis in patients infected with the predominant Mycobacterium tuberculosis outbreak strain in Denmark. New insights gained tHRough whole genome sequenCIng. Infect Genet Evol, 2020, 80:104169. doi: 10.1016/j.meegid.2020.104169. doi: 10.1016/j.meegid.2020.104169
[12]	Cox HS, Morrow M, Deutschmann PW. Long term efficacy of DOTS regimens for tuberculosis: systematic review. BMJ, 2008, 336(7642):484-487. doi: 10.1136/bmj.39463.640787.BE. doi: 10.1136/bmj.39463.640787.BE
[13]	Shen X, Yang C, Wu J, et al. Recurrent tuberculosis in an urban area in China: relapse or exogenous reinfection? Tuberculosis(Edinb), 2017, 103:97-104. doi: 10.1016/j.tube.2017.01.007. doi: 10.1016/j.tube.2017.01.007

[1]	Tuberculosis Control Branch of Chinese Antituberculosis Association, The Youth Branch of Chinese Antituberculosis Association, Editorial Board of Chinese Journal of Antituberculosis. Evidence-based guidelines for application of digital adherence technology in tuberculosis medication management in China [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 385-397.
[2]	Li Jinhao, Hu Dongmei, Xu Caihong. Investigation on the willingness of tuberculosis health-care workers to implement tuberculosis preventive treatment and analysis of influencing factors [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 398-407.
[3]	Li Yuhong, Mei Jinzhou, Su Wei, Ruan Yunzhou, Liu Yushu, Zhao Yanlin, Liu Xiaoqiu. Analysis of the treatment outcomes and influencing factors of rifampicin-resistant pulmonary tuberculosis patients aged 65 and above in China from 2015 to 2021 [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 408-415.
[4]	Jiang Xue, Bai Yunlong, Ma Jianjun, An Yuan, Yang Fan, Zhao Qinglong. Status and influencing factors of diagnosis and treatment delay of rifampicin resistant pulmonary tuberculosis patients, Jilin Province, 2020—2023 [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 416-424.
[5]	Wu Xuan, Zhang Yanqiu, Xu Jiying, Meng Dan, Sun Dingyong. Analysis of factors influencing the treatment outcomes of patients with pulmonary tuberculosis and diabetes mellitus in Henan Province (2019—2023) [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 425-431.
[6]	An Yuan, Bai Yunlong, Zhao Qinglong, Ma Jianjun, Jiang Xue, Pan Yan, Gao Ying, Gao Zhihui. Analysis of treatment outcomes and influencing factors of patients with pulmonary tuberculosis complicated with diabetes mellitus in Jilin Province,2018—2022 [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 432-438.
[7]	Feng Wei, Zheng Hailun, Meng Weili, Luo Ping. Analysis of under-reporting before arrival of pulmonary tuberculosis patients registered and managed by Tuberculosis Prevention and Control Institutions in Xicheng District, Beijing from 2018 to 2023 [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 439-443.
[8]	Hu Yifan, Du Boping, Wu Yadong, Zhu Chuanzhi, Zhang Lanyue, Jia Hongyan, Sun Qi, Pan Liping, Zhang Zongde, Li Zihui. Experimental study on the role of Mce4C in the uptake and utilization of cholesterol by Mycobacterium tuberculosis [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 444-453.
[9]	Sheng Jie, Hong Kaifeng, Mierzhati Aisha, Tang Wei, Dilixiati Abulizi. Study on the mechanism of IL-22 and p38 MAPK signaling pathways in inhibiting bone destruction in bone and joint tuberculosis [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 454-459.
[10]	Wang Yingchao, Liu Weiyi, Ji Xiuxiu, Shang Xuetian, Jia Hongyan, Zhang Lanyue, Sun Qi, Du Boping, Zhu Chuanzhi, Pan Liping, Zhang Zongde. Profile analysis of circRNA expression and identification of diagnostic markers in peripheral blood mononuclear cells of tuberculosis patients [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 460-470.
[11]	Zhu Mingzhi, Shao Yanqin, Fan Dapeng, Liu Libin, Mei Bin, Dai Lingshan, Cai Long. Diagnostic value of urine lipoarabinomannan antigen detection in extrapulmonary tuberculosis [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 471-476.
[12]	Hao Mingxiao, Mi Jie, Xu Zongyi. Effectiveness of a continuity of care model in patients with tuberculous meningitis [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 477-481.
[13]	Shang Xiyu, Zhang Huifang, Cao Yuqing, Xiong Yibai, Ji Xinyu, Tian Yaxin, Li Jiajia, Wang Ni, Ma Yan. Bibliometric analysis of global research status and hotspots in the basic research of Traditional Chinese Medicine for tuberculosis [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 482-497.
[14]	Qin Lili, Yang Chengqing, Mai Hongzhen, Xu Qifeng, Xue Xinying, Lu Xiwei. Advances in the clinical diagnosis and treatment of post-tuberculosis chronic pulmonary aspergillosis [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 498-504.
[15]	Luo Li, Luo Linzi, Yin Quhua, Zhou Lei, Lu Zhibin, Ding Yan, Xiao Yangbao. Progress in bronchoscopic diagnosis and treatment of lymph node fistula tracheobronchial tuberculosis [J]. Chinese Journal of Antituberculosis, 2025, 47(4): 505-512.