热带病与寄生虫学

热带病与寄生虫学 ›› 2023, Vol. 21 ›› Issue (2): 72-77.doi: 10.3969/j.issn.1672-2302.2023.02.003

• 结核病控制专题 • 上一篇    下一篇

2021—2022年全国亚临床结核病治疗转归及其影响因素分析

王涵飞(), 李涛, 赵雁林, 徐彩红()   

  1. 中国疾病预防控制中心结核病预防控制中心，北京102206
  • 收稿日期:2023-03-31 出版日期:2023-04-20 发布日期:2023-05-03
  • 通信作者: 徐彩红，E-mail: xuch@chinacdc.cn
  • 作者简介:王涵飞，男，硕士在读，研究方向：结核病防治。E-mail: wanghanfei0223@163.com
  • 基金资助:
    中央财政结核病预防控制项目结核业务日常运转(238711)

Analysis on factors affecting the medication outcomes of subclinical tuberculosis in China from 2021 to 2022

WANG Han-fei(), LI Tao, ZHAO Yan-lin, XU Cai-hong()   

  1. National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
  • Received:2023-03-31 Online:2023-04-20 Published:2023-05-03
  • Contact: XU Cai-hong, E-mail: xuch@chinacdc.cn

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摘要：

目的 了解我国亚临床结核病的治疗转归情况及其影响因素，为进一步开展亚临床结核病的防治工作提供参考依据。方法 通过中国疾病预防控制信息系统结核病管理信息系统收集2021—2022年全国各级结核病定点医疗机构确诊的亚临床结核病患者个案信息，包括人群分布特征、临床特征、治疗管理情况等，对其人群分布特征进行描述性分析，并采用二元logistic回归分析其治疗转归影响因素。结果 2021—2022年全国共登记3 804例亚临床结核病患者，其中男性2 587例（占68.0%）、45~64岁1 232例（占32.4%）、农民2 161例（占56.8%）、本地户籍3 445例（占90.6%）、新患者3 625例（占95.3%）、经转诊和追踪发现2 758例（占72.5%）、HIV阴性3 743例（占98.4%）；治疗成功3 558例（占93.5%），不良结局246例（占6.5%）。回归分析结果显示，45~64岁（OR=2.264，95%CI：1.244~4.119）、≥65岁（OR=4.538，95%CI：2.521~8.169），HIV阳性（OR=2.443，95%CI：1.090~5.476），有合并症（OR=1.761，95%CI：1.305~2.378），病原学阳性（OR=2.187，95%CI：1.548~3.087），首次治疗方案为2HRZE/10HRE（OR=4.466，95%CI：3.009~6.629）、2HRZE/7-10HRE（OR=2.240，95%CI：1.262~3.975）、其他敏感方案（OR=1.802, 95%CI：1.228~2.645）是治疗转归危险因素。结论 亚临床结核病患者以中老年、男性、农民、本地户籍人群为主，患者主要来源为被动发现的转诊和追踪。≥45岁、HIV阳性、有合并症、病原学结果阳性、首次治疗时未采用初治结核病标准化治疗方案会增加发生不良治疗结局的风险。因此，需要进一步加大中老年人群、农村地区结核病患者的主动发现力度，规范结核病患者诊疗，尽早发现亚临床结核病患者，以提高治疗成功率。

关键词: 亚临床结核病, 治疗转归, 影响因素

Abstract:

Objective To understand the factors affecting the treatment outcomes of patients with subclinical tuberculosis in China for evidence in prevention of the infection and treatment of such patients in the future. Methods The data of subclinical tuberculosis patients diagnosed by designated tuberculosis medical institutions at all levels in China were obtained from 2021 to 2022 via the Tuberculosis Management Information System of China Information System for Disease Control and Prevention. The case information consisted of demographic characteristics, clinical pictures and medication history, and was descriptively analyzed concerning the characteristics in population distribution. Binary logistic regression model was used to analyze the factors affecting treatment outcomes. Results Between 2021 and 2022, a total of 3 804 patients were included, in whom 2 587 (68.0%) were males. 1 232 (32.4%) patients aged from 45 to 64 years, and 2 161 (56.8%) were farmers. 3 445 (90.6%) patients were local infection, and 3 625 (95.3%) were new patients. 2 758 (72.5%) patients were identified in referral and follow-up, and 3 743 (98.4%) were HIV negative. According to the outcome, 3 558 cases (93.5%) had successful treatment and 246 cases (6.5%) had poor outcome. Logistic regression analysis showed that the risk factors for medication outcomes involved in patients aged 45-64 years old (OR=2.264, 95% CI: 1.244-4.119) or ≥65 years old (OR=4.538, 95%CI: 2.521-8.169), patients with HIV positive (OR=2.443, 95%CI: 1.090-5.476), or with comorbidities (OR=1.761, 95%CI: 1.305-2.378) and those with positive pathogen findings (OR=2.187, 95%CI: 1.548-3.087), patients undergone initial treatment regimens with 2HRZE/10HRE (OR=4.466, 95%CI: 3.009-6.629), 2HRZE/7-10HRE (OR=2.240, 95%CI: 1.262-3.975), or other sensitive regimens (OR=1.802, 95%CI: 1.228-2.645). Conclusion Subclinical tuberculosis patients were mainly middle-aged or elderly male farmers, and local infections. The patients were generally passively identified in referral and follow-up. Poor treatment outcomes may occur in patients aged ≥45 years, patients with HIV positive, or comorbidities, and those with positive pathogen results as well as failed use of standard medication regimen in patients undergone the initial treatment of tuberculosis. Therefore, it is necessary to further expand active detection of potential tuberculosis patients in the elderly population and those in rural areas, as well as further standardize the diagnosis and treatment of tuberculosis patients in order to early identify the subclinical tuberculosis patients and improve successful medication.

Key words: Subclinical tuberculosis, Treatment outcomes, Influencing factors

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