重庆市肺结核患者复发情况及影响因素分析

Relapse and influencing factors of pulmonary tuberculosis in Chongqing

目的分析重庆市初治肺结核患者成功治疗后复发流行病学特征及复发影响因素,为制定减少复发干预措施提供基础依据。方法采用回顾性队列研究方法,从结核病信息管理系统中导出2009年登记的成功治疗的初治肺结核患者信息及其复发病案信息,采用比例风险回归模型(Cox回归模型)对复发相关因素进行分析。结果共导出2009年成功治疗的初治患者23 034例资料,在2009—2019年观察期间共有519例成功治疗后的初治肺结核患者复发,复发率为2.25%(519/23 034),其中3年内复发患者和5年内复发患者分别占总复发患者的60.31%(313/519)和77.07%(400/519)。单因素分析显示,男性、≥25岁人群、少数民族、农民、病原学阳性、重症和肺部有空洞者复发比例较高,差异具有统计学意义(P<0.05)。多因素分析结果显示,男性、≥25岁人群、少数民族、农民、病原学阳性、肺部有空洞是肺结核复发的危险因素(P<0.05)。结论重庆市成功治疗后的初治肺结核患者5年复发比例较高,多种危险因素可导致复发的发生,应重视复发高危人群,强化对成功治疗患者的随访工作,尽早采取干预措施,减少复发,最终达到降低肺结核疫情的目的。

Objective To study the epidemiological characteristics and influencing factors of relapse in new tuberculosis patients who treated successfully in Chongqing,we provide the basis for formulating the intervention measures to reduce the relapse.Methods With a retrospective cohort study,the data of new tuberculosis patients registered and their relapse condition in 2009 were derived from the Tuberculosis Information Management System(TBMIS).A proportional risk regression model(Cox regression model) was used to analyze the relapse and its influencing factors.Results A total of 23 034 new patients with successful treatment in 2009 were included in this study.During the observation period of 2009-2019,a total of519 new tuberculosis patients relapsed after successful treatment,with a relapse rate of 2.25%(519/23 034).Patients with relapse at 3 years and 5 years accounted for 60.31%(313/519) and 77.07%(400/519),respectively.The univariate analysis showed that the relapse rate was higher in males,aged≥25 years,ethnic minorities,farmers,positive etiology patients,severe cases and patients with pulmonary cavity,the difference was statistically significant(P<0.05).Multifactorial analysis showed that males,aged≥25 years,ethnic minorities,farmers,positive etiology and pulmonary cavity were the risk factors for pulmonary tuberculosis relapse(P<0.05).Conclusion After successful treatment,the proportion of new tuberculosis patients in Chongqing is relatively high at 5 years,multiple risk factors could lead to relapse.Therefore,we should focus on the high-risk population of tuberculosis,strengthen the follow-up of patients after successful treatment,and take intervention measures as soon as possible,reduce the relapse,so as to finally reduce the incidence of tuberculosis.