2013-2022年杭州市临平区登记肺结核患者特点及治疗转归影响因素分析

Analysis of characteristics and factors influencing treatment outcome of registered tuberculosis patients in Linping District,Hangzhou City from 2013 to 2022

目的:分析杭州市县(区)级结核病定点医院诊治的肺结核患者的特征及治疗效果的影响因素。方法:通过“中国疾病预防控制信息系统”中的“结核病管理信息系统”子系统,按照首诊地区导出2013—2022年杭州市临平区诊治的肺结核患者数据,最终纳入1999例患者。分析患者社会人口学特征、诊疗信息及治疗结局;采用单因素和多因素logistic回归模型,分析肺结核患者发生不良治疗结局的影响因素,并进行亚组分析。结果:1999例患者中,病原学阳性者占52.58%(1051/1999),病原学阴性者占41.47%(829/1999),无病原学结果者占5.95%(119/1999);初治患者占91.80%(1835/1999),复治患者占8.20%(164/1999);43.62%(872/1999)的患者使用标准方案治疗,31.37%(627/1999)的患者使用了抗结核固定剂量复合制剂;8.75%(175/1999)的患者有除结核病外的其他合并症;12.16%(243/1999)的患者合并其他结核病;成功治疗的患者占93.00%(1859/1999),发生不良结局者占7.00%(140/1999)。多因素分析显示,65岁及以上、复治、病原学阳性、合并其他疾病的肺结核患者出现不良治疗结局的风险更高[OR(95%CI):2.320(1.402~3.838)、OR(95%CI):4.527(2.803~7.310)、OR(95%CI):3.419(2.073~5.638)、OR(95%CI):2.132(1.275~3.567)];女性、无病原学结果的肺结核患者出现不良结局的风险较低[OR(95%CI):0.486(0.293~0.808)、OR(95%CI):0.323(0.116~0.904)]。治疗方案对治疗转归的影响与年龄(交互作用P=0.002)、治疗2个月末痰涂片检查结果(交互作用P=0.046)存在交互作用;其中,较低年龄组(<35岁)使用标准方案治疗更优[OR(95%CI):0.170(0.059~0.493)],对治疗依从性较差的患者(治疗2个月末痰涂片检查未查者)使用个体化方案治疗效果不佳[OR(95%CI):0.253(0.132~0.485)]。结论:年龄、既往治疗史、病原学检查结果、合并其他疾病等因素影响肺结核患者的治疗结局。应针对不同特征患者采取个体化的治疗策略,以提高治疗成功率。

Objective:This study aims to analyze the characteristics of pulmonary tuberculosis patients diagnosed and treated in county-level(district-level)designated tuberculosis hospitals in Hangzhou,and to identify factors influencing treatment outcomes.Methods:Data for pulmonary tuberculosis patients diagnosed and treated in Linping District,Hangzhou City from 2013 to 2022 were extracted from the“Tuberculosis Management Information System”subsystem within the“China Disease Prevention and Control Information System,”based on the area of initial diagnosis.A total of 1999 patients were included in this analysis.Patient data on sociodemographic characteristics,diagnostic and treatment information,and treatment outcomes were collected and analyzed.Univariate and multivariate logistic regression models were applied to identify factors influencing adverse treatment outcomes,with further subgroup analyses conducted.Results:Of the 1999 patients,52.58%(1051/1999)tested positive for pathogens,41.47%(829/1999)were pathogen-negative,and 5.95%(119/1999)had no pathogen results.Initial treatment was administered to 91.80%(1835/1999)of patients,while 8.20%(164/1999)underwent retreatment.A standard treatment protocol was used for 43.62%(872/1999)of patients,and 31.37%(627/1999)received fixed-dose combination therapy.Additionally,8.75%(175/1999)of patients had comorbidities other than tuberculosis,and 12.16%(243/1999)had concurrent tuberculosis infections.Treatment success was achieved in 93.00%(1859/1999)of patients,while 7.00%(140/1999)experienced adverse outcomes.Multivariate analysis revealed that tuberculosis patients aged 65 and older,those undergoing retreatment,patients with positive pathogen test results,and those with additional comorbidities had an elevated risk of adverse treatment outcomes(OR(95%CI):2.320(1.402-3.838),4.527(2.803-7.310),3.419(2.073-5.638),and 2.132(1.275-3.567),respectively).Conversely,female patients and those with non-pathogenic tuberculosis exhibited a reduced risk of adverse outcomes(OR(95%CI):0.486(0.293-0.808)and 0.323(0.116-0.904),respectively).The impact of the treatment regimen on outcomes was found to correlate with age(interaction P=0.002)and to interact with sputum smear results at the end of the second month of treatment(interaction P=0.046).For younger patients(<35 years),the standard treatment regimen was more effective(OR(95%CI):0.170(0.059-0.493)),whereas individualized treatment plans yielded poorer outcomes for patients with low treatment adherence(those lacking a sputum smear test at the two-month mark)(OR(95%CI):0.253(0.132-0.485)).Conclusion:Treatment outcomes in pulmonary tuberculosis patients are influenced by factors such as age,treatment history,bacteriological findings,and comorbid conditions.Tailored treatment strategies should be implemented based on individual patient characteristics to enhance treatment success rates.