摘要
目的评估耐多药肺结核(MDR-PTB)标准长疗程方案治疗结果的影响因素。方法选取2013年1月-2017年12月在我国23个省(市)的22个结核病哨点医院和1个三级综合医院接受标准长疗程方案治疗的332例MDR-PTB患者,对其治疗转归情况进行回顾性调查并分析其影响因素。结果332例MDR-PTB患者中,治疗成功196例(59.04%),失败76例(22.89%),失访33例(9.94%),死亡12例(3.61%),转诊15例(4.52%)。多因素logistic回归分析结果显示,年龄≥50岁(OR=0.342,95%CI 0.169~0.690)、MDR-PTB病程≥1年(OR=0.297,95%CI 0.108~0.815)、不规则治疗(OR=0.429,95%CI 0.197~0.934)、治疗前有空洞(OR=0.073,95%CI 0.026~0.207)、第3个月末痰培养阳性(OR=0.161,95%CI 0.072~0.358)是治疗失败的预测因素,第6个月末空洞闭合(OR=15.723,95%CI 5.690~43.444)是治疗成功的预测因素。结论年龄、MDR-PTB病程、不规则治疗、第3个月末痰培养结果、治疗前有无空洞、第6个月末空洞闭合是MDR-PTB转归的影响因素。在MDRPTB的治疗初期,第3个月末痰培养结果、CT影像特征等对治疗结果有重要预测价值。
Objective To evaluate the risk factors of treatment outcomes in MDR-PTB patients with long-term treatment regimen in China.Methods 332 patients with MDR-PTB were recruited from 22 sentinel hospitals and 1 tertiary general hospital in 23 Provinces in China from January 2013 to December 2017.The treatment outcomes were investigated retrospectively,and the influencing factors of treatment outcomes were collected and analyzed.Results For the 332 patients,196 cases were successful(59.04%),76 cases failed(22.89%),33 cases lost follow-up(9.94%),12 cases died(3.61%),and 15 cases were transferred out(4.52%).The main factors affecting the outcome of treatment included age≥50 years(OR=0.342,95%CI 0.169-0.690),course of MDR-PTB≥1 year(OR=0.297,95%CI 0.108-0.815),irregular treatment(OR=0.429,95%CI 0.197-0.934),cavities before treatment(OR=0.073,95%CI 0.026-0.207)and positive sputum culture month 3(OR=0.161,95%CI 0.072-0.358),and cavity closure month 6(OR=15.723,95%CI 5.690-43.444)is predictor of success.Conclusions The result of this study indicated that age,course of MDR-PTB,irregular treatment,sputum culture in month 3,cavity before treatment and cavity closure in month 6 were the influencing factors of MDR-PTB outcome.In the initial stage of treatment of MDR-PTB patients,sputum culture results in month 3 and CT images have important predictive value for the treatment results of MDRPTB patients.
作者
潘辰慧
张顺先
张少言
邱磊
周伟
吴显伟
吴定中
张惠勇
肖和平
鹿振辉
Pan Chen-Hui;Zhang Shun-Xian;Zhang Shao-Yan;Qiu Lei;Zhou Wei;Wu Xian-Wei;Wu Ding-Zhong;Zhang Hui-Yong;Xiao He-Ping;Lu Zhen-Hui(Department of Respiratory Medicine,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Department of Tuberculosis,Shanghai Pulmonary Hospital Affiliated to Tongji University,Shanghai 200433,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2023年第9期1040-1047,共8页
Medical Journal of Chinese People's Liberation Army
基金
国家“十三五”传染病科技重大专项(2018ZX10725-509)
上海市“科技创新行动计划”医学创新研究专项(21Y11922500)
上海市促进市级医院临床技能与临床创新能力三年行动计划(SHDC2022CRS039)
上海中医药大学附属龙华医院人才基金(LH001.007)。
关键词
结核
肺
分枝杆菌
结核
耐多药
治疗结果
危险因素
Tuberculosis,pulmonary
Mycobacterium tuberculosis,multidrug-resistant
treatment outcome
risk factors
