河南省耐多药与非耐多药肺结核病患者9年生存比较分析

The long term （9-year） survival of multidrug-resistant tuberculosis patients compared to non-multidrug-resistant tuberculosis patients in Henan province

目的比较河南省耐多药结核病（MDR—TB）和非MDR—TB患者9年后生存情况。方法利用2001年WHO结核病耐药监测数据库中河南省数据，并随机抽取入选病例。于2010年使用调查县结核病防治部门采用问卷访谈形式登记的患者资料、治疗记录等，调查MDR－TB和非MDR－TB患者的生存情况，数据分析采用单因素和多因素logistic统计方法。结果MDR．TB患者9年后的病死率是非MDR-TB患者的2倍，两组间差异有统计学意义。与非MDR－TB相比，MDR－TB患者更多死于结核病。影响结核病患者生存的主要危险因素是年龄、耐多药状态、复治、曾经住院治疗和治疗时间〉1年。与非MDR—TB患者相比，MDR－TB患者平均生存时间减少1.3年。结论MDR-TB对结核病患者的生存有显著影响，特别是MDR—TB的青壮年患者。

Objective To investigate the long term survival of MDR-TB patients compared to non-MDR-TB in Henan province in 2010. Methods Participants were randomly selected in 2010 from a dataset generated by an anti-TB drug resistance surveillance survey conducted by the Tuberculosis Control Institute, Henan Centre for Disease Control and Prevention in 2001, supported by the World Health Organization. Information on patient＇ s demographic profile and medical records was extracted by trained doctors and nurses at local anti-TB dispensaries. Interviews were carried out using questionnaires to collect information on the socioeconomic features and survival status. Bivariate and multivariate with logistic regression were performed for data analysis. Results The long term outcome of MDR-TB patients was much poorer when compared to non-MDR-TB patients. The case fatality was much higher among MDR-TB than non-MDR-TB patients （22.1% vs. 6.7% ）. The risk factors associated with the poorer outcome would include drug resistance status, disease relapse, hospitalization for treatment and long treatment period. Compared to non-MDR-TB, the survival time for MDR-TB was much shorter after having had the disease （6.7 years vs. 8.0 years）. Conclusion MDR-TB patients had poor long term outcomes. As most of the cured TB patients were under productive age in the society, the high case fatality rate of MDR-TB would impose big burden on the related familiey and communities. Findings from this study suggested that the TB control programs should involve more efforts be paid on MDR-TB control, in order to reduce the burden of the disease.