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Article(id=1324077555703227019, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077443828560770, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202512026, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1764604800000, receivedDateStr=2025-12-02, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614289451, onlineDateStr=2026-11-02, pubDate=1775750400000, pubDateStr=2026-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614289451, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614289451, creator=13701087609, updateTime=1793614289451, updator=13701087609, issue=Issue{id=1324077443828560770, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='7', pageStart='1153', pageEnd='1344', issueExtLink='null', onlineDate='null', pubDate='1775750400000', pubDateStr='2026-04-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614262778, creator='13701087609', updateTime=1793614352085, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324077818509918661, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077443828560770, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324077818509918662, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077443828560770, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1330, endPage=1336, ext={EN=ArticleExt(id=1324077555917136524, articleId=1324077555703227019, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Outcomes and influencing factors of subclinical tuberculosis treatment in Guizhou Province from 2021 to 2023, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the treatment outcome and influencing factors of subclinical tuberculosis (STB) in Guizhou Province, and to provide a reference for further prevention and treatment of STB.

Methods

The STB patient information in Guizhou Province from 2021 to 2023 was derived from the National Tuberculosis Management Information System. Baseline characteristics of patients were described, and factors influencing patient treatment outcome were analyzed using χ2 test and multivariable logistic regression, and subgroup analysis was performed.

Results

A total of 4 406 STB patients were registered in Guizhou Province from 2021 to 2023, 190 (4.3%) cases had adverse outcomes, and 4 216 (95.7%) cases were successfully treated. Among them, 2 600 (59.0%) were male, 3 069 (69.7%) were Han, and 2 146 (48.7%) were farmers. 3 532 (80.2%) cases were found after referral and follow-up. Multivariable logistic regression analysis showed that age≥60 years old (OR=2.892, 95% CI: 1.143-7.317), comorbidities (OR=1.632, 95% CI: 1.114-2.392), hematogenous pulmonary tuberculosis (OR=9.618, 95% CI: 1.047-88.317), positive etiology (OR=2.164, 95% CI: 1.539-3.043), and retreatment (OR=5.338, 95% CI: 2.011-14.167) were risk factors for adverse outcomes in STB patients. Primary management (OR=0.124, 95% CI: 0.039-0.392) and use of standard protocols (OR=0.372, 95% CI: 0.262-0.527) were protective factors. The impact of treatment regimen on the treatment outcome of STB patients had interactions in different comorbidities and diagnostic subgroups (interaction P<0.05). Among them, patients with STB without comorbidities (OR=0.22, 95% CI: 0.15-0.31) and patients with secondary STB (OR=0.23, 95% CI: 0.17-0.31) had better treatment effects with the standard regimen.

Conclusion

The majority of subclinical tuberculosis patients in Guizhou Province are male, young and middle-aged, Han nationality, farmers, and secondary pulmonary tuberculosis, and the main source is passive detection. Patients with STB aged≥60 years old, comorbidities, hematogenous pulmonary tuberculosis, positive etiology, retreatment, no primary management, and no use of standard treatment options will increase the risk of adverse outcomes. For the above types of patients, we should focus on the occurrence and development of their clinical treatment outcomes, and take corresponding treatment and management measures to reduce the occurrence of adverse outcomes.

, authors=Peng ZHAO, Yu-ying HE, Meng-jun XUN, Ai-ju HUANG, Bing-ping WANG, Jin-lan LI, authorsList=Peng ZHAO, Yu-ying HE, Meng-jun XUN, Ai-ju HUANG, Bing-ping WANG, Jin-lan LI, authorCompany=null, correspAuthors=Jin-lan LI, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324077556718248593, articleId=1324077555703227019, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=贵州省2021—2023年亚临床结核病治疗转归结局及其影响因素分析, columnId=1228016573844226129, journalTitle=现代预防医学, columnName=疾病预防控制, runingTitle=null, highlight=null, articleAbstract=
目的

