Factors Affecting Treatment Outcomes of Pulmonary Tuberculosis in Xinjiang Uygur Population

doi:10.12114/j.issn.1007-9572.2019.00.016

Abstract

Abstract: Background　Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis infection，which is one of the major public health problems in the world.According to the analysis of Chinese Center for Disease Control and Prevention，the reported incidence of tuberculosis in Xinjiang ranked first in China in 2015.Objective　To analyze the factors affecting treatment outcomes of pulmonary tuberculosis in Xinjiang Uygur Population，providing a theoretical basis for the prevention and treatment of pulmonary tuberculosis in Xinjiang.Methods　From March to April 2016，Uygur tuberculosis patients in Xinjiang registered in the National Tuberculosis Network Special Reporting System from July 2014 to June 2015 were selected.General demographic data （age，gender，place of residence，hukou location，occupation） and clinical data （patient source，sputum smear results，type of tuberculosis，type of treatment，treatment outcomes） of the patients were collected retrospectively，and the factors affecting treatment outcomes were analyzed.Results　Of the 24 298 cases registered，29 had a diagnosis change，889 had no reported treatment outcomes，the remaining 23 380 were eventually included in the study.Among the 23 380 cases，1 490 （6.4%） had failed treatment，and 564 died（2.4%） from tuberculosis.Multivariate Logistic regression analysis showed that age ≥60 years〔OR=1.550，95%CI（1.386，1.733）〕，living in rural areas〔OR=1.241，95%CI（1.065，1.446）〕，professional，technical and managerial workers〔OR=2.031，95%CI（1.038，3.974），retirees〔OR=2.050，95%CI（1.073，3.915）〕，referral receivers〔OR=1.812，95%CI（1.190，2.758），follow-up receivers〔OR=1.624，95%CI（1.047，2.517）〕，positive sputum smear results〔OR=1.622，95%CI（1.420，1.854）〕 and retreatment〔OR=1.859，95%CI（1.545，2.237）〕 were risk factors of tuberculosis treatment failure（P<0.05）．Age≥60 years〔OR=2.462，95%CI（2.038，2.975）〕，male〔OR=1.394，95%CI（1.174，1.656）〕，living in rural areas〔OR=1.265，95%CI（1.002，1.598）〕，positive sputum smear results 〔OR=2.027，95%CI（1.652，2.486）〕，retreatment〔OR=1.606，95%CI（1.216，2.121）〕 were risk factors of death due to tuberculosis（P<0.05）．Conclusion　Age，place of residence，occupation，patient source，sputum smear results and treatment type are the influencing factors of tuberculosis treatment failure.Age，gender，place of residence，sputum smear results and treatment type are the influencing factors of death due to tuberculosis.In view of this，relevant departments in Xinjiang should take measures to strengthen the prevention and treatment of tuberculosis in Uygur population，especially the elderly，persons living in rural areas，retirees，tuberculosis referral receivers，tuberculosis follow-up receivers，persons with positive sputum smear results，or those with tuberculosis retreatment.

Key words: Tuberculosis, pulmonary；Treatment outcome；Root cause analysis；Xinjiang

