广州市2020年至2022年耐多药肺结核管理策略的实施效果以及影响因素分析

Analysis of the implementation effect and influencing factors of multi-drug resistant tuberculosis management strategy in Guangzhou from 2020 to 2022

目的探讨广州市耐多药肺结核的治疗效果及影响因素。方法选取2020年1月至2022年12月在广州市胸科医院确诊肺结核并按广州市耐多药管理策略进行管理的广州户籍患者285例,并将截止至2023年3月31日有治疗结局的137例患者纳入研究。男97例,女40例;年龄(48.2±16.2)岁;治疗史:初治50例,复治87例。收集人口统计学和临床资料。根据患者治疗转归情况分为治疗成功组和不良结局组,多因素logistic回归分析不良结局的影响因素。采用χ^(2)检验、t检验、意向性分析、符合方案分析和改良意向性分析。结果治疗结局:治疗成功102例(74.45%),不良结局35例(25.55%),其中丢失17例(12.41%),死亡11例(8.03%),失败7例(5.11%)。单因素分析显示,年龄≥65岁(χ^(2)=13.017,P<0.001)、有糖尿病(χ^(2)=5.270,P=0.022)、有既往不规则治疗史(χ^(2)=16.555,P<0.001)、喹诺酮类药物耐药(χ^(2)=9.796,P=0.002)、基线痰涂片菌量4^(+)(χ^(2)=11.587,P=0.001)、使用贝达喹啉或德拉马尼(χ^(2)=6.993,P=0.008)是影响耐多药肺结核患者治疗结局的因素。多因素logistic回归分析显示,年龄≥65岁(OR=9.702,95%CI:1.977~47.618,P=0.005)、有既往不规则治疗史(OR=3.221,95%CI:1.234~8.410,P=0.017)、喹诺酮类药物耐药(OR=4.925,95%CI:1.808~13.416,P=0.002)均为耐多药肺结核患者不良结局的危险因素。结论广州市耐多药肺结核管理策略取得了良好的治疗效果,值得推广,但需要注意危险因素对治疗效果的影响。

Objective To explore the treatment effect and influencing factors of multi-drug resistant tuberculosis(MDR-TB)in Guangzhou.Methods A total of 285 MDR-TB patients with Guangzhou household registration diagnosed and managed according to the MDR-TB management strategy in Guangzhou Chest Hospital from January 2020 to December 2022 were included in the study.Among them,137 patients with treatment outcomes as of March 31,2023 were selected for analysis.There were 97 males and 40 females,aged(48.2±16.2)years,50 cases of initial treatment and 87 cases of retreatment.The demographic and clinical data were collected.The patients were divided into a treatment success group and a poor outcome group based on their treatment outcomes,and the influencing factors of poor outcomes were analyzed by multivariate logistic regression analysis.χ^(2) test,t test,intention-to-treat analysis,per-protocol analysis,and modified intention-to-treat analysis were used.Results The treatment outcomes included 102 successful cases(74.45%)and 35 cases with poor outcomes(25.55%),including 17 cases of loss to follow-up(12.41%),11 deaths(8.03%),and 7 failures(5.11%).Univariate analysis showed statistically significant differences between the treatment success group and the poor outcome group in terms of≥65 years old(χ^(2)=13.017,P<0.001),diabetes(χ^(2)=5.270,P=0.022),history of irregular treatment(χ^(2)=16.555,P<0.001),resistance to quinolones(χ^(2)=9.796,P=0.002),baseline sputum smear positive grade 4^(+)(χ^(2)=11.587,P=0.001),and use of bedaquiline or delamanid(χ^(2)=6.993,P=0.008).Multivariate logistic regression analysis showed that age≥65 years old(OR=9.702,95%CI:1.977-47.618,P=0.005),history of irregular treatment(OR=3.221,95%CI:1.234-8.410,P=0.017),and resistance to quinolones(OR=4.925,95%CI:1.808-13.416,P=0.002)were risk factors for poor outcomes in MDR-TB patients.Conclusion MDR-TB management strategy in Guangzhou has achieved good treatment outcomes,which is worth promoting.However,attention should be paid to the impact of risk factors on treatment outcomes.