涂阳肺结核患者抗结核药物不良反应发生影响因素分析

目的 探讨涂阳肺结核患者接受抗结核药物治疗的不良反应发生情况及其影响因素,为制定结核病防治策略提供参考。方法 选择2008—2010年我国8个省(市、自治区)结核病定点医疗机构治疗诊治的涂阳肺结核患者共2 142例,根据是否发生不良反应将其分为两组,运用卡方检验单因素及logistic多因素回归对不良反应发生的危险因素进行分析。结果 2 142例涂阳肺结核患者中536例患者出现不良反应,不良反应发生率为25.0%。经单因素分析结果表明年龄(χ²=23.815, P<0.001)、吸烟情况(χ²=12.040, P=0.024)及结果差异均有统计学意义。多因素非条件logistic回归结果显示, 45~64岁和≥65岁年龄组及吸烟是不良反应发生的独立危险因素,OR(95%CI)值分别为1.524(1.159~2.422)和1.756(1.200~2.570)及1.620(1.194~2.198)。结论 涂阳肺结核患者中吸烟及中老年人是发生不良反应的危险因素,在患者诊治过程中,应及时对这类高危人群进行监测和主动干预,对发现和降低不良反应的发生率有着重要意义。     

常熟地区抗结核药致肝损害的发生及影响因素研究

目的了解常熟地区抗结核药致肝损害(ATLI)的发生、转归及其影响因素,为科学防治抗结核药致肝损害提供依据。方法基于常熟地区2013-2014年全市新诊断结核病患者的抗结核治疗病历进行回顾性分析,采用国际共识会议标准进行ATLI的判断,对其发生和转归进行分析,同时采用1:4匹配病例对照研究探讨其影响因素。结果常熟地区2年内新诊断851例结核病人,其中832人完成了抗结核治疗(19人失访)。排除了治疗期间无肝功能检测或只有基线肝功能检测的患者后,在剩余724人中,55人发生了药物性肝损害(ATLI发生率为7.6%),中位发生时间为17天(四分位间距为14-24天),且均发生在抗结核治疗的前2个月内。55人中有41例在加强保肝治疗的基础上仍沿用原治疗方案,11例患者改变了原治疗方案;24人治愈,30人完成疗程,1例患者停止治疗;多因素条件Logistic回归分析显示合并有其他疾病的结核病患者易发生ATLI(OR=3.367,95%CI:1.506-7.530)。结论 2013-2014年常熟地区ATLI的发生率为7.6%,应重点针对罹患有其他疾病的患者加强肝功能检测,以便早期发现肝损害。     

结核病在矽尘暴露人群中的流行情况及危险因素分析

目的：了解矽尘暴露者包括硅沉着病患者的结核病患病情况,并分析该人群中结核病发病的危险因素。方法对浙江温岭地区1227例矽尘暴露者进行现场调查,采集基本信息,行胸部 X 线片检查,收集痰标本行结核分枝杆菌培养及鉴定。在单因素分析中,连续变量比较采用两样本 t 检验;分类变量组间两两比较采用χ2检验。多因素分析采用二元 Logistic 回归计算优势比（OR）及95％可信区间（CI ）。结果共获得1204例矽尘暴露者完整的基本信息,其中男1201例（99．8％）,平均年龄（59．4±6．8）岁。其中硅沉着病0＋期（疑似患者）、Ⅰ、Ⅱ、Ⅲ期的患者分别为172例（14．3％）、255例（21．2％）、160例（13．3％）和617例（51．2％）。该人群中结核病患病率约为7300／10万,发病危险因素有硅沉着病Ⅱ期（OR＝2．96,95％CI ：1．05～8．32,P ＝0．04）、硅沉着病Ⅲ期（OR ＝3．88,95％CI ：1．58～9．56,P ＜0．01）、接触结核病患者（OR＝4．14,95％CI ：1．91～8．98,P ＜0．01）。硅沉着病合并肺结核患者缺乏特异性症状,发热、体质量减轻较非肺结核患者多见。结论矽尘暴露者包括硅沉着病患者是结核病的高发人群,尤其是硅沉着病Ⅱ期及Ⅲ期、有结核病患者接触史的患者。     