探讨贵州省亚临床结核病（subclinical tuberculosis，STB）的治疗转归结局及其影响因素，为进一步防治STB提供参考依据。

方法

贵州省2021—2023年STB患者信息来源于全国结核病管理信息系统，对患者基线特征进行描述，采用χ2检验和多因素logisitic回归分析患者治疗转归影响因素，并进行亚组分析。

结果

贵州省2021—2023年STB患者共登记4 406例，不良转归结局190（4.3%）例，治疗成功4 216（95.7%）例。其中男性2 600（59.0%）例，汉族3 069（69.7%）例，农民2 146（48.7%）例，经转诊和追踪发现3 532（80.2%）例。多因素logistic回归分析结果：年龄≥60岁（OR=2.892，95%CI：1.143~7.317）、有合并症（OR=1.632，95%CI：1.114~2.392）、血行播散型肺结核（OR=9.618，95%CI：1.047~88.317）、病原学阳性（OR=2.164，95%CI：1.539~3.043）、复治（OR=5.338，95%CI：2.011~14.167）是STB患者发生不良转归结局的危险因素；基层管理（OR=0.124，95%CI：0.039~0.392）和使用标准方案（OR=0.372，95%CI：0.262~0.527）是其保护因素。治疗方案对STB患者治疗转归的影响在不同合并症和诊断分型亚组中均存在交互作用（交互作用P均<0.05），其中无合并症STB患者（OR=0.229，95%CI：0.15~0.31）和继发性STB患者（OR=0.23，95%CI：0.17~0.31）使用标准方案治疗效果更好。

结论

贵州省亚临床结核患者以男性、青中年人、汉族、农民、继发性肺结核为主，来源主要为被动发现。年龄≥60岁、有合并症、血行播散型肺结核、病原学阳性、复治、无基层管理、未使用标准治疗方案会增加STB患者不良转归结局发生风险。针对以上特征患者，应重点关注其临床治疗转归发生发展，并采取相应治疗和管理措施，减少不良转归结局发生。

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赵鹏（1996—），男，硕士，主管医师，研究方向：疾病预防与控制

