【摘要】 目的 分析2021—2023年我国利福平敏感肺结核合并尘肺患者不良转归情况及影响因素，为完善结核病合并尘肺患者防控策略提供依据。方法 收集2021—2023年在“全民健康保障信息化工程疾病预防控制信息系统”结核病子系统中登记的全国肺结核合并尘肺患者病例信息。采用描述流行病学方法对利福平敏感患者的转归情况进行分析，采用多因素logistic回归对不良转归的影响因素进行分析。结果 2021—2023年全国共登记利福平敏感肺结核合并尘肺患者7 730例，纳入治疗7 710例（99.74%）。总体不良转归766例（9.94%）。出现不良转归的患者中，非结核死亡413例（53.92%），失访121例（15.80%），治疗失败84例（10.96%），因结核死亡37例（4.83%）。多因素logistic回归分析显示，年龄≥65岁（a OR=2.83,95%CI:1.11～7.24）、复治（a OR=1.55,95%CI:1.22～1.96）、2月末痰检结果为阳性（a OR=2.23,95%CI:1.63～3.06）或未评估（a OR=14.50,95%CI:11.96～17.59）、未使用固定剂量复合制剂（fixed-dose combination, FDC）(a OR=1.24, 95%CI:1.01～1.52)、服药情况未知（a OR=3.32,95%CI:1.10～10.03）或未规则服药（a OR=4.53,95%CI:3.53～5.80）是患者出现不良转归的独立危险因素。家务及待业（a OR=0.68, 95%CI:0.50～0.92）和其他职业（a OR=0.45, 95%CI:0.23～0.88）、未患其他合并症（a OR=0.76,95%CI:0.60～0.95）、未发生不良反应（a OR=0.38,95%CI:0.21～0.69）是降低不良转归风险的保护性因素。结论 我国利福平敏感肺结核合并尘肺患者的不良转归率高于一般肺结核患者。≥65岁老年人、复治、2月末痰检未转阴、治疗期间未使用FDC或未规则服药的患者是应重点关注的高风险人群。更多还原

【Abstract】 Objective To analyze the adverse outcomes and influencing factors in patients with rifampicinsensitive pulmonary tuberculosis(PTB) complicated by pneumoconiosis in China from 2021 to 2023, and to provide a basis for improving the prevention and control strategies for dust-exposed individuals. Methods Data on patients with PTB and pneumoconiosis registered in "Disease Control and Prevention Information System of the National Health Informatization Project" from 2021 to 2023 were collected. Descriptive epidemiological methods were used to analyze the outcomes of rifampicin-sensitive patients, while multivariable logistic regression was used to identify factors influencing adverse outcomes. Results A total of 7 730 cases of rifampicin-sensitive PTB patients complicated by pneumoconiosis were registered nationwide from 2021 to 2023, with 7 710 cases(99. 74%) included in treatment analysis. The overall adverse outcome was 766 cases(9. 94%). Among patients with adverse outcomes, non-tuberculous death accounted for 413 cases(53. 92%), loss to follow-up for 121 cases(15. 80%), treatment failures for 84 cases(10. 96%), and tuberculosis-related death for 37 cases(4. 83%). Multivariable logistic regression analysis revealed that aged over 65 years(a OR=2. 83, 95%CI:1. 11-7. 24), retreatment(a OR=1. 55, 95%CI:1. 22-1. 96), positive sputum smear result at the end of the second month(a OR=2. 23, 95%CI:1. 63-3. 06), or without evaluation( a OR=14. 50, 95%CI:11. 96-17. 59), not using fixed-dose combination(FDC) therapy(a OR: 1. 24, 95%CI: 1. 01-1. 52), unknown medication adherence(a OR=3. 32, 95%CI=1. 10-10. 03), or irregular medication use(a OR=4. 53, 95%CI:3. 53-5. 80) were independent risk factors for adverse outcomes. Protective factors that reduced the risk of adverse outcomes included being a homemaker or unemployed(a OR=0. 68, 95%CI: 0. 50-0. 92) and having other occupations(a OR=0. 45, 95%CI: 0. 23-0. 88). Additionally, not having other comorbidities(a OR=0. 76, 95%CI:0. 60-0. 95) and not experiencing adverse reactions(a OR=0. 38, 95%CI:0. 21-0. 69) were also protective factors. Conclusions The adverse outcome rate among patients with rifampicin sensitive PTB complicated by pneumoconiosis in China is higher than that of general PTB patients. Individuals aged ≥65 years, those undergoing retreatment, patients with positive sputum results at the end of February, and those not using FDC or exhibiting irregular medication adherence should be prioritized as high-risk groups for monitoring.更多还原