异烟肼单耐药肺结核患者的治疗转归及影响因素分析

Treatment outcome and influencing factors of isoniazid mono-resistant pulmonary tuberculosis

目的分析异烟肼单耐药肺结核患者的治疗转归, 以及发生不良治疗结局的影响因素。方法回顾性研究2018年1月1日至2020年12月31日就诊于西安市胸科医院的114例异烟肼单耐药肺结核患者, 收集其一般资料、临床症状、实验室检查结果, 以治疗成功及不良治疗结局为因变量, 采用二元logistic回归分析影响异烟肼单耐药肺结核患者发生不良治疗结局的危险因素。结果 114例患者中治愈46例(40.4%), 完成治疗41例(36.0%), 治疗成功率为76.3%(87/114);治疗失败11例(9.6%), 失访13例(11.4%), 死亡3例(2.6%)。二元logistic回归分析显示男性[比值比(odds ratio, OR)=7.22, 95%可信区间(95% confidence interval, 95%CI)1.47~35.43], 起病时无发热(OR=12.97, 95%CI 2.74~61.55), 治疗方案中不含阿米卡星(OR=5.28, 95%CI 1.20~23.31), 痰菌载量>1+(OR=5.87, 95%CI 1.76~19.60)为异烟肼单耐药肺结核患者发生不良治疗结局的危险因素(均P<0.050)。结论异烟肼单耐药肺结核患者治疗成功率较高, 男性、起病时无发热、治疗方案中不含阿米卡星、痰菌载量>1+是发生不良治疗结局的危险因素。

Objective To analyze the outcomes of isoniazid(INH)mono-resistant pulmonary tuberculosis,and risk factors associated with adverse treatment outcomes of INH mono-resistant pulmonary tuberculosis.Methods A total of 114 cases of INH mono-resistant pulmonary tuberculosis in Xi′an Chest Hospital from January 1,2018 to December 31,2020 were retrospectively recruited for analysis.The general information,clinical symptoms,and laboratory test results of patients were collected.With treatment success and adverse treatment outcomes as dependent variables,binary logistic regression analysis was used to analyze the risk factors for the adverse treatment outcome of INH mono-resistant pulmonary tuberculosis.Results Among 114 patients with INH mono-resistant tuberculosis,46 cases(40.4%)were cured and 41 cases(36.0%)completed treatment with the success rate of 76.3%(87/114),while 11 cases(9.6%)failed treatment,13 cases(11.4%)lost to follow up,three cases(2.6%)died.The binary logistic regression analysis showed that male(odds ratio(OR)=7.22,95% confidence interval(CI)1.47 to 35.43),no fever at onset(OR=12.97,95%CI 2.74 to 61.55),not containing amikacin in the regimen(OR=5.28,95%CI 1.20 to 23.31),sputum bacteria load>1+(OR=5.87,95%CI 1.76 to 19.60)were the risk factors for adverse treatment outcomes of INH mono-resistant tuberculosis.Conclusions The treatment success rate of INH mono-resistant pulmonary tuberculosis patients is high.The risk factors for adverse treatment outcome are male,no fever at the onset,not containing amikacin in the regimen,and sputum bacteria load>1+.