文章摘要
王坚杰,周美兰,陈聪,吴刚,左颖萍,任欣,陈专,王卫华.武汉市2006-2014年耐多药结核病患者生存时间及影响因素分析[J].中华流行病学杂志,2019,40(11):1409-1413
武汉市2006-2014年耐多药结核病患者生存时间及影响因素分析
Survival time and influencing factors in multidrug-resistant tuberculosis patients in Wuhan, 2006-2014
收稿日期:2019-03-28  出版日期:2019-11-26
DOI:10.3760/cma.j.issn.0254-6450.2019.11.013
中文关键词: 耐多药;结核病;生存率;影响因素
英文关键词: Multidrug-resistant;Tuberculosis;Survival rate;Influential factors
基金项目:中国全球基金结核控制项目(CHN-S10-G14-T);武汉市卫生计生委项目(WG15A04)
作者单位E-mail
王坚杰 武汉市肺科医院/武汉市结核病防治所 430030  
周美兰 武汉市肺科医院/武汉市结核病防治所 430030  
陈聪 武汉市肺科医院/武汉市结核病防治所 430030  
吴刚 武汉市肺科医院/武汉市结核病防治所 430030  
左颖萍 武汉市肺科医院/武汉市结核病防治所 430030  
任欣 武汉市肺科医院/武汉市结核病防治所 430030  
陈专 武汉市肺科医院/武汉市结核病防治所 430030  
王卫华 武汉市肺科医院/武汉市结核病防治所 430030 drwang65@163.com 
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中文摘要:
      目的 探索武汉市耐多药结核病(multidrug-resistant tuberculosis,MDR-TB)患者的生存时间及影响因素。方法 由经过培训的医生从结核病管理信息系统、死因报告系统和病历中收集相关信息。采用单因素和多因素Cox比例风险回归模型分析影响MDR-TB患者生存的相关因素。结果 共纳入分析552例MDR-TB患者,确诊为MDR-TB后患者第1~3年累积生存率分别为0.94、0.88、0.80。MDR-TB患者死亡密度达6.52人/100人年,中位生存时间为(89.52±1.85)个月。Kaplan-Meier法分析显示,规范治疗组累积生存率显著高于未规范治疗组(Log rank=101.070,P<0.001)。相对于<30岁组,30~和60~岁组HR值分别为2.987(95%CI:1.268~7.036)、4.957(95%CI:1.942~12.653);相对于高中及以上文化程度,初中和小学及以下HR值分别为1.908(95%CI:1.152~3.160)、1.681(1.033~2.735);无糖尿病相对于有糖尿病HR值为1.961(95%CI:1.347~2.854);无其他严重疾病较有其他严重疾病HR值为2.597(95%CI:1.820~3.706);既往治疗次数≥ 2次较≤ 1次HR值为1.611(95%CI:1.077~2.409);规范治疗较未规范治疗HR值为3.155(95%CI:2.132~4.670)。结论 未纳入规范治疗的MDR-TB患者较规范治疗者累积生存率明显下降。年龄大、文化程度低、有糖尿病和其他严重疾病、既往治疗次数≥ 2次、未规范治疗是影响MDR-TB患者生存的危险因素。
英文摘要:
      Objective To investigate the survival time of multidrug-resistant tuberculosis (MDR-TB) patients and the influential factors in Wuhan. Methods The relevant information were collected from TB management information system, cause of death reporting system and medical records by trained doctors. The univariate and multivariate Cox proportional hazards model were applied to analyze the factors affecting survival time of patients. Results A total of 552 patients with MDR-TB were included in the analysis. After the diagnosis of MDR-TB, the cumulative survival rates from the first year to the third year were 0.94, 0.88, and 0.80, respectively. The mortality density of MDR-TB patients was 6.52/100 person-years, and the median survival time was (89.52±1.85) months. Kaplan-Meier analysis showed that the cumulative survival rate of the standardized treatment group was significantly higher than that of the non-standardized treatment group (Log rank=101.070, P<0.001). Compared with the patients aged <30 years, the HR of the patients aged 30-years and ≥ 60 years were 2.987 (95%CI:1.268-7.036), 4.957 (95%CI:1.942-12.653). Compared with the patients with the education level of high school and above, the HR of the patients with education level of junior high school/primary school and below were 1.908 (95%CI:1.152-3.160), 1.681(95%CI:1.033-2.735). Compared with the patients without diabetes, the HR of the patients with diabetes was 1.961(95%CI:1.347-2.854). Compared with the patients without other serious diseases, the HR of the patients with other serious diseases was 2.597 (95%CI:1.820-3.706). Compared with the patients who had been treated less than one time, the HR of the patients having previous treatment with more than 2 times was 1.611(95%CI:1.077-2.409). Compared with patients receiving standard MDR regimen treatment, the HR of the patients receiving no standard MDR regimen treatment was 3.155 (95%CI:2.132-4.670). Conclusions The cumulative survival rate of MDR-TB patients without standard treatment was significantly lower than that of patients with standard treatment. Older age, low educational level, diabetes mellitus, other serious diseases, more than two times treatment in the past, and receiving no multi-drug resistance regimen treatment were the risk factors affecting the survival of MDR-TB patients.
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