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李进岚，E-mail：
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(In Chinese), articleTitle=Treatment outcomes and influencing factors in pulmonary tuberculosis patients in Guizhou, 2017-2022, refAbstract=null), Reference(id=1324077566319010524, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, doi=null, pmid=null, pmcid=null, year=2024, volume=24, issue=12, pageStart=1365, pageEnd=1375, url=null, language=null, rfNumber=[18], rfOrder=27, authorNames=中国研究型医院学会结核病学专业委员会, 国家感染性疾病临床医学研究中心/深圳市第三人民医院/深圳市结核病临床医学研究中心, 柯学, journalName=中国循证医学杂志, refType=null, unstructuredReference=中国研究型医院学会结核病学专业委员会, 国家感染性疾病临床医学研究中心/深圳市第三人民医院/深圳市结核病临床医学研究中心, 柯学, 等. 中国成人重症肺结核定义和诊断指南(2023)[J]. 中国循证医学杂志, 2024, 24(12): 1365-1375., articleTitle=中国成人重症肺结核定义和诊断指南(2023), refAbstract=null), Reference(id=1324077566486782685, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, doi=null, pmid=null, pmcid=null, year=2024, volume=24, issue=12, pageStart=1365, pageEnd=1375, url=null, language=null, rfNumber=[18], rfOrder=28, authorNames=Tuberculosis Professional Committee of Chinese Research Hospital Association, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, journalName=Chinese Journal of Evidence-Based Medicine, refType=null, unstructuredReference=Tuberculosis Professional Committee of Chinese Research Hospital Association, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, et al. Guidelines for definition and diagnosis of severe pulmonary tuberculosis in adults in China (2023)[J]. Chinese Journal of Evidence-Based Medicine, 2024, 24(12): 1365-1375. (In Chinese), articleTitle=Guidelines for definition and diagnosis of severe pulmonary tuberculosis in adults in China (2023), refAbstract=null), Reference(id=1324077568185475806, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, doi=null, pmid=null, pmcid=null, year=2023, volume=23, issue=8, pageStart=852, pageEnd=856, url=null, language=null, rfNumber=[19], rfOrder=29, authorNames=陈善颖, 刘瑞, 张福威, journalName=中国热带医学, refType=null, unstructuredReference=陈善颖, 刘瑞, 张福威, 等. 海南省2014-2020年398例耐多药肺结核影响因素分析[J]. 中国热带医学, 2023, 23(8): 852-856., articleTitle=海南省2014-2020年398例耐多药肺结核影响因素分析, refAbstract=null), Reference(id=1324077568273556191, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, doi=null, pmid=null, pmcid=null, year=2023, volume=23, issue=8, pageStart=852, pageEnd=856, url=null, language=null, rfNumber=[19], rfOrder=30, authorNames=Chen SY, Liu R, Zhang FW, journalName=China Tropical Medicine, refType=null, unstructuredReference=Chen SY, Liu R, Zhang FW, et al. 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(In Chinese), articleTitle=Clinical analysis of 2HRZSL/6HRL retreatment tuberculosis, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1324077556961518226, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, xref=null, ext=[AuthorCompanyExt(id=1324077556969906835, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, companyId=1324077556961518226, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Guizhou Province Center for Disease Control and Prevention, Institute of Tuberculosis Prevention and Control, Guiyang, Guizhou 550004, China), AuthorCompanyExt(id=1324077556982489748, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, companyId=1324077556961518226, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=贵州省疾病预防控制中心结防所，贵州　贵阳　550004)])], figs=[ArticleFig(id=1324077561000633017, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, language=EN, label=Figure 1, caption=Subgroup analysis of the effects of treatment regimens on treatment outcomes in STB patients, figureFileSmall=qwlTg3+t5cnvPdcNOgBNmA==, figureFileBig=DRF/PZFZMIUiypu9QXBzEQ==, tableContent=null), ArticleFig(id=1324077561080324794, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, language=CN, label=图1, caption=治疗方案对STB患者治疗转归结局影响的亚组分析

注：a表示该亚组中，某些数值较小，为保证统计的精确性，将其进行合并分组。

, figureFileSmall=qwlTg3+t5cnvPdcNOgBNmA==, figureFileBig=DRF/PZFZMIUiypu9QXBzEQ==, tableContent=null), ArticleFig(id=1324077561285845691, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, language=EN, label=Table 1, caption=

