佛山市193例耐多药肺结核患者的治疗转归及影响因素分析

Treatment outcomes and influencing factors of 193 patients with multidrug-resistant pulmonary tuberculosis in Foshan City

目的 了解佛山市耐多药肺结核患者的治疗转归情况,探讨影响治疗转归的相关因素。方法 通过中国疾病预防控制信息系统收集佛山市2008—2019年193例耐多药肺结核患者,利用logistics回归分析方法对影响耐多药肺结核患者治疗转归的诸多因素进行回顾性分析。结果 193例患者中男性137例(70.98%),女性56例(29.02%);年龄在19~92岁之间;治疗转归中,成功治疗119例,治疗成功率为61.66%;多因素logistics回归分析发现:年龄≥60岁(OR=4.111,95%CI:1.686~10.025)、偏瘦人群(OR=2.072,95%CI:1.112~3.883)、6月末痰培养未转阴(OR=3.332,95%CI:1.742~6.332)、复治患者(OR=3.772,95%CI:1.394~10.191)、使用过二线抗结核药物(OR=4.492,95%CI:2.092~9.663)及氧氟沙星耐药(OR=6.598,95%CI:2.612~16.603)是影响耐多药肺结核治疗成功的危险因素。结论 针对耐多药肺结核患者,需结合药敏结果制定治疗方案,特别是6月末痰培养未转阴患者,需考虑方案的合理性,加大对年龄≥60岁、复治患者的监测管理,进一步提高耐多药肺结核患者的治疗成功率。

Objective To understand the treatment outcomes of patients with multidrug-resistant pulmonary tuberculosis(MDR-TB) in Foshan City, and to explore the relevant factors affecting treatment outcomes. Methods One hundred and ninety-three patients with MDR-TB in Foshan City from 2008 to 2019 were collected through the China Disease Prevention and Control Information System. Logistic regression analysis was used to retrospectively identify factors affecting treatment outcomes of the patients with MDR-TB. Results Among the 193 patients, 137(70.98%) were males and 56(29.02%) females. The age ranged from 19 to 92 years. As for treatment outcomes, 119 cases were successfully treated, and the success rate of treatment was 61.66%. Multivariate logistic regression analysis revealed that age ≥ 60 years old(OR=4.111, 95%CI:1.686-10.025), lean population(OR=2.072, 95%CI:1.112-3.883), having no a negative result of sputum culture test after a 6-month treatment(OR=3.332, 95%CI:1.742-6.332), retreatment patients(OR=3.772, 95%CI:1.394-10.191), using second-line anti-TB drugs(OR=4.492, 95%CI:2.092-9.663), and ofloxacin resistance(OR=6.598, 95%CI:2.612-16.603) were risk factors affecting the success of MDR-TB treatment. Conclusion It is necessary to formulate a therapeutic regimen based on the drug sensitivity results for the patients with MDR-TB, and special attention should be paid to the rationality of the regimen for patients without a negative result of sputum culture test after a 6-month treatment. Monitoring and management of patients aged ≥ 60 years and retreatment patients should be enhanced, and the successful rate of treatment of the MDR-TB patients should be further improved.