南京市初治肺结核患者成功治疗后复发及影响因素分析

Recurrence and influencing factors of the new pulmonary tuberculosis after successful treatment in Nanjing

目的分析南京市初治肺结核患者成功治疗后复发情况和影响因素,为本地制定减少复发的防控策略提供科学的参考依据。方法采用回顾性队列分析,通过“结核病管理信息系统”收集南京市2011—2019年成功治疗的初治肺结核患者信息,匹配2011—2020年本地登记的复发病例,采用寿命表法分析复发情况,多因素Cox比例风险回归模型分析复发的影响因素。结果19452例成功治疗的初治肺结核患者中,484例复发,复发率密度为0.52/100人年,中位复发时间为1.66(0.67,3.18)年。73.14%的复发发生在成功治疗后3年内,5年内累计复发占复发总数的91.53%。多因素Cox比例风险回归分析显示,男性(HR=1.517,95%CI:1.219~1.889)、40岁以上(HR=2.360,95%CI:1.254~4.439)、病原学阳性(HR=2.028,95%CI:1.682~2.444)、初始肺部有空洞(HR=1.464,95%CI:1.198~1.789)、合并糖尿病(HR=5.860,95%CI:3.557~9.653)是初治肺结核患者成功治疗后复发的危险因素。结论南京市初治肺结核患者成功治疗后复发率相对较低,但对于男性、40岁以上、病原学阳性、初始肺部空洞、合并糖尿病等高危患者,仍应采取积极措施,早期识别干预,加强随访,减少复发。

ObjectiveTo analyze the recurrence and influencing factors of the new pulmonary tuberculosis(TB)cases after successful treatment in Nanjing,and provide evidence for reducing TB recurrence.MethodsWith retrospective cohort study method,the data of new TB cases which were successful treated during 2011-2019 derived from the TB Information Management System,then the recurrence condition were collected from 2011 to 2020.The recurrence rate was estimated by using life-table method,and the influencing factors were analyzed by a Cox proportional hazard regression model.ResultsAmong 19452 TB patients,484 cases had recurred by the end of 2020,with a recurrence rate density of 0.52/100 person-years.The median recurrence interval was 1.66(0.67,3.18)years.73.14%had recurrence within 3 years and 91.53%had recurrence within 5 years.Multivariate Cox proportional hazard regression model showed that men(HR=1.517,95%CI:1.219-1.889),aged≥40 years old(HR=2.360,95%CI:1.254-4.439),etiology positive(HR=2.028,95%CI:1.682-2.444),lung cavity before treatment(HR=1.464,95%CI:1.198-1.789)and complicated with diabetes mellitus(HR=5.860,95%CI:3.557-9.653)were the major risk factors for tuberculosis recurrence.ConclusionsThe recurrence rate of the new TB patients was low in Nanjing,however,affirmative measures should be taken for high-risk patients to reduce recurrence.Early identification,targeted intervention and follow-up management should be strengthened for patients who were male,over 40 years old,etiology positive,with lung cavity before treatment and complicated with diabetes mellitus.