上海市1999—2006年新登记老年肺结核患者死亡情况及影响因素分析

Death and risk factors of new registered aged pulmonary tuberculosis patients in Shanghai

目的描述上海市60岁及以上的老年肺结核患者的死亡情况,探讨其可能的影响因素。方法上海市1999—2006年期间新登记并确诊的痰分枝杆菌培养阳性肺结核病患者共14 589例,其中≥60周岁的老年患者共5068例(34.7%),<60岁的非老年患者共9521例(65.3%)。研究描述了两组患者人口学、临床特征、细菌学、死亡情况等方面的特征,并以logistic回归逐步前进法鉴别老年患者中可能与死亡有关的危险因素。结果老年患者中男性4167例,占82.2%,非老年患者中男性6699例,占70.4%(χ2=244.8,P<0.01)、老年复发患者1447例,占28.6%;非老年患者1240例,占13.0%(χ2=536.3,P<0.01);老年有合并症患者1472例,占29.0%,非老年患者1172例,占12.3%(χ2=624.2,P<0.01);老年涂阳患者4313例,占85.1%,非老年患者7625例,占80.0%(χ2=31.6,P<0.01)。两者比较差异均有统计学意义。老年患者中肺部影像学检查显示有空洞者(1480例,占29.2%)显著低于非老年患者(3120例,占32.8%),两者比较有统计学差异(χ2=11.9,P<0.01)。老年患者病死率(668例,13.2%)显著高于非老年患者(139例,1.5%),两者比较差异有统计学意义(χ2=479.7,P<0.01)。在5068例老年组患者中,经多因素logisitic回归逐步前进法分析显示,70～<80岁(OR=1.89,95%CI=1.54～3.32,P<0.01)、80岁及以上(OR=3.71,95%CI=2.91～4.74,P<0.01)、男性(OR=1.72,95%CI=1.34～2.21,P<0.01)、有合并症(OR=1.53,95%CI=1.28～1.83,P<0.01)、涂阳(OR=1.33,95%CI=1.02～1.72,P=0.03)、居住地区为郊县(OR=1.49,95%CI=1.24～1.79,P<0.01)和耐多药(OR=1.95,95%CI=1.10～3.48,P=0.02)与死亡相关。结论上海市老年肺结核患者病死率远高于非老年患者。高龄、男性、有合并症、涂阳、居住于郊县和耐多药是死亡的危险因素。

Objective To describe the mortality of pulmonary tuberculosis（PTB） patients aged 60 or above and to identify potential risk factors associated in Shanghai.Methods 14589 newly registered culture positive PTB patients in Shanghai during 1999—2006 were the study population.Among them,5068 patients（34.7%） were ≥60 years old while 9521（65.3%） were 60 years old.Demographic,clinical,bacteriological information and deaths of them were collected to describe the difference of characteristics and mortality between aged and younger patients.Forward stepwise logistic regression model was performed to investigate the potential risk factors associated with mortality among patients aged ≥60 years old.Results Compared to younger PTB patients,proportion of male patients（4167 patients,82.2% vs.6699 in younger patients,70.4%;χ2=244.8,P0.01）,retreatment cases（1447 patients,28.6% vs.1240 in younger patients,13.0%;χ2=536.3,P0.01）,with complication patients（1472 patients,29.0% vs.1172 in younger patients,12.3%;χ2=624.2,P0.01） and smear positive cases（4313 patients,85.1% vs.7625 in younger patients,80.0%;χ2=31.6,P0.01） were higher in aged patients in Shanghai,but agred patients were less likely to have a cavity（1480 patients,29.2% vs.3120 in younger patients,32.8%;χ2=11.9,P0.01）.Fatality rate of aged patients（13.2%） was significantly higher than that of patients younger than 60（1.5%,χ2=479.7,P0.01）.In the multivariable logistic regression model,aged 70-80（OR=1.89,95% CI：1.54-3.32,P0.01）,aged 80 or above（OR=3.71,95% CI：2.91-4.74,P0.01）,male（OR=1.72,95% CI：1.34-2.21,P0.01）,with complication（OR=1.53,95% CI：1.28-1.83,P0.01）,smear positive result（OR=1.33,95% CI：1.02-1.72,P=0.03）,living in suburb or rural area（OR=1.49,95% CI：1.24-1.79,P0.01） and multi-drug resistance（OR=1.95,95% CI：1.10-3.48,P=0.02） were significant associated with increasing mortality.Conclusion Fatality rate of aged PTB patients in Shanghai was much higher than that of younger patients.Aging population,male,with complication,sputum smear positive,living in suburb or rural area and multi-drug resistance were the risk factors of death among aged PTB patients in Shanghai.