涂阳肺结核患者2月末痰菌阳性的影响因素分析
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摘要
目的探讨涂阳结核病患者治疗2个月末痰检阳性的相关影响因素,为结核病患者的规范治疗、管理、监测提供参考。方法以2007-2017年乌鲁木齐市涂阳肺结核患者为研究对象,描述不同人口学特征、临床特征患者的2个月末痰检持续阳性率。采用多因素logistics回归进行影响因素分析,结果 6 714例涂阳结核病患者中,429例患者治疗2个月末痰检持续阳性,阳性率为6.4%。多因素logistics回归分析结果显示:高龄(OR=1.602)、肺部有空洞(OR=1.744)、复治(OR=1.627)、以及"三位一体"规范化管理模式实施前(OR=1.346)与2月末痰检持续阳性存在正关联(P<0.05);结论结核病患者强化治疗2个月后痰抗酸杆菌检查是评估患者治疗与结局转归的重要指标之一。加强中老年、肺部空洞、复治患者的管理、治疗和监测,及早发现不良治疗指征,有利于加强结核病的防控和完善其管理策略。
Objective To explore the influencing factors associated with persistent sputum positive at the end of two months of treatment of smear-positive pulmonary tuberculosis(PTB) patients, and provide reference for standardized treatment,management and monitoring of TB patients. Methods Taking smear positive PTB patients in Urumqi as a research object from 2007 to 2017, and to compare the differences in the positive rate of sputum examination at the end of 2 months in patients with different demographic characteristics and clinical features. Influencing factors for persistent sputum positive TB were evaluated using multivariate logistic regression model. To compare the difference in treatment outcome between patients with persistent sputum positive and those with negative conversion. Results Of the 6714 patients with smear-positive tuberculosis, 429 patients continued to be positive at the end of 2 months, with a positive rate of 6.4%. The multivariate logistic regression analysis shows that older people(OR=1.602), lung cavity(OR=1.744), retreatment(OR=1.627), and before the implementation of the "Trinity" standardized management model(OR=1.346) were associated with persistent sputum positive at the end of 2 months of treatment(P <0.05). Conclusion The anti-acid bacillus examination of tuberculosis patients after 2 months of intensive treatment is one of the important indicators to evaluate the treatment outcome of patients. Strengthen the management, treatment and monitoring of middle and old aged patients, patients with lung cavity and re-treatment patients,and early detection of poor treatment indications. It is conducive to strengthen the prevention and control of tuberculosis and improve its management strategy.
Objective To explore the influencing factors associated with persistent sputum positive at the end of two months of treatment of smear-positive pulmonary tuberculosis(PTB) patients, and provide reference for standardized treatment,management and monitoring of TB patients. Methods Taking smear positive PTB patients in Urumqi as a research object from 2007 to 2017, and to compare the differences in the positive rate of sputum examination at the end of 2 months in patients with different demographic characteristics and clinical features. Influencing factors for persistent sputum positive TB were evaluated using multivariate logistic regression model. To compare the difference in treatment outcome between patients with persistent sputum positive and those with negative conversion. Results Of the 6714 patients with smear-positive tuberculosis, 429 patients continued to be positive at the end of 2 months, with a positive rate of 6.4%. The multivariate logistic regression analysis shows that older people(OR=1.602), lung cavity(OR=1.744), retreatment(OR=1.627), and before the implementation of the "Trinity" standardized management model(OR=1.346) were associated with persistent sputum positive at the end of 2 months of treatment(P <0.05). Conclusion The anti-acid bacillus examination of tuberculosis patients after 2 months of intensive treatment is one of the important indicators to evaluate the treatment outcome of patients. Strengthen the management, treatment and monitoring of middle and old aged patients, patients with lung cavity and re-treatment patients,and early detection of poor treatment indications. It is conducive to strengthen the prevention and control of tuberculosis and improve its management strategy.
引文
[1]Singla R,Bharty SK,Gupta UA,et al.Sputum smear positivity at two months in previously untreated pulmonary tuberculosis patients[J].International Journal of Mycobacteriology,2013,2(4):199-205.
