2016—2020年广州市耐药结核病患者不良治疗结局状况及其影响因素分析

目的: 分析广州市耐药结核病患者不良治疗结局状况及其相关影响因素。 方法: 采用回顾性队列研究的方法,从《中国结核病管理信息系统》中导出2016年1月1日至2020年12月31日在广州市胸科医院登记治疗的符合选例要求的677例耐药结核病患者病案数据,分析不良治疗结局的发生情况及其影响因素。 结果: 677例研究对象中,193例(28.5%)治疗成功、280例(41.4%)在治、204例(30.1%)出现了不良治疗结局(包括13例因发生不良反应停止治疗、9例失败、32例死亡、150例失访)。其中,发生不良治疗结局患者的中位生存时间为729d。基于完整数据集的Cox模型多因素分析显示:广州市外户籍、合并糖尿病、省间流动和年龄增长是耐药结核病患者发生不良治疗结局的危险因素分别为HR(95%CI)=1.74(1.21~2.49),P=0.002;HR(95%CI)=1.59(1.10~2.32),P=0.015;HR(95%CI)=2.29(1.26~4.18),P=0.007;HR(95%CI)=1.01(1.00~1.03),P=0.011],耐多药是保护因素HR(95%CI)=0.53(0.36~0.79),P=0.002]。 结论: 耐药结核病患者的不良治疗结局发生率较高,应加强对耐药结核病患者的治疗和长期管理,特别是其中合并糖尿病、流动自外省、年龄更大、因户籍所限不能享受本市医疗优惠待遇的患者。

Analysis of adverse treatment outcomes and influencing factors of drug-resistant tuberculosis patients in Guangzhou from 2016 to 2020

Objective: To analyze the status of adverse treatment outcomes and influencing factors of drug-resistant tuberculosis patients in Guangzhou. Methods: A retrospective cohort study was conducted in 677 drug-resistant tuberculosis patients registered and treated in Guangzhou Chest Hospital from January 1, 2016 to December 31, 2020. The medical record of them were from the China Tuberculosis Management Information System. And the occurrence and influencing factors of adverse treatment outcomes were analyzed. Results: Of the 677 patients, 193 (28.5%) were successfully treated, 280 (41.4%) were under treatment, 204 (30.1%) had adverse treatment outcomes (13 stopped treatment adverse reactions, 9 failed, 32 died, and 150 failed to be followed up), and the median survival time for patients with adverse treatment outcomes was 729 days. Multivariate Cox model analysis showed that non-Guangzhou registration, complicated with diabetes, interprovincial mobility and older age were risk factors of adverse treatment outcomes in drug-resistant TB patients (HR (95%CI)=1.74 (1.21-2.49), P=0.002; HR (95%CI)=1.59 (1.10-2.32), P=0.015; HR (95%CI)=2.29 (1.26-4.18), P=0.007; HR (95%CI)=1.01 (1.00-1.03), P=0.011, respectively), and multidrug resistance was a protective factor (HR (95%CI)=0.53 (0.36-0.79), P=0.002). Conclusion: The incidence of adverse treatment outcomes in drug-resistant tuberculosis patients was high, and the treatment and long-term management of drug-resistant tuberculosis patients should be strengthened, especially those who complicated with diabetes, moved from other provinces, had an older age and could not enjoy preferential medical treatment in the city due to registered residence registrations.