安徽安庆地区肺结核复发的流行现状及影响因素研究

发布时间：2018-02-11 23:22

本文关键词： 肺结核复发复发率曲线 Cox回归分析　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:结核病患者成功治疗后的复发是当前结核病防治工作面临的一个重要问题。本研究的目的是了解安庆地区肺结核患者治愈和完成疗程后复发的流行现状并探讨复发的影响因素,为更好地制定结核病复发预防及控制策略提供理论依据和新思路。方法:以安庆市疾病预防控制中心2005-2014年期间报告登记的17297例初治治愈和11318例初治完成疗程肺结核患者作为研究对象,研究截止日期是2015年12月31日,其中在此期间内复发的患者作为病例组,而截至2015年12月31日未复发的患者为对照组。采用描述性分析方法对患者的复发情况进行了描述,同时通过卡方检验和Fisher确切概率法对复发与未复发患者的一般人口学特征和治疗相关情况进行了比较,并通过单因素和多因素Cox回归分析探讨了复发的影响因素。所有的数据分析均采用了统计软件SPSS 18.0,而复发率曲线的绘制则通过GraphPad Prism 5实现。P0.05被认为具有统计学意义。结果:在17297例治愈肺结核患者中,共有614位患者复发在研究期间复发,复发中位数时间为625.5天(四分位数间距:258-1160天)。在11318例完成疗程肺结核患者中,共有160位患者复发在研究期间复发,复发中位数时间为568.5天(四分位数间距:272.5-1055.5天)。17297例治愈肺结核患者的复发率明显高于11318例完成疗程肺结核患者(χ2=72.005,P0.001)。在治愈肺结核患者中,男性的复发率明显高于女性(χ2=10.830,P=0.001);X线胸片有空洞患者的复发率明显高于无空洞患者(χ2=21.712,P0.001);此外,复发率曲线在按照年龄组(χ2=58.753,P0.001)、职业(χ2=28.497,P0.001)、居住地(χ2=142.885,P0.001)和治疗方案(χ2=11.791,P=0.038)分层分析时有显著差异。而在完成疗程肺结核患者中,复发率曲线仅在按照X线胸片有无空洞分层分析时有显著差异(χ2=15.081,P0.001)。多因素Cox回归分析结果表明,在治愈肺结核患者中,男性比女性更易复发(HR=1.369,95%CI 1.124-1.668,P=0.002);就职业而言,农民比学生更易复发(HR=1.454,95%CI 1.158-1.825,P=0.001);就居住地而言,居住在怀宁县(HR=1.728,95%CI 1.356-2.201,P0.001)、宿松县(HR=2.362,95%CI 1.900-2.935,P0.001)、桐城市(HR=2.916,95%CI 2.372-3.584,P0.001)相对于枞阳县来说更易复发;就患者来源而言,接触者检查比健康检查更易复发(HR=6.652,95%CI 1.651-26.801,P=0.008);就治疗方案而言,采用方案“2HRZE/4HR”治疗比方案“2H3R3Z3/4H3R3”更不易复发(HR=0.560,95%CI 0.340-0.920,P=0.022);胸部X线上有空洞的患者比无空洞的患者更易复发(HR=1.645,95%CI 1.353-2.000,P0.001)。在完成疗程肺结核患者中,就居住地而言,居住在怀宁县(HR=1.992,95%CI 1.285-3.088,P=0.002)、宿松县(HR=1.682,95%CI 1.102-2.566,P=0.016)、桐城市(HR=1.885,95%CI 1.201-2.959,P=0.006)相对于枞阳县来说更易复发;胸部X线上有空洞的患者比无空洞的患者更易复发(HR=2.319,95%CI 1.499-3.586,P=0.001)。结论:治愈肺结核患者的复发率明显高于完成疗程肺结核患者。影响治愈肺结核患者和完成疗程肺结核患者复发的因素是有差异的,其中居住在怀宁县、宿松县、桐城市、X线胸片有空洞是治愈和完成疗程肺结核患者共同的复发危险因素。此外,男性、农民、接触者检查是治愈肺结核患者复发的危险因素,而治疗方案“2HRZE/4HR”则是其保护因素。
[Abstract]:Objective: successful treatment of the recurrence of tuberculosis patients is an important issue facing the current TB prevention and control work. The purpose of this study is to understand the epidemic situation of recurrence cure and completed the treatment of pulmonary tuberculosis patients in Anqing region and to explore the influencing factors of recurrence, in order to provide a theoretical basis and new ideas for better prevention and control of tuberculosis recurrence strategy. Methods: Anqing City Center for Disease Control and prevention during the 2005-2014 years report registered 17297 patients cured and 11318 cases of untreated completed the treatment of pulmonary tuberculosis patients as the research object, study the deadline is December 31, 2015, during which recurrence in the patients as case group, and as of December 31, 2015 without recurrence in patients with the control group. Descriptive analysis of recurrence were described, and the chi square test and Fisher exact probability method for complex And related demographic characteristics and treatment of patients without recurrence were compared by univariate and multivariate Cox regression analysis on the influencing factors of recurrence. All statistical analyses were performed by the statistical software SPSS 18, and the recurrence rate of the curve is drawn by GraphPad Prism 5.P0.05 was considered to be statistically significant results: 17297 cases were cured. In patients with pulmonary tuberculosis, a total of 