高危人群抗结核方案的探讨

目的观察高危人群适当弱化结核治疗强度对药物性肝损发生率及痰菌阴转率的影响,探讨高危人群的抗结核治疗方案。方法选取2007年6月～2008年6月收治于南京胸科医院结核科94例存在高危因素的初治菌阳病人,随机分为标化组（46例）与非标化治疗组（48例）,比较药物性肝损发生率及痰菌阴转率。结果 2个月内,非标化治疗组药物性肝损害发生率显著低于标化组（14.6%VS34.8%,P〈0.05）;2个月末,标化组与非标化治疗组：痰集菌阴转率相比差异无统计学意义（65.2%VS64.6%,P〉0.05）,痰结核菌培养阴转率相比差异无统计学意义（60.9%VS60.4%,P〉0.05）。结论对于高危因素人群应制订合理的个体化抗结核治疗方案。     

上海市流动人口的结核病耐药状况及相关因素分析

目的了解上海市流动人口的结核病耐药状况及相关因素，为制定流动人口的结核病控制策略提供依据。方法将上海市各区县结核病定点医院2004年2月至2005年1月诊治的流动人口中所有新发及复治的痰培养阳性肺结核病例作为研究对象，并对所有分离培养阳性菌株进行菌型鉴定及利福平、异烟肼、链霉素及乙胺丁醇敏感性测试，分析流动人口耐药结核病的流行状况及相关因素。结果共入选493例培养阳性肺结核患者，最后获得431例（占87．4％）患者的菌型鉴定及药敏结果，其中结核分枝杆菌427例（占99．1％），非结核分枝杆菌4例（占0．9％）。肺结核患者的总耐药率为18．3％（78／427），耐多药率为5．9％（25／427）；新发患者的耐药率为16．0％（62／387），耐多药率为4．1％（16／387）；复治患者的耐药率为40．0％（16／40），耐多药率为22．5％（9／40）。经单因素及多因素分析，45—60岁年龄组及复治病例是耐药及耐多药结核病的相关因素。结论上海市流动人口的结核病耐药率较高，今后要根据流动人口的特点加强防治措施。     

Epidemiological study of non-communicable diseases (NCD) risk factors in tribal district of Kinnaur,HP: A cross-sectional study

BackgroundThere are no data available on the prevalence of non-communicable diseases (NCD) risk factors among the tribal population of hill state of Himachal Pradesh (HP). The epidemiological study of NCD risk factors was done in the tribal population of district Kinnaur of HP to estimate the burden of NCD risk factors and their risk determinants.MethodsWHO STEP wise approach was used for screening of the core NCD risk indicators in 3582 randomly selected natives of Kinnaur aged 20–70 years by trained Health workers of the district health services.ResultsThe hypertension was prevalent in 19.7% (18.4–21.1%) and diabetes in 6.9% (6.1–7.8%) of the population. Awareness of hypertension and diabetes was 39.8% and 40.8% respectively. The adherence to prescribed medications was reported in 52.1% and 56.4% of patients of aware hypertension and diabetes respectively. Overall, 23.3% and 8.5% of the patients with hypertension and diabetes had controlled BP and blood glucose respectively. Overweight and obesity were observed in 38.2% (36.6–39.9%) and 8.8% (7.9–9.8%) of the population respectively. The consumption of tobacco and alcohol was reported in 22.6% and 24.9% of the population, respectively, and 34.5% were physically inactive. Physical inactivity, BMI, high alcohol consumption, and age were independently associated with risk of hypertension, while age was the only determinant of risk of diabetes. Education and women gender had a significant influence on tobacco and alcohol consumption behavior adjusted for age.ConclusionNCD risk factors are prevalent in the tribal district of Kinnaur. The awareness, treatment, control of blood pressure and blood glucose were found to be suboptimum in the study subjects.InterpretationStrengthening of primary health care services and community based interventions are urgently required to improve awareness and control of NCD risk factors in this tribal district of HP.     

