贵州省2014―2020年耐多药结核病患者三类治疗延迟现况及其影响因素

王芸; 陈慧娟; 禄晓龙; 杨敬源

doi:10.16462/j.cnki.zhjbkz.2022.11.008

贵州省2014―2020年耐多药结核病患者三类治疗延迟现况及其影响因素

doi: 10.16462/j.cnki.zhjbkz.2022.11.008

王芸^{1, 2},
陈慧娟^3, ,,
禄晓龙⁴,
杨敬源²

1.
550025 贵阳，贵州医科大学环境污染与疾病监控教育部重点实验室环境感染性疾病研究室
2.
550025 贵阳，贵州医科大学公共卫生与健康学院流行病与卫生统计学系
3.
550004 贵阳，贵州省疾病预防控制中心结核病防治研究所
4.
550025 贵阳，贵州医科大学医药卫生管理学院卫生经济学教研室

基金项目:

国家自然科学基金 81860591

贵州医科大学博士科研启动基金 2020-070

详细信息

通讯作者:
陈慧娟，E-mail: 1724263938@qq.com

中图分类号: R521; R183
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- 被引次数: 0
出版历程
- 收稿日期: 2021-07-28
- 修回日期: 2022-01-17
- 网络出版日期: 2022-12-21
- 刊出日期: 2022-11-10

Three types of treatment delay and influencing factors among Multidrug-resistant Tuberculosis patients in Guizhou Province, 2014-2020

1.
Laboratory of Environmental Infectious Diseases, Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 550025, China
2.
Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guiyang 550025, China
3.
Research Institute for Prevention and Control of Tuberculosis, Guizhou Center for Disease Control and Prevention, Guiyang 550004, China
4.
Department of Health Economics, School of Medicine and Health Management, Guizhou Medical University, Guiyang 550025, China

Funds:

National Natural Science Foundation of China 81860591

Doctor Initiation Fund of Guizhou Medical University 2020-070

More Information

Corresponding author: CHEN Hui-juan, E-mail: 1724263938@qq.com

摘要

摘要: 目的分析贵州省2014―2020年耐多药结核病(multidrug-resistant tuberculosis, MDR-TB)患者三类治疗延迟现况及影响因素。方法从“结核病管理信息系统”中收集患者信息；趋势χ²检验分析率随时间变化趋势；χ²检验和多因素logistic回归分析模型用于延迟因素分析。根据患者治疗延迟天数将其分为三类：第I类(延迟>1 d)、第II类(延迟>7 d)和第III类(延迟>14 d)。结果 2014―2020年贵州省登记的1 309例MDR-TB患者中第I、II和III类治疗延迟率分别为43.6%、30.0%和22.7%。三类延迟率均随时间变化呈总体下降趋势(均有P＜0.001)。但2019年12月―2020年延迟率较以往有所升高，其中2019年12月延迟率最高达47%；2020年总体延迟率较2019年上升。农民、有固定职业、来自毕节市诊疗机构、采用传统药物敏感性试验诊断、既往接受过抗结核病治疗和确诊时住院治疗的患者更容易发生延迟(均有P＜0.05)。结论贵州省2014―2020年MDR-TB患者三类治疗延迟率均较高，虽呈逐年下降趋势，但自2019年12月起延迟率较以往有所升高。职业、诊疗机构、诊断方式、抗结核病治疗史和确诊时治疗模式是患者治疗延迟的影响因素，应采取综合措施以降低治疗延迟的发生。
- 耐多药结核病 /
- 治疗延迟 /
- 影响因素
Abstract: Objective To analyze the status and influencing factors for three types of treatment delay among multidrug-resistant tuberculosis (MDR-TB) patients in Guizhou Province from 2014 to 2020. Methods Data were collected from the TB Management Information System. χ² trend test was adopted to analyze the rate with time change, meanwhile, univariate analysis with χ² test and multivariate logistic regression analysis were performed to obtain the influencing factors for treatment delay. Participants were classified into three types based on the days of their treatment delay, including type I (>1 day), type II (>7 days) and type III (>14 days). Results The treatment delay rates of type I, II and III among 1 309 MDR-TB patients in Guizhou Province from 2014 to 2020 were 43.6%, 30.0% and 22.7%, respectively. The three types of delay rates showed an overall downward trend with the change of time (all P-values were less than 0.001). However, the delay rate from December 2019 to 2020 was higher than that before, and the highest rate was 47% in December 2019. The overall delay rate increased in 2020 compared with that in 2019. Patients who were farmers, had fixed occupations, were diagnosed with MDR-TB and received treatment in hospital in Bijie City, were diagnosed through traditional drug sensitivity test, received anti-TB treatment in the past and were hospitalized at the time of MDR-TB diagnosis were more likely to experience treatment delay (all P < 0.05). Conclusions The three types of treatment delay rates of MDR-TB patients are high in Guizhou Province from 2014 to 2020. Although the delay rates show a downward trend year by year, they have increased since December 2019. Meanwhile, occupation, diagnosis and treatment institution, diagnosis mode, and anti-TB treatment history and treatment mode at the time of diagnosis are the influencing factors for treatment delay. Comprehensive measures should be taken to reduce the occurrence of treatment delay in Guizhou.
- Multidrug-resistant tuberculosis /
- Treatment delay /
- Influencing factors

