苏州市1 470例涂阳肺结核患者影响治愈的危险因素及其防治对策

Study on Risk Factors for Influence to Cure in 1 470 Patients with Smear-positive Pulmonary Tuberculosis and Their Countermeasures in Suzhou

目的:分析影响涂阳肺结核患者治愈的危险因素及其防治对策,为苏州市制订肺结核的防控策略提供参考。方法:抽取2015年1月1日—12月31日期间苏州市收治管理的痰涂片镜检阳性(涂阳)的肺结核患者1 470例病案资料,采用单因素χ~2检验分析法和多因素非条件Logistic回归分析法,分析涂阳肺结核患者的不同流行病学特征及治愈情况,以及影响涂阳肺结核患者治愈的危险因素及其防治对策。结果:1 470例涂阳肺结核患者经抗结核治疗后,1 273例治愈,其治愈率为86.60%;其中男性(OR=0.570,95%CI为0.366～0.888)和高年龄(OR=0.497,95%CI为0.389～0.634),以及因症就诊(OR=0.449,95%CI为0.246～0.817)或转诊(OR=0.645,95%CI为0.420～0.990)、复治(OR=0.294,95%C为0.197～0.438)、非全程督导(OR=0.022,95%CI为0.005～0.103)和未系统管理(OR=0.007,95%CI为<0.001～0.053)是影响患者治愈的危险因素。结论:对于不同流行病学特征的肺结核病患者,结核病防治机构应可持续性地提供精准健康宣教并全面施行全程督导化疗方案管理,确保有效治疗。

Objective： To analyze the risk factors for influence to cure patients with smear-positive pulmonary tuberculosis （PTB） and their countermeasures, and to provide a reference for the prevention and control strategies of tuber-culosis in Suzhou. Methods： A total of l 470 cases of sputum smear-positive （smear positive） pulmonary tuberculosis patients who were managed on January I to December 31, 2015 in Suzhou were collected. Single factor chi-squarc test and multivariate unconditional logistic regression analysis were used to analyze risk factors for influence to cure subjects and their countermeasures. Descriptive analysis of cure rates with various epidemiological characteristics was also made in this paper. Results： Among 1 470 cases of smear-positive puhnonary tuberculosis, 1 273 cases were cured after antituberculous therapy, and the cure rate was 86.60%. The male gender （OR=0.570, 95% CI was between 0.366 and 0.888）, older age（OR=0.497, 95% CI was between 0.389 and 0.634）, clinical consultation（OR=0.449, 95% CI was between 0.246 and 0.817） or transfer treatment（OR = 0.645, 95% CI was between 0.420 and 0.990）, retreatment（OR= 0.294, 95% CI was between 0.197 and 0.438）, non-directly observed treatment （OR=0.022, 95% CI was between 0.005 and 0.103） and unsystematic management （ OR=0.007, 95% CI was between 0.001 and 0.053） were the risk factors for influence to cure PTB in Suzhou. Conclusion ： For the smear-positive PTB with different epidcmiological char-acteristics in Suzhou, tuberculosis prevention and control agencies should sustainably provide accurate health education and fully implement directly observed treatment to ensure effective treatment.