86例初治涂阳肺结核患者标准抗结核方案治愈后复发的危险因素Logistic分析

Logistic Analysis of Risk Factors of Relapse in 86 Patients with Smear-positive Pulmonary Tuberculosis after Treatment with Standard Anti-tuberculosis Regimen

目的探讨86例初治涂阳肺结核患者接受标准抗结核方案治愈后出现复发的影响因素。方法本研究中共纳入86例初治涂阳肺结核患者,所有病例均来源于济源市人民医院,选取时间为2019年5月至2020年5月,进行回顾性分析,所有患者均接受标准抗结核方案治疗,至少半年,在患者治愈后对其进行2年的随访,随访期间对患者进行痰标本细菌培养、痰标本结核分歧杆菌厚涂片检查,统计患者的转阴情况,以及是否出现复发,对初治涂阳肺结核患者采用标准抗结核方案治愈后出现复发的影响因素进行分析,之后进一步对初治涂阳肺结核患者接受标准抗结核方案治愈后出现复发的高危因素进行筛选,分析年龄、转阴时间与复发率的相关性。结果68.60%的初治涂阳肺结核患者在采用标准抗结核方案治疗2个月痰标本细菌培养、痰标本结核分歧杆菌厚涂片检查结果显示转阴,而23.26%的患者在治疗3个月时转阴,8.14%的患者在治疗3个月以上时转阴;共有8例患者出现复发,复发率为9.30%(8/86);初治涂阳肺结核患者治愈后的复发率在不同年龄、痰菌转阴时间下,均有明显差异(均P<0.05);初治涂阳肺结核患者标准抗结核方案治愈后复发的高危因素在于年龄≥60岁、痰菌转阴时间>3个月(OR=1.822、2.801,均P<0.05);初治涂阳肺结核患者标准抗结核方案治愈后的复发率与年龄、痰菌转阴时间均呈正相关(r=0.422、0.495,均P<0.05)。结论初治涂阳肺结核患者标准抗结核方案治愈后复发的危险因素在于年龄≥60岁、痰菌转阴时间>3个月,临床应针对上述因素进行预防并随时对治疗方案进行调整,以降低复发率。

Objective To investigate the influencing factors of relapse in 86 patients with smear-positive pulmonary tuberculosis treated with standard antituberculosis regimen.Methods A total of 86 patients with initially treated smear positive pulmonary tuberculosis were included in this study,all of whom were from Jiyuan People's Hospital from May 2019 to May 2020 for retrospective analysis.All patients were treated with standard anti-tuberculosis regimen for at least half a year,and were followed up for 2 years after cure.During the follow-up period,sputum specimen bacterial culture and thick smear examination of tuberculous bacilli in sputum specimens were carried out to make statistics on patients'negative conversion and whether there was recurrence.The influencing factors of recurrence in patients with smear-positive pulmonary tuberculosis who were cured by standard anti-tuberculosis regimen were analyzed.Then,we further screened the risk factors of relapse after the initial treatment of smear-positive pulmonary tuberculosis patients treated with standard anti-tuberculosis regimen,and analyzed the correlation between age,negative time and recurrence rate.Results 68.60% of the newly treated patients with smear positive pulmonary tuberculosis turned negative after 2 months of treatment with standard anti-tuberculosis regimen,and 23.26% of the patients turned negative after 3 months of treatment,and 8.14% of the patients turned negative after 3 months of treatment.A total of 8 patients recurred,and the recurrence rate was 9.30%(8/86).The recurrence rate of smear-positive pulmonary tuberculosis patients after initial treatment was significantly different at different ages and the time of sputum turning negative(all P<0.05).The risk factors for recurrence of smeared positive pulmonary tuberculosis patients after treatment with standard anti-tuberculosis regimen were age≥60 years and sputum negative time>3 months(OR=1.822,2.801,all P<0.05).The recurrence rate of smear-positive pulmonary tuberculosis patients treated with standard anti-tuberculosis regimen was positively correlated with age and the time of sputum turning negative(r=0.422,0.495,both P<0.05).Conclusion The risk factors for recurrence of smear-positive pulmonary tuberculosis patients after treatment with standard anti-tuberculosis regimen are age≥60 years old and sputum negative time>3 months.Clinical prevention should be taken according to the above factors and adjustment of treatment regimen should be made at any time to reduce the recurrence rate.