影响初治涂阳肺结核治疗2月末痰仍阳性的因素分析

Analysis of influencing factors of positive sputum in new smear positive pulmonary tuberculosis 2 months after treatment

目的寻找影响初治涂阳肺结核治疗2个月仍阳性的危险因素。方法选择广州市番禺区61例户籍初治涂阳肺结核治疗2个月仍阳性的病例进行1∶1配对的病例对照研究,分别计算两组不同因素的个体所占比例并进行单因素的χ2检验。结果单因素分析有病变肺野数、有空洞的肺野数、初诊痰涂片菌量、合并糖尿病、强化期规则用药等5项因素存在统计学差异(P<0.05);将其纳入多因素Logistic回归分析,在排除混杂因素干预后全部5项因素均被纳入回归方程,按危险因素(OR值较高)高低排序为不规则服药(18.7)、合并糖尿病(6.1)、初诊痰涂片菌量(3.0)、有空洞的肺野数(1.9)、有病变肺野数(1.7)。结论初治涂阳肺结核治疗2个月仍阳性受很多因素的影响,有不规则服药、合并糖尿病、初诊痰涂片菌量、有空洞的肺野数、有病变肺野数等因素的影响。尤其应关注是否合并糖尿病、积极护肝和早期发现药物过敏反应,减少糖尿病和间歇性停药所导致的疗效下降。

Objective To explore the risk factors of positive sputum in new smear positive pulmonary tuber- culosis 2 months after treatment. Methods The sputum of 61 patients with new smear positive pulmonary tuberculo- sis was still positive 2 months after the treatment. Their clinical data were analyzed by setting survey forms. The dif- ferent factors were tested byχ2 test. Results There were significant difference in number of lesions in lung, lung field with empty, new sputum smear of bacteria, diabetes mellitus and rule medication in intensive phase （P 〈 0. 05 ）. These 5 factors were included in the multivariate logistic regression analysis, and brought into the regression equation after exclude confounding intervention factors. According to the risk factors （ high OR value） the rank of 5 factors was irregular medication （ 18.7 ）, diabetes mellitus （6.1）, the amount of bacteria in new sputum smear （3）, the number of lung field with empty （ 1.9）, and the number of lesions in lung （1.7）. Conclusion The risk factors of patients with new smear positive pulmonary tuberculosis still having positive sputum 2 months after the treatment mainly include irregular medication, diabetes, the amount of bacteria in new sputum smear, the number of lung field with empty, and the number of lesions in lung. Therefore, we should pay attention to the pulmonary tuberculosis pa- tients with large range of lesions, empty and discharge of bacteria before clinical treatment, and especially pay atten- tion to whether they are complicated with diabetes mellitus or not. Their liver should be protected positively, and their drug allergy should be detected early, in order to reduce the decreased efficacy caused by diabetes and intermittent withdrawal.