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

魏於家; 马斌忠; 王朝才; 蒋明霞; 李尔琛; 晁秀珍

doi:10.16462/j.cnki.zhjbkz.2020.03.008

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

doi: 10.16462/j.cnki.zhjbkz.2020.03.008

810007 西宁, 青海省疾病预防控制中心传染病预防控制所

基金项目: 国家自然科学基金资助项目(81860593);青海省高端创新人才千人计划项目(2017-2)

详细信息

通讯作者:
马斌忠, E-mail:qhxnmbz@126.com

中图分类号: R521;R183
计量
- 文章访问数: 386
- HTML全文浏览量: 189
- PDF下载量: 26
- 被引次数: 0
出版历程
- 收稿日期: 2019-07-04
- 修回日期: 2019-10-14
- 刊出日期: 2020-03-10

Analysis on the factors that influence the treatment outcome of Tibetan nationality new smear-positive pulmonary tuberculosis patients in Qinghai Province

Institute for Prevention and Control of Infectious Diseases, Qinghai Provincial Center for Disease Control and Prevention, Xining 810007, China

Funds: National Natural Science Foundations of China(81860593); Qinghai provincial thousand talents program for high-level innovative talents(2017-2)

More Information

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

摘要

摘要: 目的分析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, 为藏族人群肺结核防治提供依据。方法选取2008-2017年在中国结核病信息管理系统中报告, 并审核通过接受治疗的居住地为青海的5 564例藏族初治涂阳肺结核患者进行统计分析。以是否成功治疗为因变量, 以与疾病结局有关的其他因素为自变量, 通过多因素Logistic回归模型分析, 确定主要影响因素。结果青海省藏族初治涂阳肺结核患者成功治疗率为87.1%(4 848/5 564), 不良结局率为12.9%(716/5 564)。多因素Logistic回归模型分析结果显示, 非全程督导方式管理、现住址为农牧区、重症、流动人口、年龄 > 60岁是疾病发生不良结局的危险因素, OR(95% CI)值分别为13.044(10.671~15.944)、2.305(1.703~3.119)、2.090(1.346~3.243)、1.967(1.443~2.682)、1.909(1.410~2.586)。患者来源为因症就诊、职业为农牧民是保护因素, OR(95% CI)值分别为0.451(0.375~0.543)、0.786(0.627~0.985)。结论青海省藏族初治涂阳肺结核患者成功治疗率低, 应严格落实现代结核病防治策略, 加强患者全程督导管理, 提高成功治疗率; 藏族人群中的老年、重症、流动、农牧区人群应作为重点关注人群。
- 藏族 /
- 初治涂阳肺结核 /
- 治疗转归 /
- 影响因素
Abstract: Objective To analyze the treatment outcome and related influencing factors of Tibetan nationality new smear-positive pulmonary tuberculosis patients in Qinghai Province, so as to provide evidence for tuberculosis control and treatment among Tibetan population. Methods Statistical analysis was conducted on 5 564 Tibetan nationality new smear-positive pulmonary tuberculosis cases in Qinghai province who were reported in the China Tuberculosis Information Management System and approved to receive treatment from 2008 to 2017. The main influencing factors were detected by unconditional Logistic regression model analysis, dependent variable was successful treatment or not, independent variables were other factors related to the treatment outcome. Results The treatment success rate of Tibetan nationality new smear-positive pulmonary tuberculosis cases was 87.1%(4 848/5 564), and the adverse outcome rate was 12.9%(716/5 564). Unconditional Logistic regression model analysis indicated that non-full-course supervision management, living in agricultural and pastoral area, having severe disease, floating population, and age older than 60 years were risk factors of adverse outcome. The odds ratio(OR) 95% confidence interval(CI) of the above risk factors were 13.044(10.671-15.944), 2.305(1.703-3.119), 2.090(1.346-3.243), 1.967(1.443-2.682), and 1.909(1.410-2.586). Clinical consultation, farmers and herdsmen were protective factors. The OR(95% CI) were 0.451(0.375-0.543), and 0.786(0.627-0.985). Conclusions Treatment success rate of Tibetan nationality new smear-positive pulmonary tuberculosis cases was low. Therefore, the directly observed treatment short-course(DOTS) strategy should be strictly implemented and the full-course supervision management should be strengthened to improve the treatment success rate. More attention should be paid to the elderly, severe, floating, agricultural and pastoral populations among the Tibetan population.
- Tibetan /
- New smear-positive pulmonary tuberculosis patients /
- Treatment outcome /
- Influencing factors

