中国复治肺结核治疗失败危险因素的Meta分析及风险评估

发布时间：2018-04-04 21:06

本文选题：结核　切入点：肺　出处：《内蒙古医科大学》2017年硕士论文

【摘要】：目的:1中国复治肺结核治疗失败危险因素的Meta分析本研究采用Meta分析的方法系统评价复治肺结核患者发生治疗失败的危险因素。2中国复治肺结核患者治疗效果的风险评估及危险因素分析通过对复治肺结核治疗成功与失败患者的资料进行分析,探索影响复治肺结核患者治疗失败的因素,进而评估影响复治肺结核治疗失败因素的风险,为采取相关防治措施提供科学的理论依据。方法:1中国复治肺结核治疗失败危险因素的Meta分析计算机检索CNKI、VIP、CBM和WanFang Data数据库,搜集关于复治肺结核患者出现治疗失败影响因素的研究,检索时限均为从建库至2015年11月15日。2中国复治肺结核患者治疗效果的风险评估及危险因素分析根据纳入排除标准,选取2009年7月至2011年5月参与我国复治肺结核治疗方案研究确诊并接受治疗的395例复治肺结核患者作为实验队列。采用单因素和多因素Logistic回归评估个人基本信息、健康相关行为、既往抗结核治疗情况、本次治疗情况等临床特征方面与复治肺结核治疗结局的相关性。采用优化的弗明翰风险评分模型计算影响复治肺结核治疗效果因素的风险分值,评估复治肺结核患者治疗失败的风险。以2013年1月至2015年12月参与我国复治肺结核高剂量验证方案研究的231例复治肺结核患者作为验证队列,验证风险预测模型对复治肺结核患者治疗失败的预测效果。结果:1中国复治肺结核治疗失败危险因素的Meta分析最终纳入13个研究。Meta分析结果显示:在单因素分析中,标准复治方案、耐药、耐多药、肺部有空洞、合并糖尿病、痰菌含量2+与复治肺结核治疗失败相关;在多因素分析中,合并糖尿病是复治肺结核治疗失败的独立危险因素。2中国复治肺结核患者治疗效果的风险评估及危险因素分析395例复治涂阳肺结核患者中,99(25.1%)例被诊断为治疗失败,296(74.9%)例为治疗成功。多因素分析结果显示,影响复治肺结核患者治疗失败的独立危险因素包括耐药、采用国标方案、二月末痰涂片阳性、BMI18.5、高中及以下文化程度、首次服药地点(其他)、既往治疗时间6个月以及其他复治类型(返回、丢失)。根据Logistic回归分析中独立危险因素构建的风险评分模型对治疗失败有较好的预测效果[AUC=0.774,95%CI:0.715,0.883]。验证队列回带入风险评分模型,结果发现,验证队列的预测灵敏度为60.5%,验证队列外部效度验证结果为AUC=0.781[95%CI:0.695,0.866]。结论:1中国复治肺结核治疗失败危险因素的Meta分析现有证据表明,合并糖尿病、标准复治方案、耐药、耐多药、肺部有空洞、痰菌含量2+均是复治肺结核患者发生治疗失败的危险因素,尤其对于合并糖尿病的患者需要加强管理,从而降低复治失败率。2中国复治肺结核患者治疗效果的风险评估及危险因素分析影响复治肺结核患者治疗效果的因素主要包括BMI、文化程度、首次服药地点、既往治疗时间、复治类型、耐药情况、治疗方案以及二月末痰涂片阴转情况。风险预测模型对复治肺结核患者治疗失败具有较好的预测效果,且复治肺结核治疗失败的风险评分可以提高治疗失败的早期诊断特别是在使用国标方案的地区。
[Abstract]:Objective: through the analysis of pulmonary tuberculosis patients with treatment success and failure analysis of risk assessment and risk this study adopts the method of Meta analysis system evaluation of pulmonary tuberculosis patients with.2 risk factors for treatment failure Chinese retreatment treatment effect of patients with pulmonary tuberculosis and 1 Factors Chinese pulmonary tuberculosis risk factors for treatment failure Meta analysis, explore the factors affecting treatment failure in retreatment of pulmonary tuberculosis patients, and evaluate the effect of risk factors of pulmonary tuberculosis treatment failure, to take preventive measures to provide scientific and theoretical basis. Methods: 1 Chinese pulmonary tuberculosis risk factors for treatment failure of Meta VIP, databases of CNKI, CBM and WanFang Data database to collect information on retreatment of pulmonary tuberculosis patients with treatment failure factors, were searched from inception to November 15, 2015.2 China retreatment of pulmonary tuberculosis Risk assessment and risk factors of patients with treatment effect analysis according to the inclusion criteria, from July 2009 to May 2011, China's participation in the retreatment of pulmonary tuberculosis treatment on diagnosis and treatment of 395 cases of pulmonary tuberculosis patients as the experimental cohort. Using univariate and multivariate Logistic regression to evaluate the basic personal information, health related behavior, previous anti tuberculosis treatment, the treatment of the clinical features and treatment outcome of pulmonary tuberculosis retreatment correlation. The treatment effect factors by the Framingham risk score optimization model to calculate the impact of pulmonary tuberculosis risk