Baseline characteristics and treatment outcomes of STB patients in Guizhou Province in univariate analysis, 2021—2023 [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
特征例数治疗成功不良结局χ2值P值
例数4 4064 216190
性别5.0350.025
男2 600（59.0）2 473（95.1）127（4.9）
女1 806（41.0）1 743（96.5）63（3.5）
年龄（岁）92.901<0.001
0~18830（18.8）816（98.3）14（1.7）
19~391 694（38.4）1 657（97.8）37（2.2）
40~591 111（25.2）1 047（94.2）64（5.8）
≥60771（17.5）696（90.3）75（9.7）
民族4.8520.028
汉族3 069（69.7）2 923（95.2）146（4.8）
少数民族1 337（30.3）1 293（96.7）44（3.3）
人群分类42.281<0.001
农民2 146（48.7）2 013（93.8）133（6.2）
学生1 055（23.9）1 038（98.4）17（1.6）
家务及待业534（12.2）511（95.7）23（4.3）
其他671（15.2）654（97.5）17（2.5）
职业3.8890.049
无医学相关4 219（95.5）4 022（95.6）187（4.4）
医学相关197（4.5）194（98.5）3（1.5）
患者来源a13.1220.018
健康体检459（10.4）446（97.2）13（2.8）
推介12（0.3）11（91.7）1（8.3）
直接就诊343（7.8）317（92.4）26（7.6）
主动筛查60（1.4）59（98.3）1（1.7）
转诊2 172（49.3）2 074（95.5）98（4.5）
追踪1 360（30.9）1 309（96.3）51（3.7）
HIV检查结果3.9590.047
无结果和阴性4 376（99.3）4 190（95.7）186（4.3）
阳性30（0.7）26（86.7）4（13.3）
诊断延误0.0100.918
否3 883（88.1）3 716（95.7）167（4.3）
有200（4.5）174（87.0）26（13.0）
诊断分型a18.4930.001
继发4 201（95.3）4 025（95.8）176（4.2）
是523（11.9）500（95.6）23（4.4）
合并症48.729<0.001
无3 912（88.8）3 773（96.4）139（3.6）
有494（11.2）443（89.7）51（10.3）
抗结核治疗史38.322<0.001
无4 206（95.5）4 042（96.1）164（3.9）
结核性胸膜炎101（2.3）96（95.0）5（5.0）
原发67（1.5）66（98.5）1（1.5）
血行播散30（0.7）23（76.7）7（23.3）
气管支气管7（0.2）6（85.7）1（14.3）
病原学结果52.915<0.001
无结果和阴性2 517（57.1）2 457（97.6）60（2.4）
阳性1 889（42.9）1 759（93.1）130（6.9）
治疗分类87.181<0.001
初治4 267（96.8）4 105（96.2）162（3.8）
复治139（3.2）111（79.9）28（20.1）
基层管理15.962<0.001
否24（0.5）19（76.0）5（24.0）
是4 382（99.5）4 197（95.8）185（4.2）
FDC服用8.2280.004
无结果和否1 055（23.9）993（94.1）62（5.9）
是3 351（76.1）3 223（96.2）128（3.8）
使用标准方案治疗103.977<0.001
否1 252（28.4）1 136（90.7）116（9.3）
是3 154（71.6）3 080（97.7）74（2.3）
), ArticleFig(id=1324077561382314684, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, language=CN, label=表1, caption=

贵州省2021—2023年STB患者基线特征及治疗转归结局单因素分析[n（%）]

, figureFileSmall=null, figureFileBig=null, tableContent=
特征例数治疗成功不良结局χ2值P值
例数4 4064 216190
性别5.0350.025
男2 600（59.0）2 473（95.1）127（4.9）
女1 806（41.0）1 743（96.5）63（3.5）
年龄（岁）92.901<0.001
0~18830（18.8）816（98.3）14（1.7）
19~391 694（38.4）1 657（97.8）37（2.2）
40~591 111（25.2）1 047（94.2）64（5.8）
≥60771（17.5）696（90.3）75（9.7）
民族4.8520.028
汉族3 069（69.7）2 923（95.2）146（4.8）
少数民族1 337（30.3）1 293（96.7）44（3.3）
人群分类42.281<0.001
农民2 146（48.7）2 013（93.8）133（6.2）
学生1 055（23.9）1 038（98.4）17（1.6）
家务及待业534（12.2）511（95.7）23（4.3）
其他671（15.2）654（97.5）17（2.5）
职业3.8890.049
无医学相关4 219（95.5）4 022（95.6）187（4.4）
医学相关197（4.5）194（98.5）3（1.5）
患者来源a13.1220.018
健康体检459（10.4）446（97.2）13（2.8）
推介12（0.3）11（91.7）1（8.3）
直接就诊343（7.8）317（92.4）26（7.6）
主动筛查60（1.4）59（98.3）1（1.7）
转诊2 172（49.3）2 074（95.5）98（4.5）
追踪1 360（30.9）1 309（96.3）51（3.7）
HIV检查结果3.9590.047
无结果和阴性4 376（99.3）4 190（95.7）186（4.3）
阳性30（0.7）26（86.7）4（13.3）
诊断延误0.0100.918
否3 883（88.1）3 716（95.7）167（4.3）
有200（4.5）174（87.0）26（13.0）
诊断分型a18.4930.001
继发4 201（95.3）4 025（95.8）176（4.2）
是523（11.9）500（95.6）23（4.4）
合并症48.729<0.001
无3 912（88.8）3 773（96.4）139（3.6）
有494（11.2）443（89.7）51（10.3）
抗结核治疗史38.322<0.001
无4 206（95.5）4 042（96.1）164（3.9）
结核性胸膜炎101（2.3）96（95.0）5（5.0）
原发67（1.5）66（98.5）1（1.5）
血行播散30（0.7）23（76.7）7（23.3）
气管支气管7（0.2）6（85.7）1（14.3）
病原学结果52.915<0.001
无结果和阴性2 517（57.1）2 457（97.6）60（2.4）
阳性1 889（42.9）1 759（93.1）130（6.9）
治疗分类87.181<0.001
初治4 267（96.8）4 105（96.2）162（3.8）
复治139（3.2）111（79.9）28（20.1）
基层管理15.962<0.001
否24（0.5）19（76.0）5（24.0）
是4 382（99.5）4 197（95.8）185（4.2）
FDC服用8.2280.004
无结果和否1 055（23.9）993（94.1）62（5.9）
是3 351（76.1）3 223（96.2）128（3.8）
使用标准方案治疗103.977<0.001
否1 252（28.4）1 136（90.7）116（9.3）
是3 154（71.6）3 080（97.7）74（2.3）
), ArticleFig(id=1324077561478783677, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, language=EN, label=Table 2, caption=