HTML全文

表 1 青海省2008-2017年不同民族初治涂阳肺结核患者治疗转归情况[n(%)]

Table 1. The treatment outcome of new smear-positive pulmonary tuberculosis cases among different nationalities from 2008 to 2017 in Qinghai Province [n(%)]

民族	患者总数	成功治疗			不良结局
民族	患者总数	治愈	完成疗程	合计	死亡	无结果	其它	合计
藏族	5 564	4 576(82.2)	272(4.9)	4 848(87.1)	31(0.6)	552(9.9)	133(2.4)	716(12.9)
汉族	9 081	8 190(90.2)	63(0.7)	8 253(90.9)	197(2.2)	221(2.4)	410(4.5)	828(9.1)
回族	2 264	2 052(90.6)	15(0.7)	2 067(91.3)	31(1.0)	88(3.9)	78(3.5)	197(8.7)
土族	358	326(91.1)	4(1.1)	330(92.2)	8(2.2)	6(1.7)	14(3.9)	28(7.8)
蒙古族	238	216(90.8)	5(2.1)	221(92.9)	2(0.8)	1(0.4)	14(5.9)	17(7.1)
撒拉族	140	134(95.7)	4(2.9)	138(98.6)	1(0.7)	1(0.7)	0(0.0)	2(1.4)
其他^a	48	40(83.3)	1(2.1)	41(85.4)	0(0.0)	6(12.5)	1(2.1)	7(14.6)
合计	17 693	15 534(87.8)	364(2.1)	15 898(89.9)	270(1.5)	875(5.0)	650(3.7)	1 795(10.2)
注：^a表示其他民族包含满族、维吾尔族、东乡族、哈萨克族等，患者总数少于表中单列的任何民族的患者数。

下载: 导出CSV

表 2 青海省2008-2017年不同年度藏族初治涂阳肺结核患者治疗转归情况[n(%)]

Table 2. The treatment outcome of Tibetan nationality new smear-positive pulmonary tuberculosis cases from 2008 to 2017 in Qinghai Province [n(%)]

年份	患者总数	成功治疗			不良结局
年份	患者总数	治愈	完成疗程	合计	死亡	无结果	其它	合计
2008	507	474(93.5)	4(0.8)	478(94.3)	7(1.4)	5(1.0)	17(304)	29(5.7)
2009	773	661(85.5)	30(3.9)	691(89.4)	4(0.5)	59(7.6)	19(2.5)	82(10.6)
2010	838	733(87.5)	34(4.1)	767(91.5)	7(0.8)	58(6.9)	6(0.7)	71(8.5)
2011	827	735(88.9)	19(2.3)	754(91.2)	3(0.4)	58(7.0)	12(1.5)	73(8.8)
2012	743	621(83.6)	39(5.2)	660(88.8)	0(0.0)	71(9.6)	12(1.6)	83(11.2)
2013	672	569(84.7)	43(6.4)	612(91.1)	3(0.4)	43(6.4)	14(2.1)	60(8.9)
2014	316	252(79.7)	17(5.4)	269(85.1)	0(0.0)	34(10.8)	13(4.1)	47(14.9)
2015	288	227(78.8)	12(4.2)	239(83.0)	3(1.0)	33(11.5)	13(4.5)	49(17.0)
2016	237	173(73.0)	16(6.8)	189(79.7)	3(1.3)	33(13.9)	12(5.1)	48(20.3)
2017	363	131(36.1)	58(16.0)	189(52.1)	1(0.3)	158(43.5)	15(4.1)	174(47.9)
合计	5 564	4 576(82.2)	272(4.9)	4 848(87.1)	31(0.6)	552(9.9)	133(2.4)	716(12.9)