摘要： 背景　结核病是由结核分枝杆菌感染引起的一种慢性传染病，是全球主要的公共卫生问题之一。且据中国疾病预防控制中心分析显示，2015年新疆肺结核报告发病率位居全国第一。目的　分析新疆维吾尔族人群肺结核治疗结局的影响因素，为新疆肺结核防治工作提供理论依据。方法　2016年3—4月，选取2014年7月—2015年6月在全国结核病网络专报系统中登记的新疆维吾尔族肺结核患者。回顾性收集研究对象的一般人口学资料（年龄、性别、居住地、户籍地、职业）和临床资料（患者来源、痰涂片结果、诊断类型、治疗类型、治疗结局），并分析肺结核患者治疗结局的影响因素。结果　2014年7月—2015年6月在全国结核病网络专报系统中共登记24 298例新疆维吾尔族肺结核患者，其中29例诊断变更，889例无治疗结局，最终纳入研究23 380例。23 380例新疆维吾尔族肺结核患者中，治疗不成功1 490例（6.4%），死亡564例（2.4%）。多因素Logistic回归分析结果显示，年龄〔≥60岁：OR=1.550，95%CI（1.386，1.733）〕、居住地〔乡村：OR=1.241，95%CI（1.065，1.446）〕、职业〔专业技术人员及干部职员：OR=2.031，95%CI（1.038，3.974）；离退休人员：OR=2.050，95%CI（1.073，3.915）〕、患者来源〔转诊：OR=1.812，95%CI（1.190，2.758）；追踪：OR=1.624，95%CI（1.047，2.517）〕、痰涂片结果〔涂阳：OR=1.622，95%CI（1.420，1.854）〕、治疗类型〔复治：OR=1.859，95%CI（1.545，2.237）〕是患者治疗不成功的影响因素（P<0.05）。年龄〔≥60岁：OR=2.462，95%CI（2.038，2.975）〕、性别〔男：OR=1.394，95%CI（1.174，1.656）〕、居住地〔乡村：OR=1.265，95%CI（1.002，1.598）〕、痰涂片结果〔涂阳：OR=2.027，95%CI（1.652，2.486）〕、治疗类型〔复治：OR=1.606，95%CI（1.216，2.121）〕是患者死亡的影响因素（P<0.05）。结论　年龄、居住地、职业、患者来源、痰涂片结果、治疗类型是患者治疗不成功的影响因素，年龄、性别、居住地、痰涂片结果、治疗类型是患者死亡的影响因素；新疆相关部门应采取措施，尤其要加强对老年人、乡村、离退休人员、转诊、追踪、涂阳、复治维吾尔族肺结核患者的防治工作。

关键词: 结核, 肺；治疗结果；影响因素分析；新疆

YANG Dan,WEN Jin,LIU Nianqiang, et al. Factors Affecting Treatment Outcomes of Pulmonary Tuberculosis in Xinjiang Uygur Population　[J]. Chinese General Practice, 2019, 22(12): 1413-1418. DOI: 10.12114/j.issn.1007-9572.2019.00.016.
杨丹,文进,刘年强等. 新疆维吾尔族人群肺结核治疗结局影响因素研究[J]. 中国全科医学, 2019, 22(12): 1413-1418. DOI: 10.12114/j.issn.1007-9572.2019.00.016.

