摘要
目的 了解江苏省徐州市两县（丰县、沛县）和新疆乌鲁木齐市涂阳肺结核患者诊治过程中是否完成全程痰涂片检查和治疗转归,分析人口学、社会学和疾病临床进展对患者治疗结局的影响。方法 采用前瞻性队列研究方法,对徐州市丰县、沛县和乌鲁木齐市2014—2016年确诊的涂阳肺结核患者进行随访,收集患者治疗过程信息和治疗结局。应用SPSS 22.0软件进行统计分析,计数资料用构成比进行描述,组间比较采用卡方检验或Fisher精确概率检验,多因素分析采用两分类logistic回归,以P值小于0.05为差异有统计学意义。研究共有574例涂阳肺结核患者纳入分析,平均年龄（46±20.8）岁,男性420例（73.2%）,其中徐州市两县患者265例（46.2%）,乌鲁木齐市患者309例（53.8%）。结果 574例涂阳肺结核患者的治疗成功率为88.2%（506/574）,包括391例治愈和115例完成治疗。徐州市丰县、沛县涂阳肺结核患者的治疗成功率明显高于乌鲁木齐市（徐州丰县、沛县：92.8%,246/265,乌鲁木齐：84.1%,260/309,χ2=10.310,P=0.001）。治疗随访期间,有48例（8.4%,48/574）涂阳肺结核患者未完成全程痰涂片检查。单因素分析结果显示,男性（χ2=4.342,P=0.037）、外地户籍（χ2=5.646,P=0.017）及治疗第2个月末痰涂片未阴转（Fisher精确概率检验：P=0.000）的涂阳患者中,发生不良治疗结局的比率明显高于女性、本地户籍及治疗第2个月末痰涂片阴转患者。多因素分析结果显示,男性和治疗第2个月末痰涂片未阴转（OR=6.892,95%CI＝3.218～14.762,P=0.000）的涂阳肺结核患者治疗不成功的风险明显高于女性（OR=0.329,95%CI=0.121～0.898,P=0.030）和治疗第2个月末痰涂片阴转患者。结论 徐州市丰县、沛县涂阳肺结核患者的治疗成功率高于乌鲁木齐市;男性和治疗第2个月末痰涂片未阴转将增加不良结局发生风险。
Objective This study aimed to understand the normalization of the sputum smear monitoring during anti-tuberculosis treatment, and to investigate treatment outcomes and associated factors among smear-positive pulmonary tuberculosis patients in two counties （Feng County and Pei County） of Xuzhou （Jiangsu Province） and Urumqi （Xinjiang Uygur Autonomous Region）. Methods A prospective cohort study was conducted to collect the follow-up information and treatment outcomes of smear-positive tuberculosis patients diagnosed from 2014 to 2016 in Feng County and Pei County of Xuzhou and Urumqi. All statistical analyses were performed using SPSS software 22.0. The categorical data was described using proportions. Differences of two groups were compared using Pearson chi-square test or Fisher’s exact test. Multivariable analysis was conducted using binary logistic regression. A two-sided P value 〈0.05 was considered statistically significant. A total of 574 smear-positive pulmonary tuberculosis patients were included in this study, with an average age of （46±20.8） years old. Among all the subjects, 420 （73.2%） were males, 265 （46.2%） were from two counties of Xuzhou and 309 （53.8%） were from Urumqi. Results The treatment success proportion for 574 study participants was 88.2% （506/574）, including 391 patients who were cured and 115 patients who completed the treatment, and the proportion in Feng County and Pei County of Xuzhou was significantly higher than in Urumqi （Feng County and Pei County： 92.8%, 246/265, Urumqi： 84.1%, 260/309, χ2=10.310, P=0.001）. A total of 48 （8.4%, 48/574） smear-positive patients missed at least one sputum smear test during treatment. Univariate analysis indicated that the proportions of adverse treatment outcomes among males （χ2=4.342, P=0.037）, non-local residents （χ2=5.646, P=0.017） and patients with smear non-conversion after 2-month treatment （Fisher’s exact test： P=0.000） were significantly higher than females, local residents and patients with smear conversion after 2-month treatment. Multivariable analysis indicated that the risk for adverse treatment outcomes of smear-positive pulmonary tuberculosis among males and patients with smear non-conversion after 2-month treatment （OR=6.892, 95%CI=3.218-14.762, P=0.000） was significantly higher than females （OR=0.329, 95%CI=0.121-0.898, P=0.030） and patients with smear conversion after 2-month treatment. Conclusion The treatment success proportion among smear-positive tuberculosis patients was higher in two counties of Xuzhou than in Urumqi. Males and smear non-conversion after 2-month treatment will increase the risk of adverse treatment outcomes.
出处
《中国防痨杂志》
CAS
2018年第1期98-105,共8页
Chinese Journal of Antituberculosis
基金
国家自然科学基金（81361138019）
关键词
结核
肺
小地区分析
治疗结果
结果评价(卫生保健)
因素分析
统计学
Tuberculosis, pulmonary, Small-area analysis, Treatment outcome, Outcome assessment （Health care）, Factor analysis, statistical
