摘要
目的评估广州市耐多药肺结核治疗管理策略实施的效果,为结核病防治提供依据。方法选取2014年7月1日至2019年12月31日于广州市胸科医院纳入耐多药肺结核高危人群筛查的2417例患者为调查对象,收集其人口学特征及临床诊疗资料,获得耐多药肺结核者671例,截止到2019年12月31日有治疗结局者352例。其中,广州户籍患者(简称"户籍患者")由专家组讨论治疗方案,纳入定点科室住院和耐多药门诊随访;非广州户籍患者(简称"非户籍患者")自行选择医院诊疗。同时,收集2018年1-5月期间162例耐多药肺结核患者医疗费用调查资料。分析调查对象治疗及转归情况,影响治疗转归的因素,以及医疗经济负担。结果671例耐多药肺结核患者中户籍患者303例,检出率为21.37%(303/1418),低于非户籍患者的36.84%(368/999),差异有统计学意义(χ^(2)=69.93,P<0.01)。352例有治疗结局患者中治疗成功200例(56.82%),出现不良结局者152例(43.18%)。单因素分析显示,户籍患者治疗成功比例(69.23%,108/156)明显高于非户籍患者(46.94%,92/196),差异有统计学意义(χ^(2)=17.59,P<0.01);41~60岁组和≥61岁组患者出现治疗不良结局的比例明显高于治疗成功组[52.00%(78/150)vs.48.00%(72/150);56.82%(25/44)vs.43.18%(19/44)],差异有统计学意义(χ^(2)=18.45,P<0.01);2016年1月1日及以后开始治疗的患者治疗成功的比例(61.71%,166/269)明显高于此时间以前开始治疗者(40.96%,34/83),差异有统计学意义(χ^(2)=11.13,P<0.01)。多因素logistic回归分析显示,出现治疗不良结局的危险因素为非户籍[OR(95%CI)=4.01(2.37~6.79)]、年龄>40岁[41~60岁组:OR(95%CI)=4.08(1.05~15.96);≥61岁组:OR(95%CI)=6.51(1.48~28.60)];而2016年1月1日及以后开始治疗为保护因素[OR(95%CI)=0.30(0.17~0.52)]。户籍患者经济负担总费用[M(Q1,Q3)]为24674(17466,49920)元,明显低于非户籍患者[100215(63858,133720)元],差异有统计学意义(Z=-7.80,P<0.01)。结论�
Objective To evaluate the effect of the management strategies for multidrug-resistant tuberculosis(MDR-TB)in Guangzhou,to provide the basis for the prevention and treatment of tuberculosis.Methods A total of 2417 high-risk patients of MDR-TB screened in Guangzhou Chest Hospital from July 1,2014 to December 31,2019 were selected.Their demographic characteristics and clinical data were collected;671 cases were diagnosed of MDR-TB,and of them,352 had treatment outcomes until December 31,2019.The treatment plan of patients registered in Guangzhou were determined by the expert group,hospitalized in designated departments and followed-up in multidrug-resistant clinics,while the other patients chose hospitals and doctors freely.The medical costs of 162 patients from January to May,2018 were collected.The treatment and outcome of the subjects,as well as the factors affecting the outcome of treatment,and the financial burden of medical care were analyzed.Results Of the671 MDR-TB patients,303 were registered in Guangzhou and the detection rate was 21.37%(303/1418),which was significantly lower than that of non-local registered patients(36.84%(368/999);χ^(2)=69.93,P<0.01).Among the 352 patients with treatment outcomes,200 patients(56.82%)were successfully treated,and 152(43.18%)had adverse outcomes.Single factor analysis showed that the rate of successful treatment of patients registered in Guangzhou was significantly higher than that of non-local registered patients(69.23%(108/156)vs.46.94%(92/196),χ^(2)=17.59,P<0.01).The ratios of adverse outcomes in patients aged 41-60 years and≥61 years were both significantly higher than that in successfully treated patients(52.00%(78/150)vs.48.00%(72/150),56.82%(25/44)vs.43.18%(19/44),χ^(2)=18.45,P<0.01).The rate of successful treatment in patients treated since and after January 1,2016 was significantly higher than that in patients treated before January1,2016(61.71%(166/269)vs.40.96%(34/83),χ^(2)=11.13,P<0.01).According to the multivariate regression analysis,the risk factors
作者
邝浩斌
谢育红
冯治宇
覃红娟
廖雅怡
汪敏
张宏
袁园
吴迪
陈泽莹
谭守勇
KUANG Hao-bin;XIE Yu-hong;FENG Zhi-yu;QIN Hong-juan;LIAO Ya-yi;WANG Min;ZHANG Hong;YUANG Yuan;WU Di;CHEN Ze-ying;TAN Shou-yong(Department of Tuberculosis,Guangzhou Chest Hospital,Guangzhou 510095,China)
出处
《中国防痨杂志》
CAS
CSCD
2021年第2期113-118,共6页
Chinese Journal of Antituberculosis
基金
广州市医药卫生科技重大项目(20151A031002)
广州市高水平临床重点专科和培育专科建设项目(穗卫函[2019]1555号)
广东省转化医学创新平台培育建设项目(粤卫函[2018]1254号)。
关键词
结核
肺
抗药性
多药
病例管理
策略
实验性
评价研究
Tuberculosis
pulmonary
Drug resistance
multiple
Case management
Games
experimental
Evaluation studies
