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Article(id=1240972414511804654, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202311402, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1700496000000, receivedDateStr=2023-11-21, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773800479772, onlineDateStr=2026-03-18, pubDate=1715270400000, pubDateStr=2024-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773800479772, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773800479772, creator=13701087609, updateTime=1773800479772, updator=13701087609, issue=Issue{id=1240972413354176744, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773800479495, creator=13701087609, updateTime=1773800596829, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240972905568334240, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240972905568334241, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1713, endPage=1718, ext={EN=ArticleExt(id=1240972414767657203, articleId=1240972414511804654, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of treatment outcome and survival of patients with multi-drug resistant tuberculosis in Henan Province from 2011 to 2021, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the related factors of death in patients with drug-resistant tuberculosis in Henan Province.

Methods

The data of tuberculosis patients diagnosed in all 18 prefecture-level cities and 2 directly administered counties in Henan Province from 2011 to 2021 were selected. The patients with complete course of treatment and treatment outcome were selected. The cumulative survival rate was calculated by Kaplan-Meier method, and Cox proportional hazard regression was used to identify the factors affecting the survival time of patients.

Results

Among the 1 078 patients with drug-resistant tuberculosis, a total of 66 patients (6.1%) died, and the cumulative survival rate within 30 months was 90.1%. In total 50% of the patients died within 10 months. After controlling other factors, age (HR=1.053, 95%CI: 1.029-1.087), XDR-TB patients (HR=3.032, 95%CI: 1.584-5.767), smoking (HR=1.879, 95%CI: 1.006-3.509) and BMI (HR=0.294, 95%CI: 0.088-0.978) were the main risk factors for death of tuberculosis patients during treatment.

Conclusion

Among drug-resistant tuberculosis patients in Henan Province, elderly patients, XDR-TB patients, smoking patients and patients with BMI less than 18.5 have a relatively higher risk of death. Additional support should be provided for the treatment of these patients to reduce mortality.

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目的

了解河南省耐药结核病患者死亡的相关影响因素。

方法

选取河南省全部18个地级市以及2个直管县，2011—2021年期间确诊的结核病患者资料，筛选出具有完整疗程记录及治疗结局的患者，使用Kaplan-Meier法计算患者累积生存率，Cox比例风险回归识别可能影响患者生存时间的因素。

结果

1 078例耐药结核病患者中，死亡患者共计66例（6.1%），30个月内累积生存率为90.1%，50%患者的死亡发生在10个月以内。在控制了其他因素后，年龄（HR=1.053，95%CI：1.029～1.087）、广泛耐药结核病（XDR-TB）（HR=3.032，95%CI：1.584～5.767）、吸烟（HR=1.879，95%CI：1.006～3.509）、BMI（HR=0.294，95%CI：0.088～0.978）是影响结核病患者治疗期间死亡的主要危险因素。

结论

河南省耐药结核病患者中，老年、XDR-TB、有吸烟习惯以及BMI小于18.5 kg/m2的患者具有相对更高的死亡风险，为这些患者的治疗提供额外的支持以减少患者死亡率。

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孙定勇，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=wjI7GZp+FN0fO6D9tmSEYQ==, magXml=wlT8IMYRC+UpCvALnfAubw==, pdfUrl=null, pdf=i0ZSL63J1+sQLDbXqPm3XA==, pdfFileSize=2387985, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=Wyuis8QoEfq6yp4sXCLBgg==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=M0a3uGCIyGIlgrjLG93C7w==, mapNumber=null, authorCompany=null, fund=null, authors=

王硕（2000—），男，硕士在读，研究方向：流行病

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王硕（2000—），男，硕士在读，研究方向：流行病

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注：A为药敏确诊结果；B为治疗期间中断治疗；C为吸烟；D为户籍类型；E为登记分类；F为教育水平；G为BMI(kg/m2)。

