使用倾向得分匹配法评估南京市耐多药结核病的影响因素

Evaluating the influential factors of multidrug-resistant tuberculosis using a propensity score matching method

目的本研究旨在评价南京市耐多药结核病(multidrug-resistance tuberculosis,MDR-TB)的影响因素,为降低MDR-TB的发病率提供科学依据。方法对南京市2013年1月1日―2020年12月31日登记管理的6649例MDR-TB可疑者进行筛查。通过中国疾病预防控制中心结核病管理系统查询患者一般信息,通过电子病历和电话调查跟踪患者治疗管理情况。描述279例MDR-TB和6370例非MDR-TB的一般人口学特征,使用倾向得分匹配法1∶1匹配筛选出279例非MDR-TB。采用配对资料条件Logistic回归分析模型分析MDR-TB的影响因素。结果条件Logistic回归分析模型分析结果显示,既往二线抗结核药物使用史和抗结核药物不良反应史是MDR-TB发生的危险因素(OR=2.39,95%CI:1.46~3.93,P<0.001;OR=3.90,95%CI:2.45~6.21,P<0.001),初治患者、规律服药是MDR-TB发生的保护因素(OR=1.55,95%CI:1.02~2.34,P=0.038;OR=2.63,95%CI:1.69~4.07,P<0.001)。结论MDR-TB对患者自身、家庭以及社会的危害极大,临床医疗机构和CDC要加强协作,提高患者的早期发现率和规范治疗管理率,从而控制MDR-TB的传播。

Objective The aim of present study is to evaluate the influential factors of multidrug-resistance tuberculosis(MDR-TB)in Nanjing,and to provide scientific evidence for reducing the incidence rate of MDR-TB.Methods To screening 6649 suspected MDR-TB cases who registered and managed in Nanjing from January 1,2013 to December 31,2020.The general information of the patients was checked through the Tuberculosis(TB)management system of the Chinese Center for Disease Control and Prevention,and the treatment management conditions of the patients were tracked through electronic medical records and telephone investigation.A total of 279 MDR-TB and 6370 non-MDR-TB were described from general demographic characteristic.A total of 279 non-MDR-TB with 1∶1 matched were select using a propersity score matching method.Conditional Logistic regression model was used to analyze single and multiple factors influential of MDR-TB.Results Conditional Logistic regression results showed that previous history of second-line drugs and adverse reactions of anti-tuberculosis drugs were risk factors for MDR-TB(OR=2.39,95%CI:1.46-3.93,P<0.001;OR=3.90,95%CI:2.45-6.21,P<0.001),Initial treatment patient and regular medication were protective factors for MDR-TB(OR=1.55,95%CI:1.02-2.34,P=0.038;OR=2.63,95%CI:1.69-4.07,P<0.001).Conclusions MDR causes a huge of harm to patients,their families and the society.Clinical medical institution and CDC should strengthen cooperation to improve the detection rate of TB and the standard treatment management rate of patients,so as to control the spread of MDR epidemic.