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目的探讨流动人口中涂阳肺结核患者治疗失败的影响因素,为制定干预措施、改善治疗效果提供理论依据。方法以深圳市宝安区2008年1月1日至2012年12月31日完成治疗疗程且转归为失败或治愈的流动涂阳肺结核患者为研究对象。纳入的研究对象4398例,治愈患者4007例,治疗失败者391例。运用χ2检验、Kruskal-Wallis检验或Fisher精确检验比较治疗失败与治愈患者在人口学特征、临床特征、检验结果、管理方式等方面的差异,检验水准为0.05,同时采用非条件logistic回归分析探讨治疗失败的影响因素。结果治疗失败患者中男性占72.63%(284/391),明显高于治愈患者的比率[62.27%(2495/4007)],两组间差异有统计学意义(χ2=16.4636,P<0.0001);治疗失败患者中30岁以下人群占40.66%(159/391),明显低于治愈患者的比率[56.68%(2271/4007)],两组间差异有统计学意义(χ2=36.9359,P<0.0001);治疗失败患者中2个月末痰检结果阳性者占48.69%(186/382),明显高于治愈患者的比率[14.08%(562/3992)],两组间差异有统计学意义(χ2=294.6323,P<0.0001);治疗失败患者中,实行系统管理的比例为94.37%(369/391),低于治愈患者的比例98.65%(3953/4007),两组间差异有统计学意义(χ2=38.4086,P<0.0001);治疗失败患者中有空洞者占48.59%(190/391)明显高于治愈患者(36.41%,1459/4007),两组间差异有统计学意义(χ2=22.5579,P<0.0001)。多因素非条件logistic回归结果显示,女性、30岁及以上、2个月末痰检阳性、实行系统管理和有空洞与治疗失败显著相关,OR值(95%CI值)分别为0.76(0.60~0.97)、1.59(1.27~1.99)、5.13(4.10~6.43)、0.37(0.19~0.72)和1.36(1.09~1.70)。结论女性、实行系统管理是治疗失败的保护因素,30岁及以上、2个月末痰检阳性和有空洞是治疗失败的危险因素。关注导致治疗失败的危险因素,探索有效的流动人口结核病患者管理方式,有利于降低治疗失败率。
Objective To explore the influencing factors of treatment failure of smear positive pulmonary tuberculosis among floating population and provide theoretical basis for making interventions and improving treatment effect. Methods The patients with flow-smear-positive pulmonary tuberculosis who completed the treatment course from January 1, 2008 to December 31, 2012 and failed or cured were studied. Included in the study were 4398 patients, 4007 patients cured, 391 patients failed to treat. The differences between demographic characteristics, clinical features, test results, management methods and other aspects were compared using Chi-square test, Kruskal-Wallis test or Fisher’s exact test. The test level was 0.05, and unconditional logistic regression analysis was used to explore the treatment The impact of failure. Results Male patients accounted for 72.63% (284/391), which was significantly higher than that of cured patients [62.27% (2495/4007)]. The difference between the two groups was statistically significant (χ2 = 16.4636, P <0.0001). Among the patients who failed to cure, 40.66% (159/391) were lower than 30 years old, which was significantly lower than that of cured patients [56.68% (2271/4007)]. The difference between the two groups was statistically significant (χ2 = 36.9359, P <0.0001 ). The positive rate of sputum examination in the two months after treatment failed to reach 48.69% (186/382), which was significantly higher than that of cured patients [14.08% (562/3992)], with significant difference between the two groups (χ2 = 294.6323, P <0.0001). Among the failed patients, 94.37% (369/391) were systematically administered and 98.65% (3953/4007) lower than the cured patients, with a significant difference between the two groups χ2 = 38.4086, P <0.0001). The number of patients with failed treatment accounted for 48.59% (190/391), which was significantly higher than that of cured patients (36.41%, 1459/4007). There was significant difference between the two groups (χ2 = 22.5579 , P <0.0001). Multivariate non-conditional logistic regression analysis showed that women with positive sputum examination at the age of 30 and above and two months later had significant correlations with systematic management and emptiness and failed treatment, with OR (95% CI) of 0.76 (0.60-0.97 ), 1.59 (1.27-1.99), 5.13 (4.10-6.43), 0.37 (0.19-0.72) and 1.36 (1.09-1.70). Conclusions Females, the implementation of systematic management is a protective factor of treatment failure, 30 years of age and above, 2 months after the sputum examination positive and empty is a risk factor for treatment failure. Concerned about the risk factors leading to the failure of treatment to explore the effective management of floating population of patients with tuberculosis, help to reduce the treatment failure rate.