上海市1953～2005年尘肺合并肺结核患者的生存分析

Survival Analysis of Pneumoconiosis Complicated with Tuberculosis from 1953 to 2005 in Shanghai

[目的]研究上海市1953～2005年尘肺病合并肺结核的发病特征和生存年限。[方法]全部资料来源于上海市尘肺病报告数据库。采用SPSS15.0统计分析尘肺合并结核的合并率与病死率;生存分析分别采用寿命表法和含时依协变量的Cox回归模型。[结果]上海市1953～2005年累积尘肺病例6274例,其中尘肺合并结核者共880例,结核合并率为14.03%;目前尘肺合并结核者已死亡617例,病死率为70.11%。结核合并率与病死率在各尘肺种类间的差异均有统计学意义(P<0.01),且随着尘肺期别的增加而相应增高。矽肺、铸工尘肺和石棉肺合并肺结核患者的病死率分别为69.90%、75.27%和76.47%,明显高于电焊工尘肺合并肺结核的病死率(28.57%)。经Cox回归分析结果提示,除性别、发病年龄、诊断年代、尘肺种类和尘肺晋期等危险因素外,合并肺结核是影响尘肺生存的另一个重要危险因素。排除其他因素的影响,尘肺合并肺结核因素引起死亡的相对危险度(RR)为1.47(95%CI:1.33～1.63)。尘肺合并肺结核患者的平均存活期为20.20年,非合并肺结核患者的平均存活期为29.86年,两者之间差异有统计学意义(P<0.01)。[结论]尘肺合并肺结核明显影响尘肺病的生存年限与死亡风险。

[ Objective ] To study the prevalence characteristics and death hazard ratio of pneumoeoniosis complicated with tuberculosis in Shanghai during the period of 1953 through 2005. [ Methods ] The prevalence and fatality rate of pneumoeoniosis complicated with tuberculosis were analyzed using life table and time-dependent covariates Cox regression model. [ Results ] The prevalence rate of pneumoconiosis complicated with tuberculosis from 1953 to 2005 in Shanghai was 14.03%, the fatality was 70.13%. There were significant differences among various disease types, stages and diagnosis year of the pneumoeoniosis. The differences increased obviously along with the increasing of stages of the disease. The fatality of silicosis, foundry workers＇ pneumoeoniosis and asbestosis complicated with tuberculosis were 69.90%, 75.27% and 76.47% respectively, significantly higher than that of welders＇ pneumoeoniosis-tuherculosis （ 28.57% ）. The results of Cox regression analysis revealed that the main risk factors on pneumoconinsis survival included gender, age of onset, diagnosis year, types of pneumoeoniosis, upgrade of stages of pneumoconiosis, especially complicated with tuberculosis. Ruling out the influence of other factors, the death hazard ratio or relative risk （ RR ） caused by pneumoeoniosis complicated with tuberculosis was 1.47. Under the condition of 50% accumulation survival rate, the mean survival time（ MST ）of pure pneumoeoniosis and pneumoeoniosis complicated with tuberculosis were 29.86 and 20.20 years respectively with significant statistical difference （ P 〈 0.01 ）. [ Conclusion ] Complication of tuberculosis obviously decreased the survival time limit and increased the death hazard ratio of pneumoconiosis patients which definitely suggested the prevention of complication with tuberculosis in pneumoeoniosis patients was still to he strengthened.