, figureFileSmall=t7IYwXYmx67Q/JaGk3Mi7A==, figureFileBig=XhrxMD+QhYRD0ULQ4mZodg==, tableContent=null), ArticleFig(id=1240986259972223421, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414511804654, language=EN, label=Figure 3, caption=Graphs of the scaled Schoenfeld residuals and their loess smooth curves for the covariates, figureFileSmall=fa+K9wXFDo5eb9GQ7aIIAQ==, figureFileBig=iFi+bb7iowjiD3B76LoUng==, tableContent=null), ArticleFig(id=1240986260509094345, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414511804654, language=CN, label=图3, caption=耐药结核病患者年龄的Schoenfeld残差图及平滑拟合曲线图, figureFileSmall=fa+K9wXFDo5eb9GQ7aIIAQ==, figureFileBig=iFi+bb7iowjiD3B76LoUng==, tableContent=null), ArticleFig(id=1240986260655894997, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414511804654, language=EN, label=Table 1, caption=

Univariate analysis of risk factors for death during treatment in 1 078 tuberculosis patients (one-way Cox regression)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总计生存情况HR值(95%CI)P值
死亡生存
性别
男84856792
女230102200.329(1.262～0.2)0.200
药敏确诊结果
MDR-TB84338805
XDR-TB201261752.008(5.455～<0.001)<0.001
抗结核药物应用史
未使用13111120
仅使用一线药530275030.282(1.148～0.115)0.115
使用一线药及二线药386273590.286(1.569～0.483)0.483
0月痰涂片检查结果
涂片阴性20710197
涂片阳性871568150.693(2.662～0.356)0.356
中药应用
无82354769
有20992000.359(1.474～0.377)0.377
中断治疗
无90549856
有163161471.393(4.331～0.002)0.002
吸烟
否60419585
是351263251.326(4.33～0.004)0.004
饮酒
否72132689
是234122220.584(2.201～0.711)0.711
规律运动
否56729538
是385153700.379(1.32～0.277)0.277
重体力劳动
否30114287
是777527250.819(2.667～0.195)0.195
户籍类型
常住人口58928561
流动人口489384511.077(2.861～0.024)0.024
登记分类
新患56526539
非新患513404731.034(2.777～0.036)0.036
婚姻状态
已婚73036694
未婚24692370.38(1.638～0.524)0.524
教育程度
文盲及小学29324269
初中316143020.247(0.925～0.028)0.028
高中及以上35873510.094(0.506～<0.001)<0.001
BMI（kg/m2）
<18.513211121
18.5～23.9620295910.257(1.031～0.061)0.061
≥24.021852130.083(0.687～0.008)0.008
), ArticleFig(id=1240986261037576676, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414511804654, language=CN, label=表1, caption=

1 078例结核病患者治疗期间死亡危险因素的单因素分析（单因素Cox回归）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总计生存情况HR值(95%CI)P值
死亡生存
性别
男84856792
女230102200.329(1.262～0.2)0.200
药敏确诊结果
MDR-TB84338805
XDR-TB201261752.008(5.455～<0.001)<0.001
抗结核药物应用史
未使用13111120
仅使用一线药530275030.282(1.148～0.115)0.115
使用一线药及二线药386273590.286(1.569～0.483)0.483
0月痰涂片检查结果
涂片阴性20710197
涂片阳性871568150.693(2.662～0.356)0.356
中药应用
无82354769
有20992000.359(1.474～0.377)0.377
中断治疗
无90549856
有163161471.393(4.331～0.002)0.002
吸烟
否60419585
是351263251.326(4.33～0.004)0.004
饮酒
否72132689
是234122220.584(2.201～0.711)0.711
规律运动
否56729538
是385153700.379(1.32～0.277)0.277
重体力劳动
否30114287
是777527250.819(2.667～0.195)0.195
户籍类型
常住人口58928561
流动人口489384511.077(2.861～0.024)0.024
登记分类
新患56526539
非新患513404731.034(2.777～0.036)0.036
婚姻状态
已婚73036694
未婚24692370.38(1.638～0.524)0.524
教育程度
文盲及小学29324269
初中316143020.247(0.925～0.028)0.028
高中及以上35873510.094(0.506～<0.001)<0.001
BMI（kg/m2）
<18.513211121
18.5～23.9620295910.257(1.031～0.061)0.061
≥24.021852130.083(0.687～0.008)0.008
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Results of the analysis of factors influencing death in 1 078 patients with drug-resistant tuberculosis

