1552例肺结核首次复发危险因素分析

The risk factors for initial recurrence of pulmonary tuberculosis:an analysis of 1,552 cases

目的 了解沈阳市肺结核复治人群的复发影响因素,为复治肺结核控制策略提供依据. 方法 选择沈阳市中国医科大学附属第四医院十年间首次复治肺结核的1 552例患者,随机抽取388例初治肺结核为对照组,应用Logistic回归分析方法研究复治肺结核主要影响因素,先进行单因素分析,然后采用多因素非条件Logistic回归模型筛选主要危险因素. 结果 单因素分析显示肺结核复发的因素有婚姻（OR=1.341,95％ CI：1.014～1.774）、经济状况（OR=1.341,95％ CI：1.014～1.774）、营养状况（OR=1.068,95％ CI：1.038～1.099）、完成初始疗程（OR=1.198,95％ CI：1.087～1.320）、治疗依从性（OR=0.937,95％CI：0.530～0.959）、流动人口（OR=0.578,95％CI：0.452～0.738）;多因素Logistic回归分析显示治疗依从性（OR =0.731,95％CI：0.537～0.996）、流动人口（OR=0.581,95％CI：0.448～0.754）是肺结核复发的主要危险因素,而已婚（OR=1.427,95％CI：1.069～1.905）、经济状况良好（OR=1.063,95％CI：1.032～1.059）、营养状况佳（OR=1.153,95％CI：1.040～1.277）是肺结核复发的保护性因素. 结论 肺结核患者复发与多种因素有关,从病因学来说是可以预防和控制的.

Objective To investigate the risk factors for the recurrences of previously treated pulmonary tuberculosis patients in Shenyang City so as to provide evidence for intervention measures against pulmonary tuberculosis.Methods We selected 1,552 patients with initial relapse of pulmonary tuberculosis from the Fourth Affiliated Hospital of China Medical University in a ten-year period,and 388 patients with initially-treated pulmonary tuberculosis were randomly chosen as the control group.Single-factor analysis and multiple-factor non-conditional Logistic regression analysis were employed to study the main risk factors affecting recurrent pulmonary tuberculosis.Results The results of single-factor analysis showed that the factors in fluencing the relapse of pulmonary tuberculosis were marital status （OR =1.341,95 ％ CI：1.014-1.774）,economic condition （OR =1.341,95 ％ CI：1.014-1.774）,nutritional status （OR =1.068,95 ％ CI：1.038-1.099）,completion of the initial treatment （OR =1.198,95％CI：1.087-1.320）,treatment compliance （OR =0.937,95％CI：0.530-0.959） and floating population （OR =0.578,95％ CI：0.452-0.738）.The multiple-factor non-conditional Logistic regression analysis showed that treatment compliance （OR =0.731,95 ％ CI：0.537-0.996） and floating population （OR =0.581,95 ％ CI：0.448-0.754） were the main risk factors for the relapse of pulmonary tuberculosis,while the married （OR =1.427,95％ CI：1.069-1.905）,good economic condition （OR =1.063,95％ CI：1.032-1.059） and good nutritional status （OR =1.153,95％ CI：1.040-1.277） were the protective factors for the relapse of pulmonary tuberculosis.Conclusions The recurrences of pulmonary tuberculosis are correlated with multiple factors,and these factors are preventable and controllable from the etiological point of view.