下载: 导出CSV

表 3 青海省2008-2017年藏族初治涂阳肺结核患者治疗转归情况单因素分析[n(%)]

Table 3. Single factor analysis of the treatment outcome on Tibetan nationality new smear-positive pulmonary tuberculosis cases from 2008 to 2017 in Qinghai Province [n(%)]

影响因素	患者例数	治疗成功	不良结局	χ²值	P值
性别				5.258	0.022
男	3 204	2 820(88.0)	384(12.0)
女	2 360	2 028(85.9)	332(14.1)
职业				5.036	0.025
非农牧民	1 226	1 045(85.2)	181(14.8)
农牧民	4 338	3 803(87.7)	535(12.3)
年龄(岁)				15.189	0.001
≤30	2 386	2 057(86.2)	329(13.8)
30~	2 583	2 294(88.8)	289(11.2)
>60	595	497(83.5)	98(16.5)
患者来源57.481				57.481	<0.001
因症就诊	3 659	3 278(89.6)	381(10.4)
非因症就诊	1 905	1 570(82.4)	335(17.6)
实际管理方式				917.075	<0.001
全程督导	3 838	3 694(96.2)	144(3.8)
非全程督导	1 726	1 154(66.9)	572(33.1)
是否重症				9.813	0.002
否	5 378	4 700(87.4)	678(12.6)
是	186	148(79.6)	38(20.4)
是否流动人口				55.411	<0.001
否	5 236	4 606(88.0)	630(12.0)
是	328	242(73.8)	86(26.2)
现住址				45.688	<0.001
非农牧区	1 011	946(93.6)	65(6.4)
农牧区	4 553	3 902(85.7)	651(14.3)

下载: 导出CSV

表 4 青海省2008-2017年藏族初治涂阳肺结核患者治疗转归情况多因素Logistic回归分析模型

Table 4. Multivariable logistic regression model analysis of the treatment outcome on Tibetan nationality new smear-positive pulmonar tuberculosis cases from 2008 to 2017 in Qinghai Province

影响因素	β	S_x	Wald值	P值	OR(95% CI)值
性别
女					1.000
男	-0.145	0.091	2.541	0.111	0.865(0.725~1.034)
年龄(岁)
≤30					1.000
30~	0.014	0.102	0.019	0.890	1.014(0.830~1.239)
> 60	0.647	0.155	17.470	< 0.001	1.909(1.410~2.586)
流动人口
否					1.000
是	0.677	0.158	18.314	< 0.001	1.967(1.443~2.682)
患者来源
非因症就诊					1.000
因症就诊	-0.796	0.095	70.761	< 0.001	0.451(0.375~0.543)
治疗管理
全程督导					1.000
非全程督导	2.568	0.102	628.556	< 0.001	13.044(10.671~15.944)
现住址
非农牧区					1.000
农牧区	0.835	0.154	29.244	< 0.001	2.305(1.703~3.119)
重症
否					1.000
是	0.737	0.224	10.794	0.001	2.09(1.346~3.243)
职业
非农牧民					1.000
农牧民	-0.241	0.115	4.381	0.036	0.786(0.627~0.985)

下载: 导出CSV

参考文献(19)