西昌市社区美沙酮维持治疗病人保持治疗影响因素的前瞻性研究

目的对四川省西昌市社区美沙酮维持治疗(MMT)病人长期保持治疗的影响因素进行分析。方法应用前瞻性队列研究的方法,对280名2004年入组治疗病人进行为期6年的随访。采用Log-rank法、Cox比例风险模型等方法,对可能影响治疗保持的人口学特征、既往毒品滥用及治疗情况等因素进行分析。结果 280名研究对象随访期间治疗剂量为(56.7±34.6)毫克/天,治疗保持率为39.6%。不同性别、年龄、职业、居住状况、生活来源、家人关系、首次吸毒年龄、毒品滥用时间、是否注射、是否共针及不同居住地的研究对象,在治疗保持方面的差异无统计学意义。低、中、高剂量组保持率分别为9.1%、36.7%和65.7%(P<0.000 1);尿检阳性率10%及以下、11%-20%、20%以上的保持率分别为47.6%、43.9%和6.0%(P<0.000 1);有无家人也接受MMT的保持率分别为59.4%和33.2%(P<0.000 1)。Cox比例风险模型多因素分析结果显示,治疗剂量高(HR=0.15,P=0.002)、有家人接受MMT治疗(HR=0.61,P=0.024)的研究对象,退出治疗的风险低;尿检阳性率高(HR=2.83,P<0.000 1)者更容易退出治疗。结论高治疗剂量、偷吸毒品及有家人一同治疗等治疗特征,对长期治疗情况有较大影响。因此,通过改善MMT服务质量,提高治疗剂量、减少治疗期间偷吸毒品以降低病人退出治疗的风险,应成为MMT门诊的工作重点。     

青海省耐多药肺结核病危险因素的病例对照研究

目的探讨导致耐多药肺结核病的危险因素,从而为预防和控制耐多药结核病提供依据。方法采用非匹配病例对照研究的方法,以青海省第四人民医院2013年1月-2014年6月的住院肺结核患者为样本框,痰罗氏培养结果为结核分枝杆菌复合群,药敏试验证实异烟肼和利福平同时耐药的患者为病例组;异烟肼和利福平均敏感的患者为对照组。对患者的姓名、年龄、性别、民族、婚姻状况、职业、住房、吸烟史、饮酒、既往治疗是否规律、病例分类(为初治或复治患者)、病变累及肺野数、肺内空洞数、病程、住房通风情况等相关因素做统计分析。结果采取logistic回归方法进行分析,最终耐多药肺结核发生的主要危险因素为复治病人患耐药的风险是初治的5.24倍,95%CI(2.005-14.648);病变范围3个肺野数的患者患耐药的风险是≤3个肺野的0.177倍,95%CI(0.062-0.506);空洞数每上升一个等级,患耐药的风险是原来的7.686倍,95%CI(4.524-13.058)。结论加强对肺结核病例的管理,良好的治疗策略,做好基础DOTS工作,积极发现和治愈初复治结核病人,并针对其他危险因素采取措施对降低耐多药结核病疫情有重要意义。     

耐多药肺结核患者治疗结果及其影响因素调查

目的了解耐多药肺结核患者的治疗结果及其影响因素。方法对纳入项目治疗的患者进行问卷调查,并将相关结果进行病例对照研究。结果 70例接受耐多药治疗的患者中,32例治愈,1例完成疗程;多因素logistic回归分析,年龄>38岁和耐多药治疗前累计服药>15个月是患者未治愈的主要危险因素。结论规范二线药物使用,前移耐多药检测关口和加强患者的治疗管理,对具有治疗失败高风险患者进行个体化调整。     

系统性红斑狼疮患者结核菌感染的临床特点及相关因素分析

目的分析系统性红斑狼疮（SLE）患者结核菌感染的临床表现、特点以及相关危险因素。方法回顾分析了37例SLE结核感染住院患者和65例随机抽取的SLE对照组患者的临床资料．所有患者均有完整的病史、体格检查、实验室等辅助检查的资料。结果在37例SLE结核感染患者中．肺结核13例（35％），肺结核合并其他部位结核者7例，肺外结核17例。与对照组相比，结核感染组的日平均激素的剂量和细胞毒药物使用较高，存两组之间差异有统计学意义，而性别、年龄、病程、白蛋白／球蛋白、补体和激素冲击治疗等方面，两组问差异无统计学意义。讨论SLE患者发生肺外结核感染的机会较大，且日平均激素的剂量和细胞毒药物是SLE患者发生结核感染的危险因素。     

Association of HIV,cardiovascular risk factors,and carotid intimal media thickness: A cross-sectional study in Western Kenya

