衡阳市成功治疗的肺结核患者5年复发影响因素分析

Factors affecting the five-year recurrence among successfully-treated pulmonary tuberculosis patients in Hengyang City

目的了解湖南省衡阳市肺结核患者成功治疗后5年复发情况,并分析其影响因素。方法通过结核病管理信息系统收集衡阳市2014年成功治疗的肺结核患者资料,以复发为观察终点,连续观察5年。采用Kaplan-Meier法、log-rank检验和多因素Cox比例风险回归模型分析患者复发的影响因素。结果纳入成功治疗肺结核患者6626例,包括男性4961例和女性1665例,年龄中位数为54岁。5年复发536例,累计复发比例为8.09%,年均复发率为1.75/100人年。多因素Cox比例风险回归分析结果显示,男性(HR=1.592,95%CI:1.256~2.019)、≥40岁(40~<60岁,HR=7.025,95%CI:1.739~28.377;≥60岁,HR=8.175,95%CI:2.024~33.023)、农民(HR=1.379,95%CI:1.070~1.778)、复治(HR=6.398,95%CI:5.163~7.929)和病原学阳性(HR=1.255,95%CI:1.042~1.511)是成功治疗肺结核患者5年复发的危险因素。结论衡阳市肺结核患者成功治疗后5年内仍有较高的复发率。男性、40岁及以上、农民、复治和病原学阳性患者有较高的复发风险,可采取针对性干预措施。

ObjectiveTo investigate the recurrence of pulmonary tuberculosis patients 5 years after successful treatment in Hengyang City,Hunan Province,and to analyze its influencing factors.MethodsThe data of pulmonary tuberculosis patients who were successfully treated in Hengyang City in 2014 were collected through the tuberculosis management information system.The recurrence of pulmonary tuberculosis was defined as the endpoint,and all patients were observed for five consecutive years.Factors affecting recurrence of pulmonary tuberculosis were identified using Kaplan-Meier estimates,log-rank test and multivariable Cox proportional hazards regression analysis.ResultsA total of 6626 patients with successfully treated pulmonary tuberculosis were included,including 4961 males and 1665 females,with a median age of 54 years.There were 536 cases with recurrence of pulmonary tuberculosis within five years,with a 8.09%cumulative proportion of recurrence and annual recurrence rate of 1.75 per 100 person-years.Multivariable Cox proportional hazards regression analysis showed that men(HR=1.592,95%CI:1.256-2.019),age of 40 years and greater(age of40 to 59 years,HR=7.025,95%CI:1.739-28.377;age of 60 years and greater,HR=8.175,95%CI:2.024-33.023),farmers(HR=1.379,95%CI:1.070-1.778),retreatment(HR=6.398,95%CI:5.163-7.929)and positive etiology(HR=1.255,95%CI:1.042-1.511)were risk factors for five-year recurrence of pulmonary tuberculosis among successfully-treated patients.ConclusionsHigh recurrence rate is found among pulmonary tuberculosis patients within five years after successful treatment in Hengyang City.There is a high risk of pulmonary tuberculosis recurrence among male,etiologically positive,retreated farmers at ages of 40 years and older,and targeted interventions are recommended.