利福平耐药结核病(RR-TB)仍然是一个严重的全球公共卫生问题。我们评估了中国RR-TB患者的治疗结果和相关影响因素。
■本研究回顾性纳入了2018年5月至2020年4月在中国开始RR-TB治疗的1339例患者。数据是从电子病历中收集的。采用多变量logistic回归分析确定不良结局的影响因素。
■在1339例RR-TB患者中,78.8%(1055/1339)取得治疗成功(治愈或治疗完成),5.1%(68/1339)经历了治疗失败,1.1%(15/1339)在治疗期间死亡,10.1%(135/1339)失去随访,4.9%(66/1339)未进行评估。约67.7%(907/1339)的患者经历了至少一个不良事件(AE)。最常见的AE是肝功能减退(507/1339,37.9%),其次是高尿酸血症(429/1339,32.0%),贫血(368/1339,27.5%),电解质扰动(318/1339,23.7%),周围神经炎(245/1339,18.3%),胃肠道反应(203/1339,15.2%)。多因素分析显示年龄≥60岁[调整比值比(aOR):1.96,95%置信区间(CI):1.39-2.77],少数民族(AOR:2.36,95%CI:1.42-3.93),吸烟(AOR:1.50,95%CI:1.10-2.04),心脏病(AOR:2.90,95%CI:1.33-6.31),肿瘤(AOR:9.84,95%CI:2.27-42.67),免疫妥协(AOR:2.17,95%CI:1.21-3.91),再治疗的结核病(aOR:1.46,95%CI:1.08-1.97),和经历的胃肠道反应(aOR:2.27,95%CI:1.52-3.40)与不良结局相关.体重指数(BMI)≥18.5kg/m2,包含bedaquiline的方案和经历的不良事件(AE),如肝功能减退,白细胞减少症,周围神经炎,和视神经炎与良好的结局相关。
■在中国三级结核病医院,RR-TB患者的治疗成功率很高。年龄≥60岁,少数民族,吸烟状况,合并症,再治疗的结核病,和经历的胃肠道反应是不良治疗结局的独立预后因素.
UNASSIGNED: Rifampin-resistant tuberculosis (RR-TB) remains a serious global public health concern. We assessed treatment outcomes and associated influencing factors among RR-TB patients in China.
UNASSIGNED: This research enrolled 1339 patients who started RR-TB treatment between May 2018 and April 2020 in China retrospectively. Data were collected from the electronic medical records. Multivariable logistic regression analysis was used to identify the influencing factors related to unfavorable outcomes.
UNASSIGNED: Of the 1339 RR-TB patients, 78.8% (1055/1339) achieved treatment success (cured or treatment completed), 5.1% (68/1339) experienced treatment failure, 1.1% (15/1339) died during treatment, 10.1% (135/1339) were lost to follow-up, and 4.9% (66/1339) were not evaluated. About 67.7% (907/1339) of patients experienced at least one adverse event (AE). The most common AE was hypohepatia (507/1339, 37.9%), followed by hyperuricemia (429/1339, 32.0%), anemia (368/1339, 27.5%), electrolyte disturbance (318/1339, 23.7%), peripheral neuritis (245/1339, 18.3%), and gastrointestinal reactions (203/1339, 15.2%). Multivariate analysis showed that age ≥60 years [adjusted odds ratio (aOR): 1.96, 95% confidence interval (CI): 1.39-2.77], national minority (aOR: 2.36, 95% CI: 1.42-3.93), smoking (aOR: 1.50, 95% CI: 1.10-2.04), cardiopathy (aOR: 2.90, 95% CI: 1.33-6.31), tumors (aOR: 9.84, 95% CI: 2.27-42.67), immunocompromise (aOR: 2.17, 95% CI: 1.21-3.91), re-treated TB (aOR: 1.46, 95% CI: 1.08-1.97), and experienced gastrointestinal reactions (aOR: 2.27, 95% CI: 1.52-3.40) were associated with unfavorable outcomes. Body mass index (BMI) ≥18.5 kg/m2, regimens containing bedaquiline and experienced adverse events (AEs) such as hypohepatia, leukopenia, peripheral neuritis, and optic neuritis were associated with favorable outcomes.
UNASSIGNED: High rates of treatment success were achieved for RR-TB patients at tertiary tuberculosis hospitals in China. Age ≥60 years, national minority, smoking status, comorbidities, re-treated TB, and experienced gastrointestinal reactions were independent prognostic factors for unfavorable treatment outcomes.