青海省藏族人群结核病治疗转归及影响因素

杨世泽; 马斌忠; 王兆芬; 魏於家; 李尔琛; 王朝才; 蒋明霞

doi:10.16462/j.cnki.zhjbkz.2023.07.018

青海省藏族人群结核病治疗转归及影响因素

doi: 10.16462/j.cnki.zhjbkz.2023.07.018

杨世泽¹,
马斌忠^{1, 2, ,},
王兆芬^{1, 2},
魏於家²,
李尔琛²,
王朝才²,
蒋明霞²

1.
青海大学医学部公共卫生系，西宁 810001
2.
青海省疾病预防控制中心传染病防治所，西宁 810007

基金项目:

青海省高端创新人才千人计划 2017-2

详细信息

通讯作者:
马斌忠，E-mail: qhxnmbz@126.com

中图分类号: R183.1
计量
- 文章访问数: 247
- HTML全文浏览量: 111
- PDF下载量: 10
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-23
- 修回日期: 2022-07-14
- 网络出版日期: 2023-08-08
- 刊出日期: 2023-07-10

Analysis of treatment outcome and influencing factors of Tibetan tuberculosis patients in Qinghai Province

1.
Department of Public Health, Medical College, Qinghai University, Xining 810001, China
2.
Institute for Prevention and Control of Infectious Diseases, Qinghai Center for Disease Control and Prevention, Xining 810007, China

Funds:

the Qinghai Provincial Thousand Talents Program for High-level Innovative Talents 2017-2

More Information

Corresponding author: MA Binzhong, E-mail: qhxnmbz@126.com

摘要

摘要: 目的分析青海省藏族人群结核病治疗转归及影响因素，为藏族结核病的防治提供参考。方法回顾性分析2016―2020年青海省藏族人群结核病治疗转归情况，采用Cochran-Armitage趋势检验分析成功治疗率随时间变化的趋势，χ²检验初步筛选可能的影响因素，采用多因素logistic回归分析模型进行影响因素分析，方差膨胀系数(variance inflation factor, VIF)检验共线性。结果 2016―2020年青海省藏族人群肺结核成功治疗率为96.841%，成功治疗率呈上升趋势。多因素logistic回归分析模型显示，年龄≥60岁(OR=2.467, 95% CI: 1.333~4.889, P=0.006)、就诊延迟(OR=1.364, 95% CI: 1.096~1.702, P=0.006)、Ⅲ型结核病(OR=2.659, 95% CI: 1.190~7.584, P=0.034)、Ⅳ型结核病(OR=4.457, 95% CI: 1.921~12.988, P=0.002)、Ⅴ型结核病(OR=4.671, 95% CI: 1.976~13.747, P=0.001)和复治(OR=1.868, 95% CI: 1.219~2.763, P=0.003)为不良结局的危险因素，流动人口(OR=0.603, 95% CI: 0.453~0.794, P＜0.001)、疾病预防控制机构管理(OR=0.211, 95% CI: 0.081~0.661, P=0.003)、医院管理(OR=0.313, 95% CI: 0.125~0.962, P=0.023)、全程管理(OR=0.146, 95% CI: 0.100~0.213, P＜0.001)、强化期督导(OR=0.543, 95% CI: 0.373~0.795, P=0.002)和全程督导(OR=0.374, 95% CI: 0.252~0.556, P＜0.001)为保护因素。结论青海省藏族结核病成功治疗率较高，重点关注老年患者、就诊延迟患者、Ⅲ型结核病患者、Ⅳ型结核病患者、Ⅴ型结核病患者和复治患者；提高基层医疗机构的结核病治疗管理能力，采取督导和全程管理的治疗管理方式，以进一步提高成功治疗率。
- 藏族 /
- 结核病 /
- 治疗转归 /
- 影响因素
Abstract: Objective This study aims to analyze the treatment outcomes and contributing factors of Tibetan tuberculosis (TB) patients in Qinghai Province, offering a reference point for future prevention and treatment strategies. Methods A retrospective analysis of the treatment outcomes of Tibetan TB patients in Qinghai Province was conducted for the period of 2016 to 2020. The Cochran-Armitage trend test was used to analyze the successful treatment rate over time. The Chi-square test was utilized for an initial screening of potential contributing factors. Multiple logistic regression analysis was employed to further examine these factors, with multicollinearity tested using the variance inflation factor. Results The successful treatment rate of Tibetan tuberculosis patients in Qinghai Province from 2016 to 2020 was 96.841%, exhibiting an upward trend. Multiple logistic regression showed the age group of ≥60 years (OR=2.467, 95% CI: 1.333-4.889, P=0.006), delay in health-care seeking (OR=1.364, 95% CI: 1.096-1.702, P=0.006), type Ⅲ (OR=2.659, 95% CI: 1.190-7.584, P=0.034), type Ⅳ (OR=4.457, 95% CI: 1.921-12.988, P=0.002), type Ⅴ (OR=4.671, 95% CI: 1.976-13.747, P=0.001) and retreatment (OR=1.868, 95% CI: 1.219-2.763, P=0.003) were risk factors for outcomes. Floating population (OR=0.603, 95% CI: 0.453-0.794, P < 0.001), managed by disease control and prevention centers (OR=0.211, 95% CI: 0.081-0.661, P=0.003), hospital management (OR=0.313, 95% CI: 0.125-0.962, P=0.023), entire course management (OR=0.146, 95% CI: 0.100-0.213, P < 0.001), intensive term supervision (OR=0.543, 95% CI: 0.373-0.795, P=0.002) and entire course supervision (OR=0.374, 95% CI: 0.252-0.556, P < 0.001) were protective factors. Conclusions The treatment outcomes for Tibetan TB patients in Qinghai Province were encouraging. However, more attention should be given to elderly patients, those who delay seeking healthcare, patients categorized as type Ⅲ, Ⅳ, Ⅴ, and those undergoing retreatment. It is crucial to enhance TB treatment and management capacity in primary healthcare institutions and implement a supervised, full-course treatment management approach to boost the successful treatment rate.
- Tibetan /
- Tuberculosis /
- Treatment outcome /
- Influencing factors