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β WaldHR值(95%CI)P值
年龄0.0520.01219.2861.053(1.029～1.087)<0.001
药敏确诊结果
MDR-TB
XDR-TB1.1060.33011.2613.023(1.584～5.767)0.001
中断治疗
无中断
有中断0.2560.4010.4081.292(0.589～2.837)0.523
吸烟习惯
无
有0.6310.3193.9181.879(1.006～3.509)0.048
户籍类型
常住
流动0.6230.3203.7961.864(0.996～3.488)0.051
登记分类
新患
非新患0.2480.3170.6101.281(0.688～2.384)0.435
教育程度
文盲及小学
初中-0.1260.3600.1230.881(0.435～1.784)0.726
高中及以上-0.0970.4830.0400.908(0.352～2.34)0.841
BMI （kg/m2）
<18.5
18.5～23.9-0.2850.3800.5610.752(0.357～1.585)0.454
≥24.0-1.2240.6133.9850.294(0.088～0.978)0.046
), ArticleFig(id=1240986261381509629, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414511804654, language=CN, label=表2, caption=

1 078例耐药结核病患者的死亡影响因素分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β WaldHR值(95%CI)P值
年龄0.0520.01219.2861.053(1.029～1.087)<0.001
药敏确诊结果
MDR-TB
XDR-TB1.1060.33011.2613.023(1.584～5.767)0.001
中断治疗
无中断
有中断0.2560.4010.4081.292(0.589～2.837)0.523
吸烟习惯
无
有0.6310.3193.9181.879(1.006～3.509)0.048
户籍类型
常住
流动0.6230.3203.7961.864(0.996～3.488)0.051
登记分类
新患
非新患0.2480.3170.6101.281(0.688～2.384)0.435
教育程度
文盲及小学
初中-0.1260.3600.1230.881(0.435～1.784)0.726
高中及以上-0.0970.4830.0400.908(0.352～2.34)0.841
BMI （kg/m2）
<18.5
18.5～23.9-0.2850.3800.5610.752(0.357～1.585)0.454
≥24.0-1.2240.6133.9850.294(0.088～0.978)0.046
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2011—2021年河南省耐多药结核病患者治疗结局及生存分析
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王硕 , 王伟东 , 何梦雅 , 张艳秋 , 孙定勇
现代预防医学 | 临床与预防 2024,51(9): 1713-1718
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现代预防医学 | 临床与预防 2024, 51(9): 1713-1718
2011—2021年河南省耐多药结核病患者治疗结局及生存分析
全屏
王硕, 王伟东, 何梦雅, 张艳秋, 孙定勇
作者信息
  • 河南省疾病预防控制中心，河南 郑州 450016

    • 王硕（2000—），男，硕士在读，研究方向：流行病

通讯作者:

孙定勇，E-mail:
Analysis of treatment outcome and survival of patients with multi-drug resistant tuberculosis in Henan Province from 2011 to 2021
Shuo WANG, Wei-dong WANG, Meng-ya HE, Yan-qiu ZHANG, Ding-yong SUN
Affiliations
  • Henan Center for Disease Control and Prevention, Zhengzhou, Henan 450016, China
出版时间: 2024-05-10 doi: 10.20043/j.cnki.MPM.202311402
文章导航
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摘要
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目的

了解河南省耐药结核病患者死亡的相关影响因素。

方法

选取河南省全部18个地级市以及2个直管县，2011—2021年期间确诊的结核病患者资料，筛选出具有完整疗程记录及治疗结局的患者，使用Kaplan-Meier法计算患者累积生存率，Cox比例风险回归识别可能影响患者生存时间的因素。

结果

1 078例耐药结核病患者中，死亡患者共计66例（6.1%），30个月内累积生存率为90.1%，50%患者的死亡发生在10个月以内。在控制了其他因素后，年龄（HR=1.053，95%CI：1.029～1.087）、广泛耐药结核病（XDR-TB）（HR=3.032，95%CI：1.584～5.767）、吸烟（HR=1.879，95%CI：1.006～3.509）、BMI（HR=0.294，95%CI：0.088～0.978）是影响结核病患者治疗期间死亡的主要危险因素。

结论

河南省耐药结核病患者中，老年、XDR-TB、有吸烟习惯以及BMI小于18.5 kg/m2的患者具有相对更高的死亡风险，为这些患者的治疗提供额外的支持以减少患者死亡率。

生存分析  /  耐多药结核  /  广泛耐药结核  /  危险因素
Objective

To investigate the related factors of death in patients with drug-resistant tuberculosis in Henan Province.

