老年耐多药/利福平耐药肺结核患者的治疗转归及影响因素研究——全国多中心、回顾性队列研究

Treatment outcomes and influencing factors in elderly patients with multidrug/rifampicin-resistant pulmonary tuberculosis:a national multicenter,retrospective cohort study

目的:分析老年耐多药/利福平耐药肺结核(multidrug/rifampicin-resistant pulmonary tuberculosis,MDR/RR-PTB)患者的治疗转归及影响因素。方法:采用全国多中心、回顾性队列研究方法,纳入2018年1月1日至2020年12月31日期间在全国6家省级结核病专科医院收治的年龄≥60岁且诊断为MDR/RR-PTB的患者,共475例。记录患者的临床特征,随访全疗程的治疗相关信息,采用多因素logistic回归模型分析影响老年MDR/RR-PTB患者治疗转归的因素。结果:475例老年MDR/RR-PTB患者的治疗成功率为65.89%(313/475),其中治愈率为50.74%(241/475),完成治疗率为15.16%(72/475);治疗失败率为13.05%(62/475),失访率为17.05%(81/475),死亡率为4.00%(19/475)。多因素logistic回归分析结果显示,70~79岁[OR(95%CI)=1.560(1.001~2.431)]、≥80岁[OR(95%CI)=3.306(1.370~7.974)]、肺部出现空洞[OR(95%CI)=1.832(1.195~2.808)]是影响老年MDR/RR-PTB患者成功治疗的危险因素;治疗方案中含贝达喹啉[OR(95%CI)=0.193(0.044~0.841)]是老年MDR/RR-PTB患者成功治疗的保护因素。结论:老年MDR/RR-PTB患者治疗复杂、治疗难度较大,其治疗成功率较低,尤其应重视年龄≥70岁和肺部出现空洞的老年患者。

Objective:To analyze treatment outcomes and influencing factors of multidrug/rifampicin-resistant pulmonary tuberculosis(MDR/RR-PTB)in elderly patients.Methods:A national multicenter retrospective cohort study was conducted to include 475 elderly(≥60 years)MDR/RR-PTB patients who were admitted to six provincial tuberculosis hospitals from January 1,2018 to December 31,2020.Clinical characteristics of those patients were recorded and full course treatment was followed up.Multivariable logistic regression model was used to analyze factors affecting treatment outcomes.Results:Successful treatment rate of 475 elderly MDR/RR-PTB patients was 65.89%(313/475),cure rate and treatment completion rate were 50.74%(241/475)and 15.16%(72/475)respectively.Treatment failure rate was 13.05%(62/475),loss of follow-up rate was 17.05%(81/475)and mortality rate was 4.00%(19/475).Multivariable logistic regression analysis showed that 70-79 years old(OR=1.560,95%CI:1.001-2.431),≥80 years old(OR=3.306,95%CI:1.370-7.974),lung cavities(OR=1.832,95%CI:1.195-2.808)were risk factors affecting MDR/RR-PTB treatment success in elderly patients.Inclusion of Bedaquiline in treatment regimen(OR=0.193,95%CI:0.044-0.841)was a protective factor for successful treatment.Conclusion:The treatment of elderly MDR/RR-PTB patients is complicated and difficult for which the successful treatment rate is low.Special attention should be paid to elderly patients aged≥70 years and those with pulmonary cavities.