摘要
目的:分析我国结核病定点医院抗结核固定剂量复合剂(fixed-dose combination,FDC)全疗程使用情况及其影响因素,为规范使用抗结核FDC提供依据。方法:按照典型抽样的方法,从全国选择东中西部5个省,每省选择一个省级和一个地市级结核病定点医院作为研究现场。采用前瞻性调查的方法,对2021年4—7月各医院诊断登记的肺结核患者中使用FDC治疗的患者作为研究对象,分析抗结核FDC全疗程使用情况及影响全疗程使用的因素。结果:在登记的2559例使用FDC治疗的患者中,全疗程治疗者1988例,占77.69%(1988/2559);中途停止使用者571例,占22.31%(571/2559),多发生在治疗强化期,占69.00%(394/571)。多因素Cox回归分析结果显示,综合医院(HR=2.595,95%CI:1.753~3.843)、省级医院(HR=4.813,95%CI:3.347~6.923)、患者年龄≥60岁(HR=1.573,95%CI:1.245~1.988)、耐药状况未知(HR=1.408,95%CI:1.189~1.667)、发生不良反应(HR=15.934,95%CI:13.248~19.165)是抗结核FDC停止使用的危险因素。结论:对综合医院、省级医院的医生,应开展有针对性的FDC规范诊疗培训;对上述医院就诊的患者,特别是老年患者,应开展健康宣教及用药指导,加强对治疗强化期的患者的管理,提高FDC全疗程使用率。
Objective:To analyze the full course use of anti-tuberculosis fixed-dose combination(FDC)in designated tuberculosis hospitals in China and its influencing factors,so as to provide basis for standardized use of FDC.Methods:According to the typical sampling methods,we selected 5 provinces in the east,middle and west of China,one provincial and one prefecture designated tuberculosis hospital were determined in each province.Using a prospective survey method,patients diagnosed and registered with pulmonary tuberculosis from April to July 2021 who received FDC treatment were selected as the study subjects to analyze the full course use and influencing factors of FDC.Results:Among the 2559 registered patients treated with FDC,1988 patients underwent full course treatment,accounting for 77.69%(1988/2559),while 571 patients stopped using FDC midway,accounting for 22.31%(571/2559),and most of them occurred during the intensive treatment period,accounting for 69.00%(394/571).The results of multivariate Cox regression analysis showed that general hospitals(HR=2.595,95%CI:1.753-3.843),provincial hospitals(HR=4.813,95%CI:3.347-6.923),patients aged≥60 years old(HR=1.573,95%CI:1.245-1.988),unknown drug resistance status(HR=1.408,95%CI:1.189-1.667),and adverse reactions(HR=15.934,95%CI:13.248-19.165)were risk factors for discontinuation of FDC.Conclusion:Targeted FDC standardized diagnosis and treatment training should be provided to doctors in general hospitals and provincial hospitals.For patients seeking treatment at the aforementioned hospitals,especially elderly patients,health education and medication guidance should be carried out to strengthen the management during the intensive treatment period to improve the full course usage rate of FDC.
作者
杜芳芳
成诗明
王倪
周林
郭萌
郭秀花
Du Fangfang;Cheng Shiming;Wang Ni;Zhou Lin;Guo Meng;Guo Xiuhua(School of Public Health,Capital Medical University/Beijing Key Laboratory of Clinical Epidemiology,Beijing 100069,China;Chinese Antituberculosis Association,Beijing 100010,China;National Center for Tuberculosis Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China;Chinese Journal of Antituberculosis Publishing House,Beijing 100035,China)
出处
《中国防痨杂志》
CAS
CSCD
北大核心
2024年第7期792-798,共7页
Chinese Journal of Antituberculosis
基金
中国防痨协会抗结核FDC推广项目(CATA-20210410)。
关键词
结核
肺
固定剂量复合剂
因素分析
统计学
Tuberculosis,pulmonary
Fixed-dose combination
Factor analysis,statistical
