【摘要】 目的 探讨影响涂阳肺结核患者治疗失败的危险因素,为制定提高涂阳肺结核患者治愈率的相关政策提供科学依据。方法 选择2008-2010年我国8个省(市、自治区)49个结核病定点医疗机构治疗的年龄大于15岁的涂阳肺结核患者,其中治愈和治疗失败的涂阳肺结核患者共1803例,包括治愈患者1641例,治疗失败患者162例。运用卡方检验和Fisher精确概率法比较治愈和治疗失败患者在人口学特征、痰结核分枝杆菌检验结果、管理方式等方面的差异,检验水准为0.05,同时采用非条件logistic回归分析影响患者治疗失败的相关因素。结果 涂阳肺结核患者治疗失败构成比为9.0%(162/1803),治愈构成比为91.0%(1641/1803)。多因素logistic回归结果显示,年龄组45~64岁和≥65岁、复治、漏服药、1个月末及2个月末培养阳性、耐药的结核病患者是治疗失败的危险因素,OR(95%CI)值分别为3.426(1.720~6.825)和3.375(1.534~7.425)、2.037(1.326~3.129)、1.905(1.202~3.021)、2.937(1.872~4.607)、3.288(2.126~5.084)和2.317(1.381~3.889)。结论 老年人、不规律服药、复治、耐药、1个月末及2个月末痰培养阳性是治疗失败的危险因素,在肺结核的治疗过程中,对以上因素进行评估和主动干预,对于发现和有效降低患者治疗失败的风险有着非常重要的意义。更多还原

【Abstract】 Objective To explore the risk factors causing treatment failure in smear-positive pulmonary tuberculosis(PTB) patients,and thus provide evidences for the development of policies on increasing the cure rate of smear-positive PTB patients.Methods Forty-nine designated TB institutions in 8 provinces were involved in this study.A total of 1803 smear-positive PTB patients above age 15-year old who were registered at the 49 designated TB facilities from October 2008 to December 2010 and had treatment outcomes of cure or failure were recruited for analysis,including 1641 cured cases and 162 treatment failure cases.The demographic characteristics,bacteriological examination results and treatment management methods of the patients in the cured group and the treatment failure group were analyzed and compared using Chi-square test and Fisher’s exact test.P<0.05 was considered to be statistically significant.Meanwhile,multivariate logistic regression analysis was also used to explore the risk factors of treatment failure.Results In the PTB patients recruited for analysis,the proportion of treatment failure cases and cured cases was 9.0%(162/1803) vs.91.0%(1641/1803).Multivariate logistic regression analysis results showed that the treatment failure was significantly associated with age 45- 64 and ≥65,retreatment,poor treatment adherence,non-conversion of sputum culture at the end of first and second month treatment,as well as drug resistance;the OR(95%CI) related to the above mentioned factors was 3.426(1.720-6.825) and 3.375(1.534-7.425),2.037(1.326-3.129),1.905(1.202-3.021),2.937(1.872-4.607) and 3.288(2.126-5.084),as well as 2.317(1.381- 3.889) respectively.Conclusion The following factors can be the risks causing treatment failure of TB patients:age 45 and above,irregular medication,retreatment,drug resistance and sputum culturepositive at the end of first and second month treatment.If the assessment to those risk factors can be conducted and the proper interventions can be adopted in the PTB patients during their treatment,it would have great significance in identifying those risk factors and reducing treatment failure of the patients.更多还原