HTML全文

表 1 青海省2016―2020年藏族人群结核病治疗转归情况

Table 1. The treatment outcome of Tibetan tuberculosis in Qinghai Province from 2016 to 2020

年份 Year	治疗例数 Number of treatment cases	成功治疗Successful treatment			不良结局Adverse outcome
年份 Year	治疗例数 Number of treatment cases	治愈Cure	完成疗程 Treatment completed	合计 Total	失败Failure	死亡 Death	不良反应 Adverse reaction	失访 Missing	其他 Other	合计 Total
2016	1 289	185(14.352)	1 032(80.062)	1 217(94.414)	9(0.698)	10(0.776)	25(1.939)	7(0.543)	21(1.629)	72(5.586)
2017	1 928	185(9.595)	1 627(84.388)	1 812(93.983)	5(0.259)	9(0.467)	25(1.297)	12(0.622)	65(3.371)	116(6.017)
2018	2 528	365(14.438)	2 087(82.555)	2 452(96.994)	7(0.277)	10(0.396)	12(0.475)	16(0.633)	31(1.226)	76(3.006)
2019	3 605	554(15.368)	2 968(82.330)	3 522(97.698)	10(0.277)	27(0.749)	12(0.333)	5(0.139)	29(0.804)	83(2.302)
2020	2 364	467(19.755)	1 874(79.272)	2 341(99.027)	3(0.127)	4(0.169)	7(0.296)	1(0.042)	8(0.338)	23(0.973)
合计Total	11 714	1 756(14.991)	9 588(81.851)	11 344(96.841)	34(0.290)	60(0.512)	81(0.691)	41(0.350)	154(1.315)	370(3.159)

