短化后复发肺结核的流行病学影响因素分析

目的　探讨河南省结核病控制项目短程督导化疗后肺结核复发的流行病学情况及其影响因素。方法 追踪河南省结核病控制项目治疗管理的涂阳肺结核病人,了解细菌学复发情况。结果 随访观察的涂阳肺结核患者经河南省结核病控制项目短程督导化疗方案治愈后复发率为3.12%；治疗后2、3个月及以后痰菌阴转的患者复发率分别是2.1%、4.2%和8.8%(P＜0.01)；初、复治患者复发率分别为2.4%、4.7%(P＜0.01)；不同年龄别复发率差异有显著性(P＜0.01)；不同职业复发率差异有显著性(P＜0.01)；年龄、肺部空洞型病灶、家庭经济贫困及痰菌阴转时间是复发的危险因素,遵守医嘱规则服药是保护性因素。结论 河南省结核病控制项目病人短程督导化疗后复发率与痰菌阴转时间高度相关,治愈后1年内复发率最高,完成疗程应随访观察1年。家庭经济贫困以及老年空洞型肺结核患者是复发的高危人群,应作为重点随访对象。

Analysis on the epidemic characteristic of tuberculosis relapsed after short-course chemotherapy

objective To reveal the epidemiology characteristic and the risk factors in the relapse tuberculosis cases after received short-course chemotherapy. Method To follow-up the cured cases in tuberculosis control project supported by Henan provincial government and to identify the relapse cases within three years. Results The relapse rate with sputum positive tuberculosis in Henan tuberculosis control project was 3.12%, and the relapse rate in cases whose sputum smear converted negative in two months, three months and over three months with chemotherapy were 2.13%, 4.23% and 8.85% respectively (P<0.01). There was no significant difference among the cases with the quantity eliminated sputum tubercle bacillus. Conclusion It was a risk factor to recur that the time converted negative for tubercle bacillus in sputum of tuberculosis with chemotherapy. The longer time converted sputum smear negative, the higher relapsed rate. But there was no significant difference between male and female. There was no effect-reaction relationship in tubercular bacillus quantity eliminated by tuberculosis case in sputum. It was reasonable and feasible that the cases were followed up for one year after cured with finishing full course chemotherapy . The poverty and elder TB patients with cavity was high risk population to relapse, so it must be stressed to follow up them.