2009—2013年江苏省耐多药患者治疗转归及影响因素分析

Ttreatment outcomes and its risk factors analysis in patients with multidrug-resistant pulmonary tuberculosis in Jiangsu Province

目的 评价江苏省耐多药肺结核治疗转归情况,对治疗疗效的影响因素进行分析.方法 对江苏省2009-2013年期间确诊且纳入治疗的703例耐多药肺患者采用标准化治疗方案或者个体治疗方案治疗24个月（强化期6个月,巩固期18个月）,分析其治疗转归.采用SPSS 17.0软件进行数据分析,对治疗转归的影响因素进行单因素分析和多因素logistics回归分析,P＜0.05为差异有统计学意义.结果 纳入治疗的耐多药肺结核患者703例,治愈312例（44.38％）,完成治疗87例（12.38％）,治疗成功率56.76％（399/703）.通过卡方检验分析不同组别之间治疗成功率,结果显示年龄[≤40岁：68.24％（159/233）;41～岁：59.73％（135/226）;≥56岁：43.03％（105/244）;x2=32.06,P＜0.001]、患者分类[初治67.07％（110/164）;复治53.62％（289/539）;x2=9.28,P=0.002]、是否实施二线药物敏感性试验（简称“药敏试验”）[没有实施：51.46％（211/410）;实施二线药敏：64.16％（188/293）;x2=11.23,P=0.001]、既往抗结核药物使用史[无：67.07％（110/164）;仅使用过一线药：61.75％（155/251）;使用过一线和二线药：46.53％（134/288）;x2=21.94,P＜0.001]差异有统计学意义.logistic多因素回归分析发现：年龄[41～岁和≥56岁（Waldx2=24.50,P＜0.001,OR=0.38,95％CI=0.26～0.56）;≤40和≥56岁（Wald x2=13.66,P＜0.001,OR=0.49,95％CI=0.34～0.71）];患者分类（初治和复治：Wald x2=10.41,P=0.001,OR=1.99,95％CI=1.31～3.03）;既往抗结核药物使用史（无与使用过一线和二线药：Wald x2=10.00,P=0.002,OR=0.56,95％ CI=0.39～0.80）;有无开展二线药物药敏试验（没有开展与开展二线药物药敏试验：Wald x2=7.01,P=0.008,OR=0.65,95 ％CI=0.47～0.89）,是治疗结局的影响因素.结论 年龄较大、既往有一线和二线抗结核治疗史、复治患者治疗结局较差.而实施二线药物药敏试验筛查是治疗成功的有利因素.

Objective To evaluate the treatment outcomes of multidrug-resistant tuberculosis （MDR-TB） in Jiangsu Province, and to explore the risk factors for poor treatment outcomes of the patients with MDR-TB. Methods From 2009 to 2013, a total of 703 MDR-TB cases were detected and received standard or individual treat- ment regimens for 24 months （6 months intensive phase followed by 18 months continuous phase） in Jiangsu pro- vince. They were all enrolled in this study and their treatment outcomes were analyzed. SPSS 17.0 was used for data analysis. Univariate and multivariate logistic regression analyses were conducted to test the risk factors of their treatment outcomes. P〈0. 05 was considered to be statistically significant. Results The treatment outcomes of the enrolled 703 MDR-TB cases were as follows： 312 cases （44. 38%） were cured and 87 cases （12.38%） completed treatment. The treatment success rate was 56.76% （399/703）. The univariate analysis results showed that the fol- lowing factors were statistically significant factors associated with the treatment outcomes of those patients= age （〈40.. 68. 24% （159/233）% 41--： 59.73% （135/266）; 〉56= 43.02% （105/244）; X2=32.06, P〈0. 001）; treat- ment history （new eases： 67. 07% （110/164） ; retreatment cases： 53.62% （289/539） ; Ze = 9.28, P= 0. 002） ; drug susceptibility testing （DST） of second-line anti-TB drugs （unperformed= 51.46% （211/410）; performed= 64.16% （188/293） ; ;（2 =11.23, P=0. 001） ; treatment history with anti-TB drugs （no anti-TB treatment： 67. 070/oo（110/164） % only treated with first line anti-TB drugs： 61.75% （155/251） ; treated with first and second line anti-TB drugs： 46.53% （134/288） ; Z2 = 21.94, P〈0. 001）. The multivariate logistic regression results showed that the influence factors to the treatment outcomes of those MDR TB patients were： age E41-- and 〉56 （Wald Z2= 24. 50, P〈0. 001, OR=O. 38, 95%CI O. 2B--0.56） % 440 and 〉56 （Wald Z2 = 13.66, P〈0. 001, OR=O. 49, 95%CI 0. 34--0. 71） 1; treatment history [-new patients and retreatment patients （Wald Z2= 10.41, P= 0. 001, OR= 1.99, 95% CI 1.31- 3.03）1; treatment history with aniti-TB drugs E no anti-TB treatment and treated with first and second line anti-TB drugs （Wald）x2 =10.00, P=0. 002, OR=O. 56, 95%CI O. 39--0.80）1; DST of second-line anti-TB drugs [unperformed and performed （Waid Z2 = 7.01, P = 0. 008, OR = 0.65, 95% CI O. 47 -- 0.89）1. Conclusion The elderly MDR-TB patients, retreatment patients and the patients previously treated with the first and second line anti-TB drugs are associated with unfavorable treatment outcomes, while the drug susceptibility tes- ting of second-line anti-TB drugs is helpful for the MDR-TB patients to achieve successful outcomes of treatment.