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图 1 贵州省2019年与2020年MDR-TB患者第III类治疗延迟率分月比较

Figure 1. Comparison of type III of treatment delay among MDR-TB patients in Guizhou Province in 2019 and 2020 by month

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图 2 贵州省不同地区诊疗机构收治的MDR-TB患者治疗延迟率及不同DST检测方法比例的情况比较

注：^a黔铜六(3州市)为黔西南州、铜仁市和六盘水市的简称。

Figure 2. Comparison of treatment delay and proportion detected by different DST methods among MDR-TB patients admitted to medical institutions in different regions of Guizhou Province

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表 1 2014―2020年贵州省MDR-TB患者的三类治疗延迟发生率及随时间变化趋势[n(%)]

Table 1. Three types of treatment delays with time change among MDR-TB patients in Guizhou Province from 2014 to 2020 [n(%)]

年份(年)	患者总数(例)	第I类治疗延迟	第II类治疗延迟	第III类治疗延迟
2014	86	67(77.9)	54(62.8)	44(51.2)
2015	128	75(58.6)	49(38.3)	31(24.2)
2016	161	98(60.9)	55(34.2)	39(24.2)
2017	183	61(33.3)	38(20.8)	28(15.3)
2018	169	61(36.1)	41(24.3)	27(16.0)
2019	227	81(35.7)	59(26.0)	43(18.9)
2020	355	128(36.1)	97(27.3)	85(23.9)
合计	1 309	571(43.6)	393(30.0)	297(22.7)
χ_趋势²值		98.1	62.5	52.3
P值		＜0.001	＜0.001	＜0.001

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表 2 贵州省MDR-TB患者基本情况及其与三类治疗延迟关联的单因素分析结果[n(%)]

Table 2. The basic information of MDR-TB patients in Guizhou Province and their association with three types of treatment delay by univariate analysis [n(%)]

