Analysis of the efficacy and its influencing factors on multidrug-resistant tuberculosis in Shenzhen city

目的 分析深圳市近7年耐多药结核病(MDR-TB)的治疗结果及其影响因素,为今后MDR-TB临床路径的制定及治疗方案的优化提供科学依据.方法 对2006年10月至2013年10月在深圳市登记治疗的165例MDR-TB患者进行双向性队列研究,收集患者性别、年龄、婚姻状况等基础资料,以及初复治情况、影像学资料、并发其他疾病等信息.根据患者治疗转归情况进行疗效分类,选择治疗成功和疗效不佳者进行影响因素分析.采用logistic回归模型进行单因素和多因素分析.结果 165例MDR-TB患者中,109例(66.1％)治疗成功,21例(12.7％)疗效不佳,35例(21.2％)疗效无法判定.对治疗成功和疗效不佳者的单因素分析发现,年龄[11.0％(12/109);33.3％(7/21)]、婚姻状况[61.5％(67/109);85.7％(18/21)]及并发其他疾病[16.5％(18/109);42.9％(9/21)]与治疗效果密切相关(Wald x2=6.34,P=0.012;Wald x2=4.10,P=0.043;Wald x2=6.81,P=0.009);多因素logistic回归分析结果显示,年龄和并发其他疾病与MDR-TB治疗效果密切相关;＞40岁的患者较≤40岁的患者(β=1.40,OR=4.03,95％CI=1.30～12.53,Wald x2=5.82,P=0.016)以及并发其他疾病者较无并发其他疾病者(β=1.33,OR=3.79,95％CI=1.34～10.68,Wald x2=6.33,P=0.012)疗效不佳的风险高.结论 深圳市MDR-TB治疗效果的重要影响因素是患者的年龄和并发其他疾病,需对＞40岁和并发其他疾病的MDR-TB患者加强疗效的观察,随时调整治疗方案、进行个体化治疗.Objective To analyze the efficacy and its influencing factors on multidrug-resistant tuberculosis (MDR-TB) in Shenzhen for the last seven years,and to provide scientific evidences for the formulation of MDR-TB clinical pathway and the optimization of treatment regimen in the future.Methods We conducted retrospective prospective cohort study in 165 registered cases with MDR-TB from Shenzhen during Oct.2006 to Oct.2013.Data including gender,age,marital status,primary treatment or retreatment,imaging and complications were collected.The influencing factors were analyzed in patients with successful treatment and poor outcome according to the classi fication of outcome.Single factor and multivariate logistic regression analysis was used the model of logistic regression.Results Of 165 cases with MDR-TB,there were successful treatment in 109 cases (66.1％),poor ourcomes in 21 cases (12.7％) and efficacy undetermined in 35 cases (21.2％).Single factor analysis showed that age (11.0％ (12/109) vs.33.3％ (7/21)),marital status (61.5％ (67/109) vs.85.7％ (18/21)) and complications (16.5％ (18/109) vs.42.9％ (9/21)) were closely related with outcome (Wald x2 =6.34,P=0.012;Wald x2 =4.10,P=0.043;Wald x2=6.81,P=0.009).Multivariate logistic regression analysis showed that age and complications were closely related with outcome.The risk of poor outcome in cases aged more than 40 years old was high than that in cases aged less than 40 years old (β=1.40,OR =4.03,95％ CI =1.30-12.53,Wald x2 =5.82,P =0.016).The risk of poor outcome in cases with complications was high than that in cases without complications (β=1.33,OR=3.79,95％CI=1.34-10.68,Wald x2=6.33,P=0.012).Conclusion Age and complication are the important influencing factors of treatment outcome for the patients with MDR-TB in Shenzhen city.Strengthen evaluation of efficacy,adjusting the treatment regimen whenever necessary and carrying on the individual treatment need to be strengthened in cases with aged more than 40 years old and with complications.“十二五”国家科技重大专项; 深圳市科技计划项目2184-1903