重庆市利福平敏感肺结核患者的治疗转归及影响因素分析

Analysis of treatment outcomes and influencing factors of rifampicin-sensitive pulmonary tuberculosis patients in Chongqing City

目的:分析重庆市利福平敏感肺结核治疗转归及其影响因素,为完善患者治疗管理措施,准确评价治疗结局提供依据。方法:采用回顾性研究方法,从中国疾病预防控制信息系统中导出2022年重庆市所有区(县)确诊并登记治疗的利福平敏感肺结核患者,共11545例。记录并整理研究对象的基本人口学信息及临床资料,采用多因素logistic回归模型分析影响利福平敏感肺结核患者治疗转归的因素。结果:11545例利福平敏感肺结核患者的成功治疗率为90.26%(10421/11545),治疗失败率为0.72%(83/11545),失访率为1.49%(172/11545),死亡率为5.52%(637/11545)。多因素logistic回归分析显示,少数民族(OR=1.573,95%CI:1.288~1.922)、年龄在60岁以上(60~74岁组:OR=3.322,95%CI:1.043~10.583;≥75岁组:OR=7.941,95%CI:2.490~25.323)、病原学阳性(OR=1.419,95%CI:1.214~1.659)、复治(OR=1.371,95%CI:1.121~1.677)、重症肺结核(OR=1.348,95%CI:1.108~1.639)、出现不良反应(OR=4.183,95%CI:2.707~6.464),以及在二级及以下医疗机构治疗(OR=1.333,95%CI:1.161~1.532)是影响患者成功治疗的危险因素;女性(OR=0.659,95%CI:0.562~0.773)是患者成功治疗的保护因素。结论:重庆市利福平敏感肺结核患者成功治疗率约为90%左右,但应重点关注少数民族、年龄≥60岁、病原学阳性、复治、重症肺结核、出现不良反应和在二级及以下医疗机构治疗的患者。

Objective:To analyze the treatment outcomes and risk factors of rifampicin-sensitive pulmonary tuberculosis(PTB)patients in Chongqing City,and to provide evidence for improving treatment management measures of patients and accurately evaluating treatment outcomes.Methods:A retrospective study was conducted to include a total of 11545 rifampicin-sensitive PTB patients diagnosed and registered for treatment in Chongqing City in 2022 from the Chinese tuberculosis information management system(TBMIS).Basic demographic information and clinical data of the subjects were recorded and sorted out.Univariable and multivariable logistic regression models were used to analyze factors affecting treatment outcomes.Results:Treatment success rate of 11545 rifampicin-sensitive PTB patients was 90.26%(10421/11545).Treatment failure rate was 0.72%(83/11545),loss of follow-up rate was 1.49%(172/11545),and mortality rate was 5.52%(637/11545).Multivariable logistic regression analysis showed that ethnic minority(OR=1.573,95%CI:1.288-1.922),aged over 60 years old(60-74 years old:OR=3.322,95%CI:1.043-10.583;≥75 years old:OR=7.941,95%CI:2.490-25.323),etiologically positive(OR=1.419,95%CI:1.214-1.659),retreatment(OR=1.371,95%CI:1.121-1.677),severe pulmonary tuberculosis(OR=1.348,95%CI:1.108-1.639),adverse reactions(OR=4.183,95%CI:2.707-6.464),moderate and treated in secondary or lower institutions(OR=1.333,95%CI:1.161-1.532)were risk factors for treatment success.Being female(OR=0.659,95%CI:0.562-0.773)was a protective factor for treatment success.Conclusion:The treatment success rate of rifampicin-sensitive PTB patients in Chongqing City was about 90%,but special attention should be paid to patients who are ethnic minorities,over 60 years old,etiologically positive,retreatment,severe case,having adverse reactions,and treated in secondary and lower facilities.