不同化疗方案对复治肺结核治疗的效果研究

Study on the therapeutic effect of different chemotherapy regimens on patients with recurrent tuberculosis

目的分析使用不同化疗方案对复治肺结核治疗效果的研究,为复治肺结核治疗提供依据。方法选取2012至2017年于丹东市结核病防治所进行治疗的确诊318例复治肺结核患者治疗效果进行调查,收集复治肺结核患者的基本情况,详细询问复治肺结核患者既往结核病史、本次发病日期、症状诊治过程等情况,并同时填写患者的病情资料。对差异有统计学意义的临床指标与结核病复发率间的关系进行logistic回归分析。结果男性(转归率为84.85%)、<30岁(转归率为84.85%)、X线胸片上无空洞(转归率为83.78%)、痰涂片为阳性(转归率为87.80%)、无糖尿病(转归率为82.82%)、治愈4~5年以上复发的患者(转归率为89.33%)是复治肺结核患者治疗成功的重要因素。对两组治疗方案有差异的指标进行Logistic回归分析,结果显示,年龄<30岁[β=0.528,Sx=0.214,Waldχ^(2)=7.825,P=0.006,OR(95%CI)=1.743(1.630~2.758)]和化疗方案2HRZELfx/6HRE[β=0.487,Sx=0.198,Waldχ^(2)=1.355,P=0.281,OR(95%CI)=1.643(1.593~1.735)]是复发患者转归的关键因素。结论年龄>30岁,采用2HRZECm/1HRZE/5HRE化疗方案的复治肺结核患者需重点治疗,采取必要方案加快此类复治肺结核转归速度。

Objective To analyze the effects of different chemotherapy regimens on the treatment of retreated tuberculosis and provide a basis for retreatment of pulmonary tuberculosis.Methods The data of 318 confirmed cases of retreated tuberculosis who were treated at the Tuberculosis Control Center of Dandong City from 2012 to 2017 were investigated.The basic information of the retreated tuberculosis patients was collected,and the previous tuberculosis history and the date of the onset of the retreated tuberculosis patients were asked in detail,symptom diagnosis and treatment process,etc.,and fill in the patient's condition data at the same time.Using SPSS 23.0 software for statistical analysis of data,logistic regression analysis was performed on the relationship between clinical indicators with statistically significant differences and the recurrence rate of tuberculosis.Results Male(outcome rate was 84.85%),<30 years old(outcome rate was 84.85%),no holes on chest X-ray(outcome rate was 83.78%),positive sputum smear(outcome rate was 87.80%),diabetes-free(outcome rate was 82.82%),patients who have been cured for more than 4 to 5 years of recurrence(outcome rate was 89.33%)are important factors for the successful treatment of retreated pulmonary tuberculosis patients.Logistic regression analysis was performed on the indicators of the differences in treatment regimens between the two groups,the results showed that age<30 years old[β=0.528,Sx=0.214,Waldχ^(2)=7.825,P=0.006,OR(95%CI)=1.743(1.630-2.758)]and chemotherapy regimen 2HRZELfx/6HRE[β=0.487,Sx=0.198,Waldχ^(2)=1.355,P=0.281,OR(95%CI)=1.643(1.593-1.735)]were the key factors for the outcome of relapsed patients.Conclusion The patients who are shown to be older than 30 years old and using the 2HRZECm/1HRZE/5HRE chemotherapy regimen need to be focused on treatment,and necessary programs should be adopted to speed up the return of such retreatment pulmonary tuberculosis.