References

［1］World Health Organization.Global Tuberculosis report 2018［EB/OL］．［2018-10-02］．https：//www.who.int/tb/publications/global_report/en/.
［2］陈伟，夏愔愔，李涛，等．2015年全球及中国结核病疫情形势分析［J］．结核病与肺部健康杂志，2016，5（1）：32-36．DOI：10.3969/j.issn.2095-3755.2016.01.010.
CHEN W，XIA Y Y，LI T，et al．Analysis of the Global and China TB epidemic situation in 2015［J］．Journal of Tuberculosis and Lung Health，2016，5（1）：32-36．DOI：10.3969/j.issn.2095-3755.2016.01.010.
［3］MIJITI P，YUEHUA L，FENG X，et al．Prevalence of pulmonary tuberculosis in western China in 2010-11：a population-based，cross-sectional survey［J］．Lancet Global Health，2016，4（7）：e485-494．DOI：10.1016/S2214-109X（16）30074-2.
［4］中华人民共和国卫生部疾病预防控制局，中华人民共和国卫生部医政司，中国疾病预防控制中心.中国结核病防治规划实施工作指南（2008年版）［M］．北京：中国协和医科大学出版社，2008．
Directorate of Disease Control and Prevention，Ministry of Health of the People's Republic of China；Ministry of Health，People's Republic of China；Chinese Center for Disease Control and Prevention.Guidelines for the implementation of the tuberculosis control plan in China （2008 edition）［M］．Beijing：China Union Medical University Press，2008.
［5］COSTA-VEIGA A，BRIZ T，NUNES C.Unsuccessful treatment in pulmonary tuberculosis：factors and a consequent predictive model［J］．Eur J Public Health，2018，28（2）：352-358．DOI：10.1093/eurpub/ckx136.
［6］GEBREZGABIHER G，ROMHA G，EJETA E，et al．Treatment outcome of tuberculosis patients under directly observed treatment short course and factors affecting outcome in southern ethiopia：a five-year retrospective study［J］．PLoS One，2016，11（2）：e0150560．DOI：10.1371/journal.pone.0150560.
［7］KWON Y S，KIM Y H，SONG J U，et al．Risk factors for death during pulmonary tuberculosis treatment in Korea：a multicenter retrospective cohort study［J］．J Korean Med Sci，2014，29（9）：1226–1231．DOI：10.3346/jkms.2014.29.9.1226.
［8］王倪，杜建，马艳，等．涂阳肺结核患者治疗失败影响因素分析［J］．中国防痨杂志，2016，38（6）：450-455．DOI：10.3969/j.issn.1000-6621.2016.06.006.
WANG N，DU J，MA Y，et al．Risk factors of treatment failure in smear-positive pulmonary tuberculosis patients［J］．Chinese Journal of Antituberculosis，2016，38（6）：450-455．DOI：10.3969/j.issn.1000-6621.2016.06.006.
［9］李杨婷，廖雪莲，韩莉，等．脓毒症合并活动性结核危重患者的死亡危险因素分析［J］．四川大学学报（医学版），2016，47（4）：589-593.
LI Y T，LIAO X L，HAN L，et al．Risk factors for mortality among patients with sepsis complicated with active tuberculosis［J］．Journal of Sichuan University （Medical Science Edition），2016，47（4）：589-593.
［10］RODRIGO T，CASALS M，CAMINERO J A，et al．Factors associated with fatality during the intensive phase of anti-tuberculosis treatment［J］．PLoS One，2016，11（8）：e0159925．DOI：10.1371/journal.pone.0159925.
［11］WANG N，MA Y，LIU Y H，et al．Risk of treatment failure in patients with drug-susceptible pulmonary tuberculosis in China［J］．Biomed Environ Sci，2016，29（8）：612-617．DOI：10.3967/bes2016.083.
［12］刘美鹏，王昱，蔡立莉，等.肺结核患者全身健康状态调查［J］.中国全科医学，2016，19（11）：1333-1337.DOI：10.3969/j.issn.1007-9572.2016.11.022.
LIU M P，WANG Y，CAI L L，et al．Survey of the systemic health status of patients with pulmonary tuberculosis［J］．Chinese General Practice，2016，19（11）：1333-1337.DOI：10.3969/j.issn.1007-9572.2016.11.022.
［13］BABALIK A，KILICASLAN Z，KIZILTAS S，et al．A retrospective case-control study，factors affecting treatment outcomes for pulmonary tuberculosis in istanbul，Turkey［J］．Balkan Med J，2013，30（2）：204-210．
［14］ANTOINE D，CHE D.Treatment outcome monitoring of pulmonary tuberculosis cases notified in France in 2009［J］．Euro Surveill，2013，18（12）：20434.
［15］PELTZER K，LOUW J S.Prevalence and factors associated with tuberculosis treatment outcome among hazardous or harmful alcohol users in public primary health care in South Africa［J］．Afr Health Sci，2014，14（1）：157-166．DOI：10.4314/ahs.v14i1.24.
［16］康桂芹，李科峰.肺结核患者死亡情况及其影响因素的历史性队列研究［J］．健康研究，2015，35（6）：611-613．DOI：10.3969/j.issn.1674-6449.2015.06.005.
［17］DALE K，TAY E，TREVAN P，et al．Mortality among tuberculosis cases in Victoria，2002—2013：case fatality and factors associated with death［J］．Int J Tuberc Lung Dis，2016，20（4）：515-523．DOI：10.5588/ijtld.15.0659.

