摘要
目的:分析2015—2021年全国65岁及以上利福平耐药肺结核(rifampicin-resistant pulmonary tuberculosis,RR-PTB)患者的治疗转归及影响因素。方法:从“中国疾病预防控制信息系统”子系统“监测报告管理”的“耐药病案管理”中收集2015年1月1日至2021年12月31日期间登记治疗的全国年龄≥65岁的RR-PTB患者病案资料。描述性分析患者人口学特征、诊疗信息及治疗结局,采用单因素和多因素logistic回归模型分析影响患者治疗转归的因素。结果:2015—2021年,全国共登记≥65岁RR-PTB患者13806例,登记率为1.16/10万(13806/119133万),从2015年的0.50/10万(726/14524万)上升至2021年的1.37/10万(2743/20056万);老年RR-PTB患者占全部RR-PTB患者的比例为16.15%(13806/85494),从2015年的13.24%(726/5484)上升至2021年的19.12%(2743/14348);登记患者治疗率为80.18%(11070/13806),从2015年的58.13%(422/726)上升至2021年的90.01%(2469/2743);成功治疗率为46.37%(5133/11070),从2015年的37.20%(157/422)上升至2021年的48.85%(1206/2469),均呈明显上升趋势(χ^(2)趋势值分别为96.329、272.135、919.021、30.029,P值均<0.001)。多因素logistic回归分析显示:与65~69岁年龄组、女性、家务及待业、居住在东部地区、初治和利福平单耐药患者相比,70~74岁年龄组、75~79岁年龄组、≥80岁年龄组、男性、从事农/林/牧/渔、居住在中部和西部地区、复治、耐多药和准广泛/广泛耐药患者未成功治疗的风险均更高(OR=1.156,95%CI:1.055~1.268;OR=1.415,95%CI:1.269~1.578;OR=1.887,95%CI:1.655~2.154;OR=1.202,95%CI:1.101~1.312;OR=1.152,95%CI:1.037~1.279;OR=1.655,95%CI:1.503~1.823;OR=1.657,95%CI:1.494~1.837;OR=1.109,95%CI:1.028~1.197;OR=1.243,95%CI:1.147~1.346;OR=1.331,95%CI:1.015~1.752)。结论:我国65岁及以上老年RR-PTB患者登记率、在人群中的占比均呈上升趋势,登记患者治疗率较高,但成功治疗率较低。需要重点关注男性、年龄≥70岁、职业为农/林/牧/渔、居住在中西部地区、复治,以及分类为耐多药、准广泛/广泛耐药的患者。
Objective:To analyse the treatment outcomes and influencing factors of patients with rifampicin-resistant pulmonary tuberculosis(RR-PTB)aged 65 years and above in China from 2015 to 2021.Methods:The medical records of patients aged 65 years and older diagnosed with RR-PTB and treated nationwide from January 1,2015,to December 31,2021,were retrieved from the“Drug-Resistant Case Management”section of the“Surveillance Report Management”module within the“China Information System for Disease Control and Prevention”.Descriptive analysis was performed on the patients’demographic characteristics,diagnostic and treatment details,and treatment outcomes.Univariate and multivariate logistic regression analysis were used to analyse the factors influencing treatment outcomes.Results:From 2015 to 2021,a total of 13806 RR-PTB patients aged 65 and above were registered nationwide,with an incidence rate of 1.16 per 100000(13806/1191.33 million).The rate increased from 0.50 per 100000(726/145.24 million)in 2015 to 1.37 per 100000(2743/200.56 million)in 2021.The proportion of elderly RR-PTB patients among all RR-PTB patients was 16.15%(13806/85494),increasing from 13.24%(726/5484)in 2015 to 19.12%(2743/14348)in 2021.The treatment rate of registered patients was 80.18%(11070/13806),increasing from 58.13%(422/726)in 2015 to 90.01%(2469/2743)in 2021.The treatment success rate was 46.37%(5133/11070),increasing from 37.20%(157/422)in 2015 to 48.85%(1206/2469)in 2021,showing a significant upward trend(χ^(2)trend values were 96.329,272.135,919.021,and 30.029,with P-values all<0.001).Multivariate logistic regression analysis revealed that,relative to individuals aged 65-69,females,homemakers,and unemployed individuals,eastern region,primary treatment,and rifampicin monoresistance,those in older age groups(70-74,75-79,and 80+),males,individuals engaged in agriculture,pastoralism,or fishing,residents of central and western regions,retreatment,with multidrug-resistant,pre-extensively drug-resistant,or extensively drug-resistant pulmonary tuberculosis exhibited significantly higher risks of treatment failure(OR=1.156,95%CI:1.055-1.268;OR=1.415,95%CI:1.269-1.578;OR=1.887,95%CI:1.655-2.154;OR=1.202,95%CI:1.101-1.312;OR=1.152,95%CI:1.037-1.279;OR=1.655,95%CI:1.503-1.823;OR=1.657,95%CI:1.494-1.837;OR=1.109,95%CI:1.028-1.197;OR=1.243,95%CI:1.147-1.346;OR=1.331,95%CI:1.015-1.752).Conclusion:The registration rate and proportion of elderly RR-PTB patients aged 65 and above in China have exhibited an upward trend.Although the treatment initiation rate among registered patients is relatively high,the treatment success rate remains suboptimal.Particular attention should be directed towards male patients,those aged 70 and above,individuals engaged in agriculture,pastoralism,or fishing,residents of central and western regions,patients with prior treatment history,as well as those diagnosed with multidrug-resistant tuberculosis,pre-extensively drug-resistant tuberculosis,or extensively drug-resistant tuberculosis.
作者
李玉红
梅金周
苏伟
阮云洲
刘玉舒
赵雁林
刘小秋
Li Yuhong;Mei Jinzhou;Su Wei;Ruan Yunzhou;Liu Yushu;Zhao Yanlin;Liu Xiaoqiu(National Center for Tuberculosis Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China;National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases,Chinese Center for Disease Control and Prevention,Beijing 102206,China;Department of Tuberculosis Prevention and Control,Shenzhen Bao’an Center for Chronic Disease Control,Shenzhen 518101,China)
出处
《中国防痨杂志》
北大核心
2025年第4期408-415,共8页
Chinese Journal of Antituberculosis
基金
中央财政结核预防病控制项目(2428)
开展老年人和糖尿病主动发现肺结核方法的可行性和效果的研究(CS-2020-5)。
关键词
结核
老年人
利福平
药物耐受性
治疗结果
因素分析
统计学
Tuberculosis
Elderly
Rifampicin
Drug resistance
Treatment outcome
Factor analysis,statistical