下载: 导出CSV

表 2 青海省2016―2020年藏族人群结核病治疗转归多因素logistic回归分析

Table 2. Multivariate logistic regression analysisof treatment outcome for Tibetan tuberculosis among Tibetan population in Qinghai Province from 2016 to 2020

因素Factor	β	s_x	Wald值 Wald value	OR值(95% CI) OR value (95% CI)	P值 P value
年龄组/岁Age group /years
＜14				1.000
14~＜45	0.160	0.301	0.283	1.174(0.675~2.220)	0.595
45~＜60	0.329	0.330	0.993	1.389(0.749~2.755)	0.319
≥60	0.903	0.329	7.527	2.467(1.333~4.889)	0.006
职业Occupation
非农牧民Non agro-pastoralist				1.000
农牧民Agro-pastoralist	0.217	0.136	2.539	1.243(0.955~1.631)	0.111
流动人口Transient population
非流动人口Not transient population				1.000
流动人口Transient population	-0.506	0.143	12.489	0.603(0.453~0.794)	< 0.001
患者来源Patient source
其他Other				1.000
检查发现Examination revealed	-0.480	1.206	0.158	0.619(0.071~13.235)	0.691
督促就诊Urge medical treatment	-0.551	1.062	0.270	0.576(0.107~10.722)	0.604
主动就诊Active visiting	-0.326	1.054	0.096	0.722(0.137~13.328)	0.757
就诊延迟Health-care seeking delay
无就诊延迟Not health-care seeking delay				1.000
就诊延迟Health-care seeking delay	0.310	0.112	7.641	1.364(1.096~1.702)	0.006
诊断分型Diagnosis and classification
Ⅰ型Model Ⅰ				1.000
Ⅱ型Model Ⅱ	0.904	0.506	3.190	2.469(0.986~7.491)	0.074
Ⅲ型Model Ⅲ	0.978	0.462	4.474	2.659(1.190~7.584)	0.034
Ⅳ型Model Ⅳ	1.495	0.477	9.801	4.457(1.921~12.988)	0.002
Ⅴ型Model Ⅴ	1.541	0.484	10.122	4.671(1.976~13.747)	0.001
现管理单位性质The property of the current management unit
基层医疗机构Primary medical institutions				1.000
疾病预防控制机构Disease control institutions	-1.558	0.525	8.799	0.211(0.081~0.661)	0.003
医院Hospitals	-1.163	0.512	5.160	0.313(0.125~0.962)	0.023
治疗分类Treatment classification
初治Initial treatment				1.000
复治Repeated treatment	0.625	0.208	9.019	1.868(1.219~2.763)	0.003
实际治疗管理方案Actual treatment management plan
自服药Self-administered				1.000
全程管理Whole course management	-1.927	0.191	101.770	0.146(0.100~0.213)	< 0.001
强化期督导Intensify phase direct	-0.610	0.193	10.051	0.543(0.373~0.795)	0.002
全程督导Whole course supervision	-0.985	0.202	23.840	0.374(0.252~0.556)	< 0.001

下载: 导出CSV

参考文献(9)