Variable assignment

, figureFileSmall=null, figureFileBig=null, tableContent=
因素赋值
治疗转归结局治疗成功=0，不良结局=1
性别女性=0，男性=1
年龄（岁）0~18=0，19~39=1，40~59=2，≥60=3
民族汉族=0，少数民族=1
人群分类其他=0，农民=1，学生=2，家务及待业=3
职业无医学相关=0，医学相关=1
患者来源健康体检=0，推介=1，直接就诊=2，主动筛查=3，转诊=4，追踪=5
HIV检查结果无结果和阴性=0，阳性=1
合并症无=0，有=1
抗结核治疗史无=0，有=1
诊断分型原发=0，血行播散=1，继发=2，气管支气管=3，结核性胸膜炎=4
病原学结果无结果和阴性=0，阳性=1
治疗分类初治=0，复治=1
基层管理否=0，是=1
FDC服用无结果和否=0，是=1
使用标准方案治疗否=0，是=1
), ArticleFig(id=1324077561587835582, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, language=CN, label=表2, caption=

变量赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
因素赋值
治疗转归结局治疗成功=0，不良结局=1
性别女性=0，男性=1
年龄（岁）0~18=0，19~39=1，40~59=2，≥60=3
民族汉族=0，少数民族=1
人群分类其他=0，农民=1，学生=2，家务及待业=3
职业无医学相关=0，医学相关=1
患者来源健康体检=0，推介=1，直接就诊=2，主动筛查=3，转诊=4，追踪=5
HIV检查结果无结果和阴性=0，阳性=1
合并症无=0，有=1
抗结核治疗史无=0，有=1
诊断分型原发=0，血行播散=1，继发=2，气管支气管=3，结核性胸膜炎=4
病原学结果无结果和阴性=0，阳性=1
治疗分类初治=0，复治=1
基层管理否=0，是=1
FDC服用无结果和否=0，是=1
使用标准方案治疗否=0，是=1
), ArticleFig(id=1324077561709470399, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, language=EN, label=Table 3, caption=

Multivariable analysis of unfavorable treatment outcomes in STB patients: Guizhou Province, 2021—2023