The carotid intimal media thickness (CIMT) is a validated measure of subclinical atherosclerosis. Human immunodeficiency virus (HIV) is a risk factor for cardiovascular disease (CVD) and has been associated with CIMT in North America and Europe; however, there are limited data from Sub-Saharan Africa (SSA). In this cross-sectional study, we measured CIMT in a cohort of 262 people living with HIV (PLHIV) on antiretroviral therapy (ART) for ≥6 months and HIV-negative adults in western Kenya. Using linear regression, we examined the associations between CVD risk factors and CIMT, both overall and stratified according to the HIV status. Among the PLHIV, we examined the association between CIMT and HIV-related factors. Of 262 participants, approximately half were women. The HIV-negative group had a higher prevalence of age ≥55 years (P = .002), previously diagnosed hypertension (P = .02), treatment for hypertension (P = .03), and elevated blood pressure (BP) (P = .01). Overall prevalence of carotid plaques was low (15/262 [6.0%]). HIV-positive status was not significantly associated with a greater mean CIMT (P = .19). In multivariable regression models, PLHIV with elevated blood pressure or treatment for hypertension had a greater mean CIMT (P = .002). However, the CD4 count, viral load, and ART regimen were not associated with differences in CIMT. In the HIV-negative group, older age (P = .006), high total cholesterol levels (P = .01), and diabetes (P = .02) were associated with a greater mean CIMT. In this cross-sectional study of Kenyan adults, traditional CVD risk factors were found to be more prevalent among HIV-negative participants. After multivariable regression analysis, we found no association between HIV status and CIMT, and PLHIV had fewer CVD risk factors associated with CIMT than HIV-negative participants did. HIV-specific factors were not associated with the CIMT.     

滨州市流动人口的结核病耐药状况及相关因素分析

目的了解滨州市流动人口的结核病耐药状况及相关因素。方法将滨州市各区县结核病定点医院2004年2月至2005年1月诊治的流动人口中所有新发及复治的痰培养阳性肺结核病例作为研究对象,并对所有分离培养阳性菌株进行菌型鉴定及药物敏感性测试,分析流动人口耐药结核病的流行状况。结果所入选493例培养阳性肺结核患者,最后获得431例（占87.4%）患者的菌型鉴定及药敏结果,其中结核分枝杆菌427例（占99.1%）,非结核分枝杆菌4例（占0.9%）。肺结核患者的总耐药率为18.3%（78/427）,耐多药率为5.9%（25/427）;新发患者的耐药率为16.0%（62/387）,耐多药率为4.1%（16/387）;复治患者的耐药率为40.0%（16/40）,耐多药率为22.5%（9/40）。结论滨州市流动人口的结核病耐药率较高,要加强防治措施。     

Health literacy and its socio-demographic risk factors in Hebei: A cross-sectional survey

This study aimed to evaluate the prevalence of low health literacy in Hebei Province of China, and to investigate its socio-demographic risk factors.This study was a community-based, cross-sectional questionnaire survey with a multiple-stage randomization design and a sample size of 10,560. Participants’ health literacy status was evaluated by a questionnaire based on the 2012 Chinese Resident Health Literacy Scale. Meanwhile, participants’ socio-demographic characteristics were also collected by the questionnaire.A total of 9952 participants provided valid questionnaires and were included in the final analyses. The mean health literacy score was 63.1 ± 17.1 points; for its subscales, the mean basic knowledge and concepts score, lifestyle score, health-related skills score were 31.7 ± 9.0, 17.2 ± 4.8, 14.3 ± 4.1, respectively. Meanwhile, low health literacy prevalence was 81.0%; for its subscales, low basic knowledge and concepts prevalence (70.6%) was numerically reduced compared to low lifestyle prevalence (87.4%) and low health-related skills prevalence (86.1%). Further analyses showed that age, male, and rural area were positively associated, but education level and annual household income were negatively associated with low health literacy prevalence. Further multivariate logistic regression analyses showed that higher age, male, lower education level, lower annual household income, and rural area were closely correlated with the risks of low total health literacy or low health literacy in subscales in Hebei Province.The prevalence of low health literacy is 81.0% in Hebei Province. Meanwhile, higher age, male, lower education level, lower annual household income, and rural area closely associate with low health literacy risk.     

Prevalence,risk factors,and management of uncontrolled hypertension among patients with diabetes: A hospital-based cross-sectional study