[1]	CHEN Tao, FAN Qingze, SUN Xuemei, YU Yongqi, LUO Hongli. Efficacy and Safety of Anti-tuberculosis Drugs for the Treatment of Multidrug Resistance-tuberculosis: a Network Meta-analysis [J]. Chinese General Practice, 2023, 26(05): 598-606.
[2]	ZHAO Mingyang, ZHOU Qianyu, WANG Rongrong, WANG Zongxi, HE Wenqian, ZHANG Wensen, ZHANG Hengzhen, TIAN Zhuoyang, WU Ke, WANG Biyao, SUN Changqing. Influencing Factors of the Incidence of Pulmonary Tuberculosis in China: an Analysis Using the Geographically and Temporally Weighted Regression Model [J]. Chinese General Practice, 2023, 26(05): 583-590.
[3]	Zeshun JIANG, Zhenggui YANG, Jiangping LI, Xue HAN, Lifang REN, Shenghong QI, Xinyi LIU, Lan LIU. Influencing Factors of Latent Tuberculosis Infection in Patients Living with HIV/AIDS [J]. Chinese General Practice, 2022, 25(30): 3796-3802.
[4]	Yingmei ZHANG, Fei WANG, Xiaobing REN, Yuelian WANG, Jun CHEN, Ying HU, Xiaoqin HU, Wenge XU. Phenotypic Drug Resistance and Gene Mutation in Mycobacterium Tuberculosis with and without Diabetes: a Prospective Study [J]. Chinese General Practice, 2022, 25(29): 3616-3620.
[5]	Peng ZHANG, Yanping HUANG, Mingjia LIN, Wenjuan JING, Zhongsheng JIANG. Development and Application Assessment of a Clinical Diagnostic Scoring System for Tuberculous Meningitis [J]. Chinese General Practice, 2022, 25(24): 3043-3048.
[6]	Yide WANG, Zongxiang TIAN, Zheng LI, Fengsen LI. Pulmonary Function and Imaging Characteristics of Tuberculosis Associated Obstructive Pulmonary Disease Using Propensity Score-matched Analysis [J]. Chinese General Practice, 2022, 25(14): 1718-1723.
[7]	Yunhong WU, Shaolong ZHOU, Jing WANG, Yiqiu CAI, Yaming LIN. Expression Levels and Clinical Significance of Serum NCAM1 and TTR in Tuberculous Meningitis [J]. Chinese General Practice, 2022, 25(12): 1435-1440.
[8]	. [J]. Chinese General Practice, 2022, 25(08): 930-936.
[9]	LI Jinghong，WU Yuqing，LIAO Yongmei，LIU Zhou. Study on the Influencing Factors and Prognosis of Liver Injury in Patients with Newly Diagnosed Pulmonary Tuberculosis and Hepatitis B Co-infection during Anti-tuberculosis Treatment　 [J]. Chinese General Practice, 2021, 24(30): 3837-3842.
[10]	LI Ying，WANG Zukang，WEI Youliang，GONG Zhihua. Recurrence and Associated Factors in Cured Patients with Newly Diagnosed Smear-positive Pulmonary Tuberculosis：a Follow-up Study　 [J]. Chinese General Practice, 2021, 24(14): 1785-1789.
[11]	SHAO Meng，WU Fang，ZHANG Jie，DONG Jiangtao，LIU Xiaoling，WU Jiangdong，ZHANG Le，ZHAO Haijun，ZHANG Wanjiang. Effects of a New Tuberculosis Vaccine Strain on T Cell Immune Memory and Proliferation Capacity　 [J]. Chinese General Practice, 2021, 24(11): 1376-1382.
[12]	RUAN Hang，WU Yanfei，ZHENG Yulan. Addison's Disease with Refractory Hyponatremia as the First Manifestation：Report of One Case and Diagnostic Procedure Analysis　 [J]. Chinese General Practice, 2020, 23(33): 4264-4266.
[13]	CHEN Ruman，AN Na，XU Mingzhi，FENG Haihuan，LI Hong. Prevalence and Influencing Factors of Pulmonary Tuberculosis in Maintenance Hemodialysis Patients in Hainan Province，2017　 [J]. Chinese General Practice, 2020, 23(15): 1942-1949.
[14]	ZHANG Jinjing，YANG Yunyun，PENG Dali. Research Progress in Improving the Treatment Compliance of Tuberculosis Patients with the Utilization of New Technologies　 [J]. Chinese General Practice, 2020, 23(1): 114-119.
[15]	LIU Xiaojuan，LI Yan，SHA Xiaolan，LIU Lan. Epidemiological Characteristics from 2008 to 2018 and Trend Prediction of Pulmonary Tuberculosis in Yinchuan City　 [J]. Chinese General Practice, 2019, 22(32): 3975-3979.