[2]潘稚芬,高跃中.1319例涂阳肺结核患者化疗2个月后痰检结果评价及影响因素分析[J].中国初级卫生保健,2010,24(9):56-57.
[3]Evangelista MD,Maia R,Toledo JP,et al.Second month sputum smear as a predictor of tuberculosis treatment outcomes in Brazil[J].BMC Research Notes,2018,11(1):414.
[4]古丽娜·巴德尔汗,贾卫,阿依努尔·莫合买提,等.2009-2014年新疆涂阳肺结核病患者的治疗转归分析[J].疾病预防控制通报,2016,(4):13-15.
[5]谢美凤,赖世锋,连盛添.武平县“三位一体”结核病防治模式实施效果分析[J].预防医学论坛,2018,24(1):70-72.
[6]Djouma FN,Noubom M,Ateudjieu JA.Delay in sputum smear conversion and outcomes of smear-positive tuberculosis patients:a retrospective cohort study in Bafoussam,Cameroon[J].BMC Infectious Diseases,2015,15(1):139.
[7]Kigozi NG,Chikobvu P,Heunis JC,et al.A retrospective analysis of two-month sputum smear non-conversion in new sputum smear positive tuberculosis patients in the Free State Province,South Africa[J].Journal of Public Health in Africa,2014,5(2):324.
[8]Mlotshwa M,Abraham N,Beery M,et al.Risk factors for tuberculosis smear non-conversion in Eden district,Western Cape,South Africa,2007-2013:a retrospective cohort study[J].BMC Infectious Diseases,2016,16(1):365.
[9]梁冰,何庆秋,黄瑞霞,等.复治涂阳肺结核患者化疗后2个月末痰涂片阴转与未阴转情况分析[J].中国防痨杂志,2013,35(12):965-968.
[10]郭婉如,周琳,何超文,等.影响初治涂阳肺结核治疗2月末痰仍阳性的因素分析[J].临床肺科杂志,2014,(6):1049-1051,1052.
[2]潘稚芬,高跃中.1319例涂阳肺结核患者化疗2个月后痰检结果评价及影响因素分析[J].中国初级卫生保健,2010,24(9):56-57.
[3]Evangelista MD,Maia R,Toledo JP,et al.Second month sputum smear as a predictor of tuberculosis treatment outcomes in Brazil[J].BMC Research Notes,2018,11(1):414.
[4]古丽娜·巴德尔汗,贾卫,阿依努尔·莫合买提,等.2009-2014年新疆涂阳肺结核病患者的治疗转归分析[J].疾病预防控制通报,2016,(4):13-15.
[5]谢美凤,赖世锋,连盛添.武平县“三位一体”结核病防治模式实施效果分析[J].预防医学论坛,2018,24(1):70-72.
[6]Djouma FN,Noubom M,Ateudjieu JA.Delay in sputum smear conversion and outcomes of smear-positive tuberculosis patients:a retrospective cohort study in Bafoussam,Cameroon[J].BMC Infectious Diseases,2015,15(1):139.
[7]Kigozi NG,Chikobvu P,Heunis JC,et al.A retrospective analysis of two-month sputum smear non-conversion in new sputum smear positive tuberculosis patients in the Free State Province,South Africa[J].Journal of Public Health in Africa,2014,5(2):324.
[8]Mlotshwa M,Abraham N,Beery M,et al.Risk factors for tuberculosis smear non-conversion in Eden district,Western Cape,South Africa,2007-2013:a retrospective cohort study[J].BMC Infectious Diseases,2016,16(1):365.
[9]梁冰,何庆秋,黄瑞霞,等.复治涂阳肺结核患者化疗后2个月末痰涂片阴转与未阴转情况分析[J].中国防痨杂志,2013,35(12):965-968.
[10]郭婉如,周琳,何超文,等.影响初治涂阳肺结核治疗2月末痰仍阳性的因素分析[J].临床肺科杂志,2014,(6):1049-1051,1052.