Methods

The data of tuberculosis patients diagnosed in all 18 prefecture-level cities and 2 directly administered counties in Henan Province from 2011 to 2021 were selected. The patients with complete course of treatment and treatment outcome were selected. The cumulative survival rate was calculated by Kaplan-Meier method, and Cox proportional hazard regression was used to identify the factors affecting the survival time of patients.

Results

Among the 1 078 patients with drug-resistant tuberculosis, a total of 66 patients (6.1%) died, and the cumulative survival rate within 30 months was 90.1%. In total 50% of the patients died within 10 months. After controlling other factors, age (HR=1.053, 95%CI: 1.029-1.087), XDR-TB patients (HR=3.032, 95%CI: 1.584-5.767), smoking (HR=1.879, 95%CI: 1.006-3.509) and BMI (HR=0.294, 95%CI: 0.088-0.978) were the main risk factors for death of tuberculosis patients during treatment.

Conclusion

Among drug-resistant tuberculosis patients in Henan Province, elderly patients, XDR-TB patients, smoking patients and patients with BMI less than 18.5 have a relatively higher risk of death. Additional support should be provided for the treatment of these patients to reduce mortality.

Survival analysis  /  Multi-drug resistant tuberculosis  /  Extensively drug resistant tuberculosis  /  Risk factors
王硕, 王伟东, 何梦雅, 张艳秋, 孙定勇. 2011—2021年河南省耐多药结核病患者治疗结局及生存分析. 现代预防医学, 2024 , 51 (9) : 1713 -1718 . DOI: 10.20043/j.cnki.MPM.202311402
Shuo WANG, Wei-dong WANG, Meng-ya HE, Yan-qiu ZHANG, Ding-yong SUN. Analysis of treatment outcome and survival of patients with multi-drug resistant tuberculosis in Henan Province from 2011 to 2021[J]. Modern Preventive Medicine, 2024 , 51 (9) : 1713 -1718 . DOI: 10.20043/j.cnki.MPM.202311402
正文
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肺结核（tuberculosis）是一种由结核分枝杆菌引起的慢性呼吸道传染病，目前，结核病依然是世界范围内主要的公共卫生问题[1]。根据世界卫生组织2022年结核病报告的统计数据，2021年约有1 060万人罹患结核病，其中约有158.7万人死亡，并且死亡人数自2019年起不断增加[1]。结核分枝杆菌耐药性的产生会明显降低目前最有效抗结核药物的疗效，使患者的治疗效果不佳[2-3]。耐药肺结核的特点是发病率和死亡率相较普通肺结核更高，复杂性、后遗症、以及治疗成本都严重威胁人体健康[4-5]。
