广州市涂阳肺结核患者治疗失败及病死的影响因素分析

Analysis on the factors that influence the treatment failure and death of smear-positive pulmonary tuberculosis patients in Guangzhou city

目的探讨广州市涂阳肺结核患者治疗失败及病死的流行病学情况及其影响因素。方法采用整群抽样方法随机抽取1994—2003年广州市原8区的中的2个区结核病登记资料进行统计分析。结果年龄、未规则治疗、肺部空洞性病灶、合并其他疾病,是肺结核治疗失败的危险因素,其中未规则治疗,OR值为409.5,明显高于其他影响因素的OR值,是肺结核治疗失败的最主要影响因素,而女性比男性的治疗失败的风险小。肺结核患者病死的危险因素是年龄、肺部空洞性病灶,而治疗时间是有保护作用因素。结论未规则治疗是结核病治疗失败的重要危险因素,强化对结核病治疗的督导力度,提高治愈率。老年空洞型涂阳肺结核患者治疗失败率高,病死率也高,应作为重点管治人群,加强督导管理,并采取有针对性的治疗方案。

Objective To explore the epidemiological characteristics and the factors influencing the treatment failure and death of smear- positive pulmonary tuberculosis patients in Guangzhou city. Method Cluster sampling was used to randomly sample registered cases of 2 districts from 8 districts in Guangzhou from 1994 to 2003. Results Age, standardized treatment, lung cavernous tuberculosis and complications were risk factors for treatment failure. The OR of standardized treatment was 409.5, significantly higher than those of other risk fac- tors, indicating the standardized treatment was the main influential factor. Sex was protective factor. Age, lung cavernous tuberculosis, and positive smear sputum were risk factors for death, and treatment time was protective factor. Conclusion Standardized treatment was the main risk factor for treatment failure. It is important to strengthen the supervision and to ensure high cure rate. The old patients with cavernous lung tuberculosis are with high risk of treatment failure and death. They are the priority population to be with the specific treatment regimen.