影响耐多药肺结核早期疗效危险因素分析

doi:10.19871/j.cnki.xfcrbzz.2023.05.001

摘要/Abstract

摘要： 目的探讨影响耐多药肺结核（multidrug-resistant pulmonary tuberculosis,MDR-PTB）早期疗效的危险因素,为MDR-PTB患者的早期疗效评估及精准治疗提供依据。方法选取2020年11月至2022年1月南京中医药大学附属南京医院（南京市第二医院）结核科诊治的经痰培养及药物敏感试验证实的MDR-PTB患者作为研究对象,根据抗结核治疗3个月末的治疗效果纳入疗效欠佳组（n=35）和疗效良好组（n=117）,比较两组患者的临床资料,分析影响早期疗效的危险因素。结果单因素方差分析显示：性别、年龄、职业、复治、合并2型糖尿病、合并其他病原体感染、对氟喹诺酮耐药、病灶累及范围≥3个肺野、肺部空洞性病变、空洞直径、血红蛋白水平、白蛋白、体质指数与MDR-TB治疗3个月末疗效欠佳相关（均P<0.05）。多因素Logistic回归分析显示：复治肺结核（OR=4.138,95%CI 1.063~16.110）、对氟喹诺酮耐药（OR=6.677,95%CI 1.526~29.211）、肺部空洞性病变（OR=18.879,95%CI 3.585~99.411）是影响MDR-PTB患者疗效的独立危险因素。结论影响耐多药肺结核早期疗效的因素是多元的。复治肺结核、肺部空洞性病变、对氟喹诺酮耐药是早期疗效欠佳的独立危险因素。对合并以上危险因素的患者应尽早发现并进行精准抗结核治疗,以期改善预后。

关键词: 耐多药肺结核, 早期疗效, 危险因素, 复治肺结核, 空洞性病变, 氟喹诺酮

Abstract: Objective To explore the relevant factors affecting the early curative effect of multidrug-resistant pulmonary tuberculosis, and to provide the basis for the early curative effect evaluation and precise treatment of multidrug-resistant pulmonary tuberculosis. Method Patients with multidrug-resistant pulmonary tuberculosis who were diagnosed by sputum culture and drug sensitivity in the Department of Tuberculosis, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine between November 2020 and January 2022 were selected as the research subjects. According to the treatment effect of anti-tuberculosis treatment at the end of 3 months, the patients were divided into: poor curative effect group (n=35) and good curative effect group (n=117). The clinical data of the two groups were compared, to analyze the risk factors of poor early curative effect. Result Univariate variance analysis showed that: gender, age, occupation, retreatment, T2DM, infections with other pathogens, fluoroquinolone resistance, lesions involving lung fields≥3, cavity, cavity diameter, Hb level, albumin, and BMI index were associated with poor efficacy at the end of 3 months (all P<0.05); Logistic regression multivariate analysis Shows: Retreatment of tuberculosis (OR=4.138, 95%CI 1.063-16.110), quinolone resistance (OR=6.677, 95%CI 1.526-29.211), and pulmonary cavitation (OR=18.879, 95%CI 3.585-99.411) were independent risk factors for poor outcomes after 3 months of MDR-TB treatment. Conclusion There are multiple factors affecting the early treatment effect of MDR-TB. Retreatment of pulmonary tuberculosis, combined with pulmonary cavitary lesions and resistance to fluoroquinolone are independent risk factors for poor early treatment effect. Patients with the above risk factors should be detected earlier, and accurate anti-tuberculosis treatment should be performed in order to improve the prognosis.

Key words: Multidrug-resistant pulmonary tuberculosis, Early efficacy, Risk factors, Re-treatment of tuberculosis, Pulmonary cavitary lesions, Fluoroquinolone

中图分类号:

R521

牛玉兰, 孔君, 黄艳, 杨燕, 刘裔, 曾谊, 张侠, 张向荣. 影响耐多药肺结核早期疗效危险因素分析[J]. 新发传染病电子杂志, 2023, 8(5): 1-5.

Niu Yulan, Kong Jun, Huang Yan, Yang Yan, Liu Yi, Zeng Yi, Zhang Xia, Zhang Xiangrong. Analysis of risk factors influencing the early curative effect of multidrug-resistant pulmonary tuberculosis[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(5): 1-5.

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