[1]	Smith KC, Armitige L, Wanger A. A review of tuberculosis: reflections on the past, present and future of a global epidemic disease[J]. Expert Rev. Anti-infect Ther, 2003, 1(3): 483-491. DOI: 10.1586/14787210.1.3.483.
[2]	陈伟, 夏愔愔, 李涛, 等. 2015年全球及中国结核病疫情形势分析[J].结核病与肺部健康杂志, 2016, 5(1): 32-36. DOI: 10.3969/j.issn.2095-3755.2016.01.010. Chen W, Xia YY, Li T, et al. Analysis for the global and China TB epidemic situation in 2015[J]. J Tuberc Lung Health, 2016, 5(1): 32-36. DOI: 10.3969/j.issn.2095-3755.2016.01.010.
[3]	王蓉, 李永盛, 马永成, 等. 2013-2016年青海省结核病地区分布情况分析[J].医学动物防制, 2017(12): 1307-1308, 1311. DOI: 10.7629/yxdwfz201712025. Wang R, Li YS, Ma YC, et al. Distribution situation of TB region in Qinghai Province from 2013 to 2016[J]. J Med Pest Control, 2017(12): 1307-1308+1311. DOI: 10.7629/yxdwfz201712025.
[4]	王朝才, 刘燕, 晁秀珍, 等. 2006-2015年青海省肺结核流行特征分析[J].现代预防医学, 2017(03): 19-22. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=xdyfyx201703004 Wang ZC, Liu Y, Chao XZ, et al. Epidemiological characteristics of pulmonary tuberculosis of Qinghai, 2006-2015[J]. Modern Prevent Med, 2017(03): 19-22. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=xdyfyx201703004
[5]	杨智琪, 胡屹, 赵琦, 等.徐州市两县和乌鲁木齐市涂阳肺结核患者疗效及其影响因素分析[J].中国防痨杂志, 2018, 40(1): 98-105. DOI: 10.3969/j.issn.1000-6621.2018.01.022. Yang ZQ, Hu Y, Zhao Q, et al. Treatment outcomes and associated factors among smear-positive pulmonary tuberculosis patients in two counties of Xuzhou, Jiangsu Province and Urumqi, Xinjiang Uygur Autonomous Region[J]. Chin J Antituberc, 2018, 40(1): 98-105. DOI: 10.3969/j.issn.1000-6621.2018.01.022.
[6]	刘凤仁, 叶临湘, 梁享生, 等.影响肺结核治疗转归的因素分析[J].中国防痨杂志, 2006, 28(4): 247-249. DOI: 10.3969/j.issn.1000-6621.2006.04.016. Liu FR, Ye LX, Liang XS, et al. Analysis on factors influencing the treatment outcome of tuberculosis patient[J]. Chin J Antituberc, 2006, 28(4): 247-249. DOI: 10.3969/j.issn.1000-6621.2006.04.016.
[7]	卫生部疾病预防控制局.中国结核病防治规划实施工作指南, 2008年版[M].北京: 中国协和医科大学出版社, 2009. Bureau of disease prevention and control, Ministry of health guidelines for tuberculosis prevention and control planning in China, 2008[M]. BeiJing: China Union Medical University Press, 2009.
[8]	杜雨华, 卢次勇, 陈其琛.广州市涂阳肺结核患者治疗失败及病死的影响因素分析[J].中国防痨杂志, 2007, 29(3): 226-229. DOI: 10.3969/j.issn.1000-6621.2007.03.006. Du YH, Lu CY, Chen QC. Analysis on the factors that influence the treatment failure and death of smear-positive pulmonary tuberculosis patients in Guangzhou city[J]. Chin J Antituberc, 2007, 29(3): 226-229. DOI: 10.3969/j.issn.1000-6621.2007.03.006.
[9]	陆丽红, 刘爱华, 周流凤, 等.北海市实施结核病防治十年规划终期效果评价[J].广西医学, 2012, 34(3): 348-351. DOI: 10.3969/j.issn.0253-4304.2012.03.035. Lu LH, Liu AH, Zhou LF, et al. Final effect evaluation on national tuberculosis control program in Beihai city[J]. Guangxi Med J, 2012, 34(3): 348-351. DOI: 10.3969/j.issn.0253-4304.2012.03.035.