患者的死亡率可以用来评价疾病控制效果、衡量疾病负担。针对结核病患者死亡的因素，国内外研究结果表明，年龄、性别、HIV感染、药物滥用等都会影响患者的死亡[6-7]。目前，中国已经建立了结核病监测系统，用于收集患者诊断、治疗信息，提出更具体、具有针对性的政策，对遏制结核病传播，实现终止结核流行具有重大意义。但目前针对耐多药结核病（multidrug-resistant tuberculosis，MDR-TB）患者死亡危险因素的独立研究较少，本研究收集耐药结核病患者的相关信息，分析影响患者死亡的因素，为进一步采取有效的干预措施，降低耐药结核病患者死亡率，提高患者生命质量提供依据[8]。
1　对象与方法
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1.1　调查对象
本研究是一项回顾性的队列研究。从“中国疾病预防控制信息系统”的子系统“结核病管理信息系统”中获得河南省2011年1月1日—2021年8月31日登记报告中具有结核分枝杆菌体外药敏试验结果的肺结核患者，河南省全部18个地级市参与了本次研究。所有参与研究的患者均符合国家结核病诊断标准（WS288-2008和WS288-2017）以及结核病分类（WS196-2017）的肺结核确诊病例分类和临床诊断标准[9-10]。死亡被定义为本研究的终点事件，到达观察期限或出现死亡以外的治疗结局被定义为删失数据，包括治愈、完成治疗、治疗失败、丢失。患者的生存时间从确诊为耐药结核病开始到完成疗程、死亡、最后一次随访日期，或截至30个月观察期限结束时。排除了在观察期内且治疗结局未知以及无明确观察时间的患者，最终有1 078例患者纳入了本研究。
本研究获得了河南省疾病预防控制中心伦理委员会的批准，审批号为2023-KY-002-02，参与调查者均签署知情同意书，任何与研究参与者有关的信息都以编号代替姓名，并予以保密。
1.2　调查方法
以调查问卷的形式收集信息，问卷内容主要包含患者的内容包含人口学信息、诊断、治疗情况、患者生活习惯等。无法接受随访的患者由患者家属、监护人进行问卷填写。问卷由定点机构专业人员辅助填写、录入，并由省级单位进行督导、核查，以确保数据的完整性、一致性和准确性。
1.3　相关定义
MDR-TB：对异烟肼和利福平两种最有效抗结核药物耐药的结核病[1]。
广泛耐药结核病（extensively drug-resistant tuberculosis，XDR-TB）：对利福平、任何氟喹诺酮类药物以及至少一种贝达奎林和利奈唑胺类药物耐药的结核病[1]。
治疗转归：（1）治愈：患者完成疗程，且强化期最后至少连续3次痰培养阴性，每次至少间隔30 d。（2）完成治疗：患者完成疗程，但强化期后没有达到连续3次痰培养阴性。（3）治疗失败：强化期结束时未出现痰菌转阴；痰菌转阴后继续期阳转；对氟喹诺酮类药物或二线抗结核药物注射剂耐药；出现药物不良反应。（4）死亡：治疗过程中由于任何原因死亡。（5）丢失：治疗中断连续2个月以上。（6）其他：除以上分类以外的转归[11]。
登记分类：（1）新患者/初治患者：从未应用过抗结核药物治疗或正进行标准化治疗方案规则用药而未满疗程的患者以及不规则化疗未满1月的患者。（2）非新患/复治患者：因结核病不合理或不规则治疗≥1个月以及初治失败和复发患者[11]。
中断治疗：指患者在治疗过程中存在14 d以上中断服药的情况。
1.4　统计分析方法
使用Epi Data 3.1软件录入数据，使用SPSS 27.0进行数据的整理和分析。采用Kaplan-Meier法估计不同分类下患者的累积生存概率，患者死亡风险相关的因素分析采用Cox回归模型，所有检验的显著性水平均为α=0.05。
2　结果
收起
2.1　患者基本情况
纳入分析的1 078例患者中，男性848例（78.7%），女性230例（21.3%）；平均年龄（45.89±17.18）岁，最小14岁，最大92岁；从事重体力劳动（农民、工人、牧民、渔民）的患者共777例（72.1%）；589例（54.6%）患者为当地常住人口，489例（45.4%）患者为市间/省间流动人口。新登记的患者为565例（52.4%），复治患者为513例（47.6%）；871例（80.8%）患者确诊时痰涂片检查结果为阳性。治疗期间，209例（20.3%）患者添加了中药及中药制剂用于辅助治疗；163例（15.3%）患者存在超过14 d以上的中断治疗情况。351例（36.8%）患者在确诊前有吸烟的习惯。未曾使用过抗结核药物，仅使用一线药物以及使用过一线以及二线药物的患者分别为131（12.5%）、530（50.6%）和386例（36.9%）。
2.2　耐药情况
201例（19.3%）患者被诊断为XDR-TB，843例（80.7%）被诊断为MDR-TB。
2.3　随访结局
随访时间30个月，平均随访时间为18.95月。1 078例患者中，死亡66例，死亡率为6.1%，成功治疗共计651例（60.4%），治疗失败的患者共计37例（3.4%），因不良反应停止治疗64例（5.9%），因失访、拒绝随访等原因未获得相关治疗结局260例（24.1%）。见表1。
66例死亡患者的平均年龄为（58.74±15.67）岁，男性死亡56例（84.8%），女性死亡10例（15.2%），50%患者的死亡发生在治疗开始后10个月以内。不同时间患者累积生存概率见图1。
2.4　影响患者死亡的因素分析
