2016—2018年喀什地区初治涂阳肺结核患者治疗效果及其影响因素分析

目的 探索喀什地区初治涂阳肺结核患者治疗效果及其影响因素,以提高治疗成功率并为制定适宜的干预措施提供参考。方法 采用分层整群抽样法,抽取喀什地区12个县(市)结核病定点医疗机构在2016—2018年期间登记治疗且已完成规定抗结核疗程的4970例初治涂阳肺结核患者中的240例作为研究对象,231例患者完成问卷调查、现场访谈及个案调查分析。收集患者的一般人口学资料、服药管理、治疗转归和不良反应等信息,采用单因素和多因素logistic回归模型分析纳入患者的治疗效果及其影响因素。结果 231例完成调查的研究对象中,治疗成功率为77.49%(179/231)。多因素logistic回归分析结果显示:患者体质量指数(BMI)18.50~24.00(OR=0.036,95%CI:0.002~0.700)、2个月末痰涂片阴性(OR=0.054,95%CI:0.003~0.930)、5个月末痰涂片阴性(OR=0.003,95%CI:0.000~0.057)、按剂量服药(OR=0.013,95%CI:0.001~0.107)、规律服药(OR=0.077,95%CI:0.022~0.268)、知晓肺结核的主要传播途径(OR=0.076,95%CI:0.008~0.768)和知晓治疗多久后可以停药(OR=0.254,95%CI:0.074~0.875)是影响初治涂阳肺结核患者治疗效果的保护因素。结论 喀什地区初治涂阳肺结核患者治疗成功率较低,与患者营养状况、随访痰检结果、按剂量规律服药及患者自身防治意识等因素有关。应进一步加强喀什地区初治涂阳肺结核患者的治疗管理、营养支持和健康宣教工作,以提高初治涂阳肺结核患者的治疗成功率。

Analysis on the therapeutic effect and influencing factors of initial treated smear-positive pulmonary tuberculosis patients in Kashgar Prefecture from 2016 to 2018

Objective To explore the treatment effect and influencing factors of initial treated smear-positive pulmonary tuberculosis patients in Kashgar Prefecture, and to improve the treatment success rate and provide references for formulating appropriate intervention measures. Methods With stratified cluster sampling method, 240 out of 4970 initial treated smear-positive pulmonary tuberculosis patients who were registered at tuberculosis designated hospitals in Kashgar Prefecture from 2016 to 2018 and completed treatment were selected as the research objects, 231 patients completed questionnaire survey, on-site interview and case investigation analysis. General demographic data, medication management, treatment outcomes and adverse reactions were collected. Univariate and multivariate logistic regression models were used to analyze the treatment effect and its influencing factors of the enrolled patients. Results Among the 231 cases who completed the survey, 179 cases were successfully treated (77.49%, 179/231). Multivariate logistic regression analysis showed that BMI 18.50-24.00 (OR=0.036, 95%CI: 0.002-0.700), sputum smear negative after two months treatment (OR=0.054, 95%CI: 0.003-0.930), sputum smear negative after five months treatment (OR=0.003, 95%CI: 0.000-0.057), taking medication according to the dose (OR=0.013, 95%CI: 0.001-0.107), regular medication (OR=0.077, 95%CI: 0.022-0.268), knowing the route of transmission of tuberculosis (OR=0.076, 95%CI: 0.008-0.768) and when the treatment can be stopped (OR=0.254, 95%CI: 0.074-0.875) were the protective factors for the treatment effect of patients. Conclusion The treatment success rate of initial treated smear-positive pulmonary tuberculosis patients in Kashgar Prefecture is relatively low, which is related to the nutritional status of patients, follow-up sputum examination results, medication according to the dose and schedule, and the patients’ awareness of prevention and treatment. The treatment management, nutritional support and health education of initial treated smear-positive pulmonary tuberculosis patients in Kashgar Prefecture should be further strengthened to improve the treatment success rate of the initial treated smear-positive pulmonary tuberculosis patients.