[10]	戈启萍, 孔忠顺, 卜建玲, 等. 95例住院高龄肺结核临床分析[J].中国防痨杂志, 2000, 22(4): 188-191. DOI: 10.3969/j.issn.1000-6621.2000.04.004. Ge QP, Kong ZS, Po JL, et al. Clinical analysis of 95 cases inpatients with pulmonary tuberculosis in the senility[J]. Chin J Antituberc, 2000, 22(4): 188-191. DOI: 10.3969/j.issn.1000-6621.2000.04.004.
[11]	吴妍, 李琦.老年肺结核的诊治现状与进展[J].中国防痨杂志, 2015, 37(9): 975-978. DOI: 10.3969/j.issn.1000-6621.2015.09.012. Wu Y, Li Q. The status and progress of diagnosis and treatment for elderly patients with tuberculosis[J]. Chin J Antituberc, 2015, 37(9): 975-978. DOI: 10.3969/j.issn.1000-6621.2015.09.012.
[12]	杨应周.关注脆弱人群的结核病防控[J].中国防痨杂志, 2013, 35(11): 868-870. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgflzz201311004 Yang YZ. Pay attention to tuberculosis prevention and control in vulnerable population[J]. Chin J Antituberc, 2013, 35(11): 868-870. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgflzz201311004
[13]	张耀亭.肺结核控制的重点难点和亮点[J].东南国防医药, 2005, 7(2): 156-157. DOI: 10.3969/j.issn.1672-271X.2005.02.046. Zhang YT. The stress, difficult and bright point on controlling of pulmonary tuberculosis[J]. Journal of Southeast China National Defence Medical Science, 2005, 7(2): 156-157. DOI: 10.3969/j.issn.1672-271X.2005.02.046.
[14]	徐广保, 刘飞鹰, 冯启明, 等.广西农村肺结核病防治管理新模式的效果评价[J].中华预防医学杂志, 2011, 45(1): 30-35. DOI: 10.3760/cma.j.issn.0253-9624.2011.01.009. Xu GB, Liu FY, Feng QM, et al. The effect evaluation of a new tuberculosis management model in rural areas of Guangxi[J]. Chin J Prev Med, 2011, 45(1): 30-35. DOI: 10.3760/cma.j.issn.0253-9624.2011.01.009.
[15]	沈建恩, 雷涛, 王祖恩, 等.肺结核病人化疗依从性相关因素研究[J].中国防痨杂志, 2007, 29(2): 133-135. DOI: 10.3969/j.issn.1000-6621.2007.02.006. Shen JE, Lei T, Wang ZE, et al. Study on the relevant factors of compliance that affect the regular treatment for pulmonary TB[J]. Chin J Antituberc, 2007, 29(2): 133-135. DOI: 10.3969/j.issn.1000-6621.2007.02.006.
[16]	蔡穆, 黎永华.三亚市流动人口肺结核患者实施全程督导管理效果分析[J].中国全科医学, 2018, 21(z1): 139-140. DOI: 10.3969/j.issn.1007-9572.2018.z1.057. Cai M, Li YH. Analysis on the effect of directly observed treatment of tuberculosis patients about floating population in Sanya city[J]. Chin Gen Pract, 2018, 21(z1): 139-140. DOI: 10.3969/j.issn.1007-9572.2018.z1.057.
[17]	杨世平, 许云飞.直接面视下全程督导管理策略实施效果分析[J].中国防痨杂志, 2003, 25(s1): 199-200. DOI: 10.3969/j.issn.1000-6621.2003.z1.325. Yang SP, Xu YF. Analysis of the implementation effect of directly observed treatment[J]. Chin J Antituberc, 2003, 25(s1): 199-200. DOI: 10.3969/j.issn.1000-6621.2003.z1.325.
[18]	王撷秀.积极发现、治愈肺结核病人[J].中国防痨杂志, 2001, 23(4): 213. DOI: 10.3969/j.issn.1000-6621.2001.04.007. Wang XX. Actively discover and cure tuberculosis patients[J]. Chin J Antituberc, 2001, 23(4): 213. DOI: 10.3969/j.issn.1000-6621.2001.04.007.
[19]	陈瑜.某市2006年-2010年初治涂阳肺结核的化疗效果分析[J].中国医药指南, 2012, (26): 490-491. DOI: 10.15912/j.cnki.gocm.2012.26.257. Chen Y. Analysis of chemotherapy effect of new smear positive pulmonary tuberculosis in a city from 2006 to 2010[J]. Guide of China Medicine, 2012, (26): 490-491. DOI: 10.15912/j.cnki.gocm.2012.26.257.