AimsThis research examines the prevalence of uncontrolled hypertension and associated risk factors among patients with diabetes in Saudi Arabia.MethodsA hospital-based, cross-sectional study was used in patients with diabetes and hypertension attending outpatient diabetes clinics in King Khaled Hospital and Prince Sultan Center for Health Care in Al-Kharj, Riyadh. Patients’ information, data on hypertension, type of treatment, and comorbidities were captured through electronic medical records. Uncontrolled hypertension was defined as blood pressure (BP) measurements greater than or equal to 140/90 mmHg. Antihypertensive medication use among these patients was analyzed. Multivariate analysis was performed to detect the associated factors of uncontrolled hypertension.ResultsOf 1178 outpatients‬ with diabetes who were included in the study sample, uncontrolled hypertension presented in 846 (71.8%). Most patients were on two antihypertensive medications, and the most frequently used was calcium channel blockers, followed by angiotensin-converting enzyme inhibitors. Individuals most likely to have uncontrolled hypertension were those older than 65 years (OR 1.99, 95%CI: 1.059, 3.77), male (OR = 1.51, 95%CI: 1.031, 2.22), and obese (OR = 2.39, 95%CI: 1.63, 3.504), with two (OR = 3.894, 95% CI: 2.481, 6.114) or three or more comorbidities (OR = 4.020, 95% CI: 2.510, 6.439), and with polypharmacy (OR = 1.814, 95% CI: 1.238, 2.656).ConclusionThe extent of uncontrolled hypertension among patients with diabetes in the study sample was found to be high. Age, sex, obesity, number of comorbidities, and polypharmacy are the most important correlates with increased risk of uncontrolled hypertension.     

Risk factors for in-hospital death in elderly patients over 65 years of age with dementia: A retrospective cross-sectional study

As the population continues to age, dementia is becoming a huge social, economic, and healthcare burden. However, the risk factors for in-hospital death in elderly patients over 65 years of age with dementia are not well understood. Identifying factors that affect their prognosis could help clinicians with scientific decision-making.To examine the risk factors for in-hospital death in elderly patients over 65 years of age with dementia in the Geriatric Department of West China Hospital.In this retrospective, cross-sectional study, we analyzed inpatients aged ≥65 years with dementia between 2010 and 2016 using electronic medical records from the Information Center of West China Hospital. The risk factors for death were assessed using multivariable logistic regression.Out of a total of 2986 inpatients with dementia, 3.4% died. Patient deaths were related to digestive diseases, respiratory diseases, circulatory diseases, urinary diseases, and chronic obstructive pulmonary disease, whereas patient survival was associated with osteoporosis and Parkinson disease. Patients with a mean length of hospital stay of ≥60 days had an increased risk of death (all P <.05). In the multiple logistic regression analysis, age ≥80 years, digestive diseases, respiratory diseases, urinary diseases, diabetes, chronic obstructive pulmonary disease, and ≥7 comorbidities were risk factors for death.Mortality in hospitalized older patients with dementia is low, but some risk factors may be easily ignored. These findings could raise awareness among clinicians and caregivers about risk factors in hospitalized older patients, particularly hospitalized elderly patients with multiple comorbidities. Therefore, to reduce mortality, early prevention and management of potential risks are necessary.     

Hyperlipidemia in Iranian liver transplant recipients: prevalence and risk factors

Background Hyperlipidemia is a metabolic complication after liver transplantation (LT). The aim of this study was to investigate the prevalence and risk factors for developing hyperlipidemia in patients who underwent LT in the Shiraz Organ Transplantation Center. Methods Our patients were 170 liver recipients who underwent LT from 1994 to 2006 in the Organ Transplantation Center of the Shiraz University of Medical Sciences. To perform this study we administered questionnaires, including information about age, sex, body mass index (BMI), underlying liver disease, graft type, immunosuppressive medications, and serum levels of triglycerides and cholesterol, before and 6 months after LT. Serum triglyceride and cholesterol levels were considered elevated if they were >150 mg/dl and >250 mg/dl, respectively. Data were analyzed with SPSS software. Results There were 108 male and 62 female patients, with a mean age of 31.4 ± 13.3 years, and the mean duration of follow-up was 25.9 ± 23.5 months. The average pretransplant serum triglyceride and cholesterol (mean of individual means) levels were 104.6 ± 73.2 and 109.5 ± 51.5 mg/dl, respectively, and the average posttransplant levels were 230.1 ± 131 and 185 ± 77 mg/dl, respectively. Six months after LT, 119 (70%) and 26 (15.3%) patients developed hypertriglyceridemia and hypercholesterolemia, respectively. Age, sex, BMI, and underlying liver disease were not predictors of hypertriglyceridemia or hypercholesterolemia (P > 0.05). Posttransplant hypertriglyceridemia was significantly more common in patients receiving tacrolimus than in those receiving cyclosporine (P = 0.040), but posttransplant hypercholesterolemia had no significant correlation with type of immune suppression (P > 0.05). Conclusions Hyperlipidemia was common after LT, and hypertriglyceridemia was more common than hypercholesterolemia. Among all risk factors, tacrolimus therapy was correlated with development of hypertriglyceridemia after LT.