[1]	梁达, 商越, 赵晓银, 等. 青海省2014-2019年肺结核流行特征及预测模型比较研究[J]. 医学动物防制, 2021, 37(4): 313-318. DOI: 10.7629/yxdwfz202104002. Liang D, Shang Y, Zhao XY, et al. Epidemiological characteristics and comparative study of prediction model for pulmonary tuberculosis in Qinghai Province from 2014 to 2019[J]. J Med Pest Control, 2021, 37(4): 313-318. DOI: 10.7629/yxdwfz202104002.
[2]	魏於家, 马斌忠, 王朝才, 等. 青海省藏族初治涂阳肺结核患者治疗转归情况及影响因素[J]. 中华疾病控制杂志, 2020, 24(3): 284-289. DOI: 10.16462/j.cnki.zhjbkz.2020.03.008. Wei YJ, Ma BZ, Wang ZC, et al. Analysis on the factors that influence the treatment outcome of Tibetan nationality new smear-positive pulmonary tuberculosis patients in Qinghai Province[J]. Chin J Dis Control Prev, 2020, 24(3): 284-289. DOI: 10.16462/j.cnki.zhjbkz.2020.03.008.
[3]	马斌忠, 饶华祥, 蒋明霞, 等. 青海省新发涂阳肺结核病人治疗转归分析[J]. 医学动物防制, 2019, 35(9): 817-821. DOI: 10.7629/yxdwfz201909001. Ma BZ, Rao HX, Jiang MX, et al. Analysis of treatment outcome of new smear positive pulmonary tuberculosis cases in Qinghai Province[J]. J Med Pest Contrl, 2019, 35(9): 817-821. DOI: 10.7629/yxdwfz201909001.
[4]	赵雁林, 陈明亭. 中国结核病防治工作技术指南[M]. 北京: 人民卫生出版社, 2021: 12-17, 48-49, 77-78, 228-229. Zhao YL, Chen MT. Technical Guidelines for Tuberculosis Control and Prevention in China[M]. Beijing: Peoples Medical Publishing House, 2021: 12-17, 48-49, 77-78, 228-229.
[5]	Cohen DB, Meghji J, Squire SB. A systematic review of clinical outcomes on the WHO Category Ⅱ retreatment regimen for tuberculosis[J]. Int J Tuberc Lung Dis, 2018, 22(10): 1127-1134. DOI: 10.5588/ijtld.17.0705.
[6]	蒋明霞, 王兆芬, 马斌忠, 等. 青海省利福平耐药/耐多药肺结核流行特征分析[J]. 疾病监测, 2022, 37(3): 401-404. DOI: 10.3784/jbjc.202104290235. Jiang MX, Wang ZF, Ma BZ, et al. Epidemiological characteristics of rifampicin-resistant and multidrug-resistant tuberculosis in Qinghai[J]. Dis Surveillance, 2022, 37(3): 401-404. DOI: 10.3784/jbjc.202104290235.
[7]	上海市感染性疾病(结核病)临床医学研究中心/同济大学附属上海市肺科医院, 首都医科大学附属北京胸科医院/北京市结核病胸部肿瘤研究所, 中国防痨协会《中国防痨杂志》编辑委员会. 复治肺结核病诊断和治疗专家共识[J]. 中国防痨杂志, 2021, 43(12): 1226-1238. DOI: 10.3969/j.issn.1000-6621.2021.12.002. Shanghai Clinical Medical Research Center of Infectious Diseases (Tuberculosis)/Shanghai Pulmonary Hospital Affiliated to Tongji University, Beijing Chest Hospital Affiliated to Capital Medical University/Beijing Institute of Tuberculosis and Chest Cancer, Editorial Committee of the Journal of Tuberculosis and Chest Cancer published by the Chinese Tuberculosis Association. Expert consensus on the diagnosis and treatment of retreatment of pulmonary tuberculosis[J]. Chin J Antitubercul, 2021, 43(12): 1226-1338. DOI: 10.3969/j.issn.1000-6621.2021.12.002.
[8]	中国防痨协会. 流动人口肺结核患者管理指南[J]. 新发传染病电子杂志, 2021, 6(1): 7-12. DOI: 10.19871/j.cnki.xfcrbzz.2021.01.002. Chinese Antituberculosis Association. Guidelines for the management of tuberculosis patients in floating population[J]. Electronic Journal of Emerging Infectious Diseases, 2021, 6(1): 7-12. DOI: 10.19871/j.cnki.xfcrbzz.2021.01.002.
[9]	杨思晨. 肺结核患者遵医行为的影响因素及干预对策研究进展[J]. 内科, 2018, 13(1): 55-58. DOI: 10.16121/j.cnki.cn45-1347/r.2018.01.17. Yang SC. Research progress on influencing factors and intervention measures of compliance behavior in patients with pulmonary tuberculosis[J]. Internal Medicine, 2018, 13(1): 55-58. DOI: 10.16121/j.cnki.cn45-1347/r.2018.01.17.