2018—2020年甘肃省利福平敏感肺结核患者治疗不良结局的随机效应logistic模型分析

Analysis of treatment adverse outcomes for rifampicin sensitive pulmonary tuberculosis patients with random effects logistic model in Gansu Province from 2018 to 2020

目的:了解甘肃省利福平敏感肺结核患者治疗不良结局的相关影响因素,为有效提升利福平敏感肺结核患者成功治疗率提供科学依据。方法:收集甘肃省2018—2020年登记治疗管理的20398例利福平敏感肺结核患者,构建随机效应logistic模型,探讨影响利福平敏感肺结核患者治疗不良结局的相关因素。结果:20398例利福平敏感肺结核患者治疗发生不良结局1407例,不良结局发生率为6.90%(1407/20398)。随机效应logistic模型分析显示,男性[OR(95%CI)=1.273(1.133~1.430)]、年龄25~45岁[OR(95%CI)=1.501(1.295~1.740)]、46~60岁[OR(95%CI)=1.623(1.372~1.920)]、>60岁[OR(95%CI)=2.272(1.752~2.948)]、职业为离退/家政/餐饮等服务业/待业/其他[OR(95%CI)=1.587(1.089~2.312)]、农牧渔民/民工/长途驾驶员[OR(95%CI)=1.532(1.098~2.138)]、合并症[OR(95%CI)=1.366(1.031~1.811)]、病原学结果阳性[OR(95%CI)=2.590(2.271~2.953)]、重症[OR(95%CI)=1.271(1.009~1.600)]、复治[OR(95%CI)=2.795(2.300~3.398)]均是利福平敏感肺结核患者发生治疗不良结局的危险因素。结论:结核病防治相关部门要加强利福平敏感肺结核患者中25岁及以上人群(尤其是>60岁老年人)、离退/家政/餐饮等服务业/待业/农牧渔民/民工/长途驾驶人员、重症、复治、合并其他疾病、病原学阳性等患者的治疗管理,动态监测患者随访复查、督导服药过程,重视健康教育,降低利福平敏感肺结核患者的治疗不良结局发生率。

Objective:To understand the related influencing factors of treatment adverse outcomes for rifampicin sensitive pulmonary tuberculosis patients in Gansu Province.To provide scientific basis for effectively,in order to improve the rate of successful treatment for rifampicin sensitive pulmonary tuberculosis patients.Methods:A total of 20398 rifampicin sensitive pulmonary tuberculosis patients registered for treatment management in Gansu Province from 2018 to 2020 were collected,and a random effects logistic model was constructed to explore the relevant factors affecting the treatment adverse outcomes of rifampicin sensitive pulmonary tuberculosis patients.Results:Among the 20398 rifampicin sensitive pulmonary tuberculosis patients,1407 had adverse treatment outcomes,the rate of adverse outcomes was 6.90%(1407/20398).The random effects logistic model showed that patients with male OR(95%CI)=1.273(1.133-1.430),age 25-45 years old OR(95%CI)=1.501(1.295-1.740),46-60 years old OR(95%CI)=1.623(1.372-1.920),more than 60 years old OR(95%CI)=2.272(1.752-2.948),occupation with retired/housekeeping/catering/unemployed/others OR(95%CI)=1.587(1.089-2.312),occupation with farmers,herdsmen,fishermen/migrant workers/long-distance drivers OR(95%CI)=1.532(1.098-2.138),comorbidities OR(95%CI)=1.366(1.031-1.811),positive etiological diagnosis OR(95%CI)=2.590(2.271-2.953),critically ill OR(95%CI)=1.271(1.009-1.600),retreatment OR(95%CI)=2.795(2.300-3.398)were more likely to fail in treatment.Conclusion:The relevant departments of tuberculosis prevention and control should strengthen the management of treatment tuberculosis patients aged 25 and over(especially those over 60),retired/housekeeping/catering/unemployed/farmers/herdsmen/fishermen/migrant workers/long-distance drivers,retreatment patients,patients with comorbidities,and patients with positive etiology,dynamically monitor patients review,supervise the drug-taking process,and pay attention to health education to reduce the incidence of adverse outcomes of rifampicin sensitive pulmonary tuberculosis patients.