CAJ | 학술논문

目的：分析徐州市完成全球基金耐多药结核病项目全程治疗的耐多药结核病（ MDR－TB）患者治疗效果的影响因素。方法选取2009年10月—2014年12月徐州市完成全球基金耐多药结核病项目全程治疗的130例MDR－TB患者，回顾性分析其临床资料，并分析MDR－TB患者治疗效果的影响因素。结果全程治疗结束后， MDR－TB患者治疗成功77例、死亡15例、失败34例（其中包括严重不良反应导致失败12例）、丢失3例、其他1例。单因素Logistic回归分析结果显示，性别〔OR ＝0.28，95％CI （0.11，0.75）〕、既往抗结核治疗史〔OR ＝1.60，95％CI （0.66，3.88）〕、结核病灶分布〔OR＝4.01，95％CI （1.23，12.59）〕、结核病灶数量〔OR＝3.06，95％CI （1.48，6.32）〕、6个月末痰培养结果〔OR＝4.78，95％CI （1.43，15.96）〕、12个月末痰培养结果〔OR＝12.82，95％CI （3.46，47.54）〕、治疗时间〔OR＝0.06，95％CI （0.03，0.15）〕是MDR－TB患者治疗效果的影响因素（ P＜0.05）。多因素Logistic回归分析结果显示，合并糖尿病〔OR＝5.31，95％CI （1.14，24.71）〕、结核病灶双侧分布〔OR＝16.12，95％CI （2.67，97.20）〕、12个月末痰培养结果阳性〔OR＝19.02，95％CI （3.51，103.03）〕是MDR－TB患者治疗不成功的危险因素（P＜0.05），治疗时间≥33 d 〔OR＝0.02，95％CI （0.01，0.09）〕是其保护因素（P＜0.05）。结论糖尿病、结核病灶分布、12个月末痰培养结果及治疗时间均会影响MDR－TB患者的治疗效果，应进一步加强MDR－TB治疗的全程规范化管理，重点做好强化期药物治疗，积极改善糖尿病等相关病症，根据治疗情况及时调整个体化治疗方案，引进更为先进的检查手段和外科治疗技术，以提高MDR－TB患者治疗成功率。
목적：분석서주시완성전구기금내다약결핵병항목전정치료적내다약결핵병（ MDR－TB）환자치료효과적영향인소。방법선취2009년10월—2014년12월서주시완성전구기금내다약결핵병항목전정치료적130례MDR－TB환자，회고성분석기림상자료，병분석MDR－TB환자치료효과적영향인소。결과전정치료결속후， MDR－TB환자치료성공77례、사망15례、실패34례（기중포괄엄중불량반응도치실패12례）、주실3례、기타1례。단인소Logistic회귀분석결과현시，성별〔OR ＝0.28，95％CI （0.11，0.75）〕、기왕항결핵치료사〔OR ＝1.60，95％CI （0.66，3.88）〕、결핵병조분포〔OR＝4.01，95％CI （1.23，12.59）〕、결핵병조수량〔OR＝3.06，95％CI （1.48，6.32）〕、6개월말담배양결과〔OR＝4.78，95％CI （1.43，15.96）〕、12개월말담배양결과〔OR＝12.82，95％CI （3.46，47.54）〕、치료시간〔OR＝0.06，95％CI （0.03，0.15）〕시MDR－TB환자치료효과적영향인소（ P＜0.05）。다인소Logistic회귀분석결과현시，합병당뇨병〔OR＝5.31，95％CI （1.14，24.71）〕、결핵병조쌍측분포〔OR＝16.12，95％CI （2.67，97.20）〕、12개월말담배양결과양성〔OR＝19.02，95％CI （3.51，103.03）〕시MDR－TB환자치료불성공적위험인소（P＜0.05），치료시간≥33 d 〔OR＝0.02，95％CI （0.01，0.09）〕시기보호인소（P＜0.05）。결론당뇨병、결핵병조분포、12개월말담배양결과급치료시간균회영향MDR－TB환자적치료효과，응진일보가강MDR－TB치료적전정규범화관리，중점주호강화기약물치료，적겁개선당뇨병등상관병증，근거치료정황급시조정개체화치료방안，인진경위선진적검사수단화외과치료기술，이제고MDR－TB환자치료성공솔。
Objective To analyze the influencing factors of treatment outcome of MDR-TB patients that completed the whole-process treatment of Global Fund MDR-TB Project in Xuzhou.Methods From October 2009 to December 2014, a total of 130 MDR-TB patients that completed the whole-process treatment of Global Fund MDR-TB Project in Xuzhou were collected, their clinical data was retrospectively analyzed, and the influencing factors of treatment outcome was analyzed. Results After the whole-process treatment of Global Fund MDR-TB Project, 77 cases were successfully cured, 15 cases were dead, 34 cases were failed ( including 12 cases caused by sever adverse reactions) , 3 cases were lost, 1 case′s information was unknown.Univariate Logistic regression analysis showed that, gender 〔OR=0.28, 95%CI (0.11, 0.75)〕, history of anti-tuberculosis treatment 〔OR =1.60, 95%CI (0.66, 3.88)〕, TB nidus distribution 〔OR =4.01, 95%CI (1.23, 12.59)〕, amount of TB nidus 〔OR=3.06, 95%CI (1.48, 6.32)〕, sputum culture results at the end of 6th month 〔OR=4.78, 95%CI (1.43, 15.96)〕, sputum culture results at the end of 12th month 〔OR=12.82, 95%CI (3.46, 47.54)〕, treatment time 〔OR=0.06, 95%CI (0.03, 0.15)〕 were influencing factors of treatment outcome (P<0.05); multivariate Logistic regression analysis showed that, complicated with diabetes 〔OR =5.31, 95%CI ( 1.14, 24.71 )〕, bilateral distribution of TB nidus 〔OR=16.12, 95%CI (2.67, 97.20)〕, positive sputum culture results at the end of 12th month〔OR=19.02, 95%CI ( 3.51, 103.03 )〕 were risk factors of failed treatment outcome ( P <0.05 ) , while treatment time equal or over 33 days was the protect factor 〔OR=0.02, 95%CI (0.01, 0.09), P<0.05〕.Conclusion Diabetes, TB nidus distribution, sputum culture results at the end of 12th month and treatment time can affect the treatment outcome of MDR-TB patients, medical workers should strengthen the whole -process normalized management of MDR -TB treatment, make intensive phase medications effectively works, treat diabetes and other related diseases in time, adjust the individualized treatment regimen according the therapeutic effect, introduce the new advanced examinational means and surgical technologies, to improve the successful treatment rate of MDR-TB.