Abstract: Background　There are chances of tuberculosis recurrence in cured patients with newly diagnosed smear-positive pulmonary tuberculosis（NDSPT），which is a major barrier to controlling the disease，and how to control it has become a key and difficult part in containing the disease.Objective　To explore the recurrence and associated factors in NDSPT patients cured by antituberculosis chemotherapy by analyzing the follow-up results.Methods　One hundred and fifteen cured patients with NDSPT treated in Department of Respiratory Medicine，the Third People's Hospital of Pingxiang City，from January 2015 to January 2018 were recruited.All of them were treated with 2HRZE/4HR as a standard antituberculosis chemotherapy for at least months，and were followed up for two consecutive years after being cured.Sputum smear microscopy for tuberculosis mycobacterium and sputum culture were performed during the follow-up and the results were collected to analyze the recurrence.Multivariate Logistic regression analysis was used to explore the factors associated with tuberculosis recurrence.Results　In total，94.8%（109/115）of the patients who were cured（sputum smear- and culture-negative）after completing the chemotherapy were finally included.The recurrence rate was 7.34%（8/109）during the follow-up，but there was no death caused by tuberculosis.The recurrence rate differed significantly by age and the time to sputum smear /culture conversion（P<0.05）.Those aged 60 or over had a higher recurrence rate than those aged 18-39 years old（P<0.05）.And those who needed more than three months to have sputum smear/culture conversion had higher recurrence rate than those who needed two months（P<0.05）.Multivariate Logistic regression analysis indicated that 60 years or older〔OR=1.768，95%CI（1.275，2.896）〕 and requiring more than three months to have sputum smear /culture conversion 〔OR=4.254，95%CI（2.983，6.415）〕 were risk factors for recurrence（P<0.05）.Conclusion　The recurrence in cured patients with NDSPT may be associated with older age，and longer time to sputum smear/culture conversion.To reduce the recurrence rate，chemotherapy regimen can be modified in accordance with the sputum test results in the short-term chemotherapy.

Key words: Tuberculosis, pulmonary；Cure；Recovery of yang；Short course chemotherapy；Follow-up observation；Root cause analysis

摘要： 背景　初治涂阳肺结核患者治愈后仍然存在一定的复发率，复发的控制成为该病防治工作的重点与难点，也是该病难以根本控制的主要原因之一。目的　对初治涂阳肺结核患者抗结核化疗的效果及随访结果进行分析，探讨影响复发的因素。方法　选取江西省萍乡市第三人民医院呼吸内科2015年1月—2018年1月收治的初治涂阳肺结核患者115例为研究对象，患者前2个月，均经标准抗结核病2HRZE/4HR化疗方案（至少6个月），并在治愈后持续随访2年，随访期间进行了痰结核分枝杆菌厚涂片、痰菌培养等检查，并记录相关结果及痰菌复发的情况。采用多因素Logistic回归分析探讨初治涂阳肺结核患者治愈后复发情况的影响因素。结果　94.8%（109/115）的患者完成全部短程化疗并治愈〔痰涂（-）培（-）〕，这部分患者均纳入本研究的统计分析。化疗疗程结束后，随访2年，共复发8例，复发率为7.34%（8/109），无结核病致死的病例。不同年龄、痰菌转阴时间初治涂阳肺结核患者治愈后复发率比较，差异均有统计学意义（P<0.05）；其中≥60岁的初治涂阳肺结核患者治愈后复发率高于18~39岁（P<0.05）；痰菌转阴时间>3个月的初治涂阳肺结核患者治愈后复发率高于痰菌转阴时间2个月（P<0.05）。多因素Logistic回归分析结果显示，年龄≥60岁〔OR=1.768，95%CI（1.275，2.896）〕、痰菌转阴时间>3个月〔OR=4.254，95%CI（2.983，6.415）〕是初治涂阳肺结核患者治愈后复发的危险因素（P<0.05）。结论　初治涂阳肺结核患者治愈后复发情况可能与年龄大及痰菌转阴时间晚有关，临床可根据在短程化疗过程中监测痰菌结果调整化疗方案，以降低复发率。

关键词: 结核, 肺；治愈；复发；短程化疗；随访观察；影响因素分析