武汉市首次复治涂阳肺结核治疗结局及影响因素分析

Analysis on factors influencing the therapeutic outcome of the first-time retreated smear-positive pulmonary tuberculosis patients in Wuhan city

目的探讨武汉市首次复治涂阳肺结核患者疗效影响因素，以便有针对性地采取措施提高复治肺结核疗效。方法采用整群抽样法，抽取武汉市2011年7月至2012年3月登记的全部首次复治涂阳患者（共232例）作为研究对象。面访式问卷调查，随访治疗结局。232份调查问卷中，219份合格，合格率94．40%。进行χ2检验及多因素逐步logistic回归分析疗效影响因素。结果219例首次复治涂阳肺结核患者中，治疗成功156例，成功率为71．2％。伴发糖尿病患者治疗成功率为51．2％（21／41），不伴发糖尿病患者治疗成功率为75．8％（135／178），差异有统计学意义（χ2=9．860，P=0．002）；耐药者治疗成功率为55．0％（33／60），不耐药者治疗成功率为73．7％（87／118），差异有统计学意义（χ2=6．351，P=0．012）；耐多药者治疗成功率为26．1％（6／23），非耐多药患者治疗成功率为73．5％（114／155），差异有统计学意义（χ2=20．538，P=0．000）。多因素逐步logistic回归分析显示，耐多药（0R=10．758，95％CI=3．481～33．247）是治疗不成功的危险因素，差异有统计学意义（P〈0．01）；伴发糖尿病（0R=2．838，95％CI：1．187-6．788）及未采用医生督导式管理（0R=1.678，95％CI=1．0872．588）是治疗不成功的危险因素，差异有统计学意义（P值均〈0．05）。结论武汉市首次复治涂阳肺结核患者治疗成功率不高，耐多药、伴发糖尿病及未采用医生督导模式管理是影响复治涂阳肺结核疗效的主要因素。

Objective To investigate factors influencing the therapeutic outcome of the first-time retreated smear-positive pulmonary tuberculosis （TB） patients and to improve the cure rate of retreated smear positive TB pa- tients. Methods A cluster sampling was used to select all of the firs-time retreated smear-positive pulmonary TB patients registered in Wuhan TB center from July 2011 to March 2012, which had a total of 232 subjects. Face to face questionnaire survey and 9 months follow-up were conducted~ A total of 232 TB patients were interviewed,and 219 questionnaires were eligible, the qualification rate was 94.4%. χ2 test and stepwise logistic regression were used to analyze the influencing factors. Results Among 219 first-time retreated smear-positive pulmonary TB patients, 156 cases were treated successfully, and the treatment success rate was 71.2%. The treatment success rates of pa- tients with diabetes mellitus and without diabetes mellitus were 51.2%（21/41） and 75.8% （135/178） respectively （χ2=9. 860, P〈0. 002）. The treatment success rates of drug resistant TB （DR-TB） patients and those without drug resistance were 55.0% （33/60） and 73.7% （87/118） respectively （Z2 =6. 351, P=0. 012）. The treatment success rates of multi-drug resistant TB （MDR-TB） patients and non MDR-TB patients were 26.1%（6/23） and 73.5% （114/155） respectively （X2 =20. 538, P=0. 000）. The stepwise logistic regression revealed that MDR-TB （OR=10. 758, 95% CI：3. 481-33. 247） was the risk factor for treatment success, the difference was highly sig nificant （P〈0.01）. With diabetes mellitus （OR=2. 838, 95% CI=1. 187-6. 788） and treatment without supervi- sion by doctors （OR= 1. 678, 95%CI= 1. 087-2. 588） were also the risk factors for treatment success, the diffe- rence were significant （P〈0.05）. Conclusion The treatment success rate of the first-time retreated smear-positive pulmonary TB patients was low in Wuhan. MDR-TB, with diabetes mellitus and treatment without supervision by doctors were the main influential factors on therapeutic effect of firs-time retreated smear-positive pulmonary TB.