614 patients with recurrent recurrence during the study period, the median recurrence time was 625.5 days (four percentile interval: 258-1160 days). The completion of treatment of pulmonary tuberculosis patients in 11318 cases, a total of 160 patients with recurrent recurrence during the study period, the median time to relapse for 568.5 days (four percentile interval: 272.5-1055.5 days).17297 cases were cured with pulmonary tuberculosis recurrence rate was significantly higher than that of 11318 patients completed the treatment of patients with pulmonary tuberculosis (2=72.005, P0.001) in the prevention and cure of tuberculosis patients. In the male the recurrence rate was significantly higher than that in female (2=10.830, P=0.001); X-ray cavity recurrence rate in patients with significantly higher than non empty patients (x 2=21.712, P0.001); in addition, the recurrence rate curve in accordance with the age group (2=58.753, P0.001), occupation (2=28.497, P0.001), where (x 2=142.885, P0.001) and treatment (2=11.791, P=0.038) stratified analysis has significant difference. In the treatment of patients with pulmonary tuberculosis, the recurrence rate curve only had significant differences in accordance with the X-ray empty stratified analysis (2=15.081, P0.001). Cox regression analysis results show that in the cure of lung TB patients, more men than women (HR=1.369,95%CI, 1.124-1.668, P=0.002) recurrence; on the occupation, farmers are more likely to relapse than students (HR=1.454,95%CI 1.158-1.825, P=0.001); they live, live in Huaining county (HR=1.728,95%CI 1.356-2.201 P0.001), Susong county (HR=2.362,95%CI 1.900-2.935, P0.001), Tongcheng (HR=2.916,95%CI 2.372-3.584, P0.001) with respect to Zongyang county is more easy to relapse; patients in terms of contact examination than health examination more easy to relapse (HR=6.652,95%CI 1.651-26.801, P=0.008); treatment scheme, the scheme of "2HRZE/4HR" for "2H3R3Z3/4H3R3" is more than plan recurrence (HR=0.560,95%CI 0.340-0.920, P=0.022); empty empty than patients without relapse on chest X-ray (HR=1.645,95%CI 1.353-2.000, P0.001). In the treatment of patients with pulmonary tuberculosis, we live, live in Huaining county (HR=1.992,95%CI 1.285-3.088, P=0.002), Susong county (HR=1.682,95%CI 1.102-2.566, P=0.016), Tongcheng (HR=1.885,95%CI, 1.201-2.959, P=0.006) with respect to Zongyang county is more easy to relapse; empty than patients without empty patients on chest X-ray People are more likely to relapse (HR=2.319,95%CI 1.499-3.586, P=0.001). Conclusion: the cure of patients with pulmonary tuberculosis recurrence rate was significantly higher than that of the completion of treatment in patients with pulmonary tuberculosis. Effect of pulmonary tuberculosis and pulmonary tuberculosis patients completed the treatment of recurrence factors of cure is different, which resides in the Huaining County, Susong County, Tongcheng City, there is empty chest X-ray complete cure and recurrence risk common treatment in patients with pulmonary tuberculosis. In addition, men, farmers, contact examination is a risk factor for cure of recurrence in patients with pulmonary tuberculosis, and the treatment of "2HRZE/4HR" is the protective factor.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R521;R181.3

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