2014—2018年佛山市肺结核患者复发情况及影响因素分析

目的 通过对佛山市肺结核患者复发率及其影响因素的研究,为预防肺结核复发提供科学依据。方法 从《中国疾病预防控制信息系统》子系统《结核病管理信息系统》中,收集2014年1月至2018年12月佛山市报告登记、且治疗结果为治愈或完成疗程的15208例初治肺结核患者病案信息,采用Cox比例风险回归模型对161例复发肺结核患者的一般资料、临床信息、病原学结果及治疗转归等情况进行分析。结果 15208例肺结核患者5年内发现161例(1.06%)复发。1年后的累积复发率为0.40%(61/15208),2年后的累积复发率为0.70%(106/15208),5年后的累积复发率为1.05%(159/15208)。在Cox比例风险回归模型中,本地户籍(HR=1.56,95%CI:1.14~2.14,P=0.005)、诊断时痰涂片阳性(HR=2.92,95%CI:2.10~4.06,P<0.001)、治疗2个月末痰涂片阳性(HR=3.94,95%CI:2.41~6.47,P<0.001)、血尿素氮异常(HR=8.76,95%CI:5.00~15.36,P<0.001)是肺结核复发的独立危险因素。结论 重点加强对本地户籍、诊断时痰涂片阳性、血尿素氮异常的肺结核患者的管理,保证其规范治疗管理质量,同时对这一类肺结核复发的高危人群开展有针对性的干预措施,可减少肺结核复发。

Analysis of recurrence rate of pulmonary tuberculosis patients in Foshan and the influencing factors from 2014 to 2018

Objective: To investigate the recurrence rate of pulmonary tuberculosis patients in Foshan and its influencing factors,to provide scientific basis for preventing the recurrence of pulmonary tuberculosis. Methods: The medical record information of 15208 newly treated pulmonary tuberculosis patients who were reported and registered in Foshan City and whose treatment results were cured or the course of treatment was completed from January 2014 to December 2018 were collected from the “Tuberculosis Management Information System”, a subsystem of the “Chinese Disease Prevention and Control Information System”. Cox proportional hazards regression model was used to analyze the general data, clinical information, etiological results and treatment outcome of 161 patients with recurrent pulmonary tuberculosis. Results: A total of 15208 cases were included in this study. Of them, 161 cases (1.06%) relapse within 5 years. The cumulative recurrence rates were 0.40% (61/15208) after 1 year, 0.70% (106/15208) after 2 years, and 1.05% (159/15208) after 5 years. In the Cox proportional hazards regression model, local household registration (HR=1.56, 95%CI: 1.14-2.14, P=0.005), positive sputum smear at diagnosis (HR=2.92, 95%CI: 2.10-4.06, P<0.001), positive sputum smear after 2 months of treatment (HR=3.94, 95%CI: 2.41-6.47, P<0.001), abnormal blood urea nitrogen (HR=8.76, 95%CI: 5.00-15.36, P<0.001) were independent risk factors for the recurrence of pulmonary tuberculosis. Conclusion: The management of tuberculosis patients with local household registration, positive sputum smear at diagnosis, and abnormal blood urea nitrogen should be strengthened, and the quality of standardized treatment and management should be ensured. At the same time, targeted intervention measures should be carried out for this kind of high-risk population to reduce recurrence of pulmonary tuberculosis.