score, risk assessment of failure in retreatment in treatment of pulmonary tuberculosis patients. In 231 cases from January 2013 to December 2015 in China Study on high dose verification scheme of pulmonary tuberculosis retreatment of pulmonary tuberculosis patients as a validation cohort, validation of risk prediction model for pulmonary tuberculosis patients The prediction effect of treatment failure. Results: Meta analysis of 1 China pulmonary tuberculosis risk factors for treatment failure and ultimately into the 13.Meta analysis results showed that: in univariate analysis, standard retreatment regimen, drug resistance, multidrug resistance, lung cavity, diabetes, sputum and retreatment of pulmonary 2+ content tuberculosis treatment failure; in multivariate analysis, risk assessment and risk of diabetes mellitus is.2 independent risk factors of pulmonary tuberculosis treatment failure China retreatment treatment effect of patients with pulmonary tuberculosis factors analysis of 395 cases of smear positive pulmonary tuberculosis patients, 99 (25.1%) cases were diagnosed as treatment failure (296 74.9%) cases were treated successfully. The results of multivariate analysis showed that independent risk factors of re treatment failure in treatment of patients with pulmonary tuberculosis including drug resistance, using the national standard scheme at the end of February, sputum smear positive, BMI18.5, high school and the cultural level, for the first time of taking medicine Some (other), the previous 6 months of treatment and retreatment type (return loss, time). According to the risk score model Logistic regression analysis of independent risk factors to construct the prediction effect of [AUC=0.774,95%CI:0.715,0.883]. back into the validation cohort better risk scoring model, the failure of treatment results show that the predictive sensitivity validation cohort of 60.5% verification external validation results for the queue AUC=0.781[95%CI:0.695,0.866]. conclusion: 1 Chinese pulmonary tuberculosis risk factors for Meta failure analysis of the existing evidence that diabetes mellitus, standard retreatment regimen, drug resistance, multidrug resistance, lung cavity, sputum content of 2+ were pulmonary tuberculosis patients with risk factors for treatment failure, especially for patients with diabetes need to strengthen management, so as to reduce the relapse rate of.2 failure risk assessment Chinese retreatment treatment effect of patients with pulmonary tuberculosis and Analysis of the factors influencing the risk factors of the retreatment patients in the treatment of pulmonary tuberculosis mainly include BMI, culture degree, for the first time taking place, previous treatment time, treatment type, drug resistance, treatment and at the end of February sputum conversion. A risk prediction model for the retreatment of pulmonary tuberculosis has good prediction of failure in the treatment of patients with nuclear. And retreatment of pulmonary tuberculosis treatment failure risk score can improve the early diagnosis of treatment failure especially in the scheme use GB area.

【学位授予单位】：内蒙古医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R521

【参考文献】