2.4.1　单因素分析
用Kaplan-Meier生存函数检验估计不同相关因素的累积生存概率的差异，将收集到的信息纳入单因素Cox分析，结果显示，不同年龄、药敏确诊结果、中断治疗、吸烟、户籍类型、登记分类、教育程度患者之间的累积生存概率差异均具有统计学意义（P<0.05）。
2.4.2　多因素分析
治疗期间中断治疗的患者较少，曲线出现部分交叉，其余各曲线整体无明显交叉，说明满足比例风险假定，可以进行Cox回归模型的建立，见图2。年龄残差随时间变化的Schenfeld残差图中，残差随时间秩次的变化在0水平线上平滑、随机地波动，斜率近似于0，无明显趋势，说明年龄变量基本满足比例风险假定，见图3。经过计算，各变量之间的容忍度为0.962～0.983，方差膨胀因子为1.017～1.040，表明变量之间不存在多重共线性的问题。
多因素分析结果显示，患者年龄每增加一岁，死亡风险会增加5.3%，XDR-TB患者治疗期间的死亡率是MDR-TB患者的3.023倍，有吸烟习惯的患者死亡率是无吸烟习惯患者的1.879倍，与BMI小于18.5的患者相比，BMI大于23.9的患者治疗期间死亡率为前者的29.4%。见表2。
3　讨论
收起
本次研究共纳入了河南省2011年1月1日—2021年8月31日共1 078例耐药结核病患者，30个月随访期内的死亡率为6.1%，与国内其他地区报告的存活率相近，低于国外部分地区[12-13]。得益于我国较低的HIV感染率以及结合全球遏制结核病策略，提出并不断更新的中国结核病控制策略，我国结核病患者的死亡率得到了很好的控制[14]。
高龄患者具有更高的死亡风险，其他研究也得出了一致的结论[15]。老年群体免疫力下降，同时耐药结核病的治疗药物可能会引发不良反应，从而加重病情，可根据患者状况及时给予支持，从而减少老年患者群体的死亡率[16]。XDR-TB的患者存活率低于MDR-TB患者，一线药物的治疗效果最佳，而MDR-TB以及XDR-TB均对其具有耐药性，必须使用二线药物，其杀菌活性更弱且可能具有副作用，因此随着耐药性的增强，对治疗方案的要求会更加苛刻，治疗方案的治疗效果会更差，最终导致XDR-TB患者的治疗预后更糟糕，耐药结核病的治疗流程较长，采用新药，推行短程治疗方案，并加强督导管理可以改善耐药患者的治疗效果[17-18]。有研究表明，吸烟会使感染结核病和发展成活动性肺结核的概率分别增加两倍和三倍，活动性肺结核患者继续吸烟也会影响其临床治疗结局，本研究证实了吸烟会影响患者的生存率[19-20]。目前，结核病治疗指南中仅将劝导患者戒烟列入随访关怀内容，在今后的结核病治疗中，可以将强制戒烟纳入治疗规范，以此改善患者治疗预后。相较于BMI小于18.5的患者，BMI大于23.9的患者有着更高的生存率，肺结核是一种慢性消耗性疾病，会导致发热、乏力、消瘦等症状，营养水平较高的患者承受疾病带来伤害的能力更强[1]。单因素分析中还显示了流动人口、复治患者以及有中断治疗的患者具有较低的生存率，在患者治疗管理工作中需加以留心，监督患者规范治疗。
由于人力以及调查方法的限制，本研究结局变量为全因死亡、并未将结核病导致的直接死亡与其他原因导致的偶然死亡区分开来。未来可以开展更加充分、细致的多中心研究，全面考虑可能的相关因素，以建立更加稳定的风险模型。
综上所述，1 078例患者中，30个月累积生存率为90.1%，在耐药结核病患者治疗过程中，需要关注老年、XDR-TB、确诊前有吸烟习惯以及BMI小于18.5的患者，为这些患者的治疗提供额外的支持以减少患者死亡率。
基金
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  • 河南省科技发展计划(212102310156)
  • 河南省医学科技攻关计划联合共建项目(LHGJ20200130)
文献
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2024年第51卷第9期
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doi: 10.20043/j.cnki.MPM.202311402
  • 接收时间：2023-11-21
  • 首发时间：2026-03-18
  • 出版时间：2024-05-10
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  • 收稿日期：2023-11-21
基金
河南省科技发展计划(212102310156)
河南省医学科技攻关计划联合共建项目(LHGJ20200130)
作者信息
    河南省疾病预防控制中心，河南 郑州 450016

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孙定勇，E-mail:
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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