变量	患者数(例)	第I类			第II类			第III类
变量	患者数(例)	延迟	χ²值	P值	延迟	χ²值	P值	延迟	χ²值	P值
性别			0.09	0.760		0.02	0.876		0.43	0.511
女	392(29.9)	174(44.4)			116(29.6)			94(24.0)
男	917(70.1)	397(43.3)			277(30.2)			203(22.1)
年龄(岁)			6.79	0.034		1.08	0.583		2.01	0.365
＜26	262(20.0)	98(37.4)			72(27.5)			53(20.2)
26~＜60	866(66.2)	399(46.1)			264(30.5)			197(22.7)
≥60	181(13.8)	74(40.0)			57(31.5)			47(26.0)
民族			0.43	0.510		2.08	0.150		3.98	0.046
汉族	1 100(84.0)	475(43.2)			321(29.2)			238(21.6)
少数民族	209(16.0)	96(45.9)			72(34.4)			59(28.2)
职业			49.50	< 0.001		19.40	< 0.001		20.15	< 0.001
学生	45(3.4)	16(35.6)			11(24.4)			8(17.8)
工人	675(51.6)	236(35.0)			169(25.0)			122(18.1)
固定职业	49(3.7)	23(46.9)			19(38.8)			16(32.7)
农民	540(41.3)	296(54.8)			194(35.9)			151(28.0)
抗结核病治疗史			2.54	0.281		6.22	0.045		12.76	0.002
未使用过抗结核病药	50(3.8)	19(38.0)			13(26.0)			6(12.0)
用过一线抗结核病药	1 181(90.2)	512(43.4)			347(29.4)			262(22.2)
用过一线和二线抗结核病药	78(6.0)	40(51.3)			33(42.3)			29(37.2)
DST检测方法			154.96	< 0.001		213.96	< 0.001		206.35	< 0.001
快速	991(75.7)	336(33.9)			193(19.5)			131(13.2)
传统	318(24.3)	235(73.9)			200(62.9)			166(52.2)
治疗模式			59.38	< 0.001		44.03	< 0.001		28.56	< 0.001
门诊	1 000(76.4)	377(37.7)			253(25.3)			192(19.2)
住院	309(23.6)	194(62.8)			140(45.3)			105(34.0)
合计	1 309(100.0)	571(43.6)			393(30.0)			297(22.7)

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表 3 影响贵州省MDR-TB患者三类治疗延迟的多因素分析结果

Table 3. Results of influencing factors for three types of treatment delay among MDR-TB patients in Guizhou Province by multivariate analysis

变量	第I类		第II类		第III类
变量	OR_adj(95% CI)值	P值	OR_adj(95% CI)值	P值	OR_adj(95% CI)值	P值
年龄(岁)
＜26	1.00	0.089
26~＜60	1.37(1.00~1.89)
≥60	1.08(0.70~1.67)
民族
汉族			1.00	0.415	1.00	0.414
少数民族			1.14(0.83~1.57)		1.18(0.80~1.73)
职业
学生	1.00	< 0.001		< 0.001		0.010
工人	1.10(0.55~2.20)		1.01(0.50~2.06)		0.98(0.44~2.22)
固定职业	1.43(0.58~3.54)		1.94(1.08~4.77)		2.07(1.17~5.57)
农民	2.04(1.02~4.07)		1.66(1.01~3.39)		1.50(1.06~3.36)
诊疗机构所在州(市)
贵阳市	1.00	0.002	1.00	0.022	1.00	0.044
黔东南州	0.79(0.48~1.31)		1.19(0.69~2.06)		1.43(0.81~2.52)
黔铜六(3州市) ^a	0.51(0.25~1.04)		1.20(0.59~2.45)		1.54(0.74~3.20)
遵义市	1.19(0.56~2.55)		1.34(0.95~1.88)		1.07(0.73~1.57)
毕节市	1.70(1.22~2.35)		3.00(1.49~6.03)		2.85(1.41~5.76)
抗结核病治疗史
未使用过抗结核病药			1.00	0.078	1.00	0.010
用过一线抗结核病药			1.08(0.56~2.08)		2.19(0.90~5.35)
用过一线和二线抗结核病药			1.86(0.84~4.11)		4.01(1.47~10.94)
DST检测方法
快速	1.00	< 0.001	1.00	< 0.001	1.00	< 0.001
传统	4.94(3.62~6.72)		7.10(5.21~9.68)		8.37(6.03~11.63)
治疗模式
门诊	1.00	< 0.001	1.00	< 0.001	1.00	0.078
住院	2.62(1.95~3.51)		1.78(1.30~2.44)		1.37(0.97~1.94)
注：^a黔铜六(3州市)为黔西南州、铜仁市和六盘水市的简称。

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