, figureFileSmall=null, figureFileBig=null, tableContent=
因素β WaldP值OR（95%CI）
年龄（岁，ref：0~18）
19~39-0.1000.4380.0520.8190.905（0.384~2.134）
40~590.5030.4741.1290.2881.654（0.654~4.186）
≥601.0620.4745.0310.0252.892（1.143~7.317）
合并症（ref：无）
有0.4900.1956.3270.0121.632（1.114~2.392）
诊断分型（ref：原发）
血行播散2.2641.1314.0040.0459.618（1.047~88.317）
继发0.7441.0250.5270.4682.104（0.282~15.686）
气管支气管1.9941.5541.6460.1997.345（0.349~154.501）
结核性胸膜炎1.0051.1300.7910.3742.733（0.298~25.054）
病原学结果（ref：无结果和阴性）
阳性0.7720.17419.710<0.0012.164（1.539~3.043）
治疗分类（ref：初治）
复治1.6750.49811.3100.0015.338（2.011~14.167）
基层管理（ref：否）
是-2.0870.58812.615<0.0010.124（0.039~0.392）
使用标准方案治疗（ref：否）
是-0.9900.17830.880<0.0010.372（0.262~0.527）
), ArticleFig(id=1324077561793356480, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077555703227019, language=CN, label=表3, caption=

贵州省2021—2023年STB患者治疗不良转归结局的多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
因素β WaldP值OR（95%CI）
年龄（岁，ref：0~18）
19~39-0.1000.4380.0520.8190.905（0.384~2.134）
40~590.5030.4741.1290.2881.654（0.654~4.186）
≥601.0620.4745.0310.0252.892（1.143~7.317）
合并症（ref：无）
有0.4900.1956.3270.0121.632（1.114~2.392）
诊断分型（ref：原发）
血行播散2.2641.1314.0040.0459.618（1.047~88.317）
继发0.7441.0250.5270.4682.104（0.282~15.686）
气管支气管1.9941.5541.6460.1997.345（0.349~154.501）
结核性胸膜炎1.0051.1300.7910.3742.733（0.298~25.054）
病原学结果（ref：无结果和阴性）
阳性0.7720.17419.710<0.0012.164（1.539~3.043）
治疗分类（ref：初治）
复治1.6750.49811.3100.0015.338（2.011~14.167）
基层管理（ref：否）
是-2.0870.58812.615<0.0010.124（0.039~0.392）
使用标准方案治疗（ref：否）
是-0.9900.17830.880<0.0010.372（0.262~0.527）
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贵州省2021—2023年亚临床结核病治疗转归结局及其影响因素分析
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赵鹏 , 何昱颖 , 荀梦君 , 黄爱菊 , 王秉萍 , 李进岚
现代预防医学 | 疾病预防控制 2026,53(7): 1330-1336
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现代预防医学 |疾病预防控制 2026 , 53 (7) : 1330 -1336
贵州省2021—2023年亚临床结核病治疗转归结局及其影响因素分析
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赵鹏, 何昱颖, 荀梦君, 黄爱菊, 王秉萍, 李进岚
作者信息
  • 贵州省疾病预防控制中心结防所，贵州　贵阳　550004
通讯作者:
李进岚，E-mail：
作者简介:

赵鹏（1996—），男，硕士，主管医师，研究方向：疾病预防与控制

Outcomes and influencing factors of subclinical tuberculosis treatment in Guizhou Province from 2021 to 2023
Peng ZHAO, Yu-ying HE, Meng-jun XUN, Ai-ju HUANG, Bing-ping WANG, Jin-lan LI
Affiliations
  • Guizhou Province Center for Disease Control and Prevention, Institute of Tuberculosis Prevention and Control, Guiyang, Guizhou 550004, China
出版时间: 2026-04-10 doi: 10.20043/j.cnki.MPM.202512026
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摘要
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目的

探讨贵州省亚临床结核病（subclinical tuberculosis，STB）的治疗转归结局及其影响因素，为进一步防治STB提供参考依据。

方法

贵州省2021—2023年STB患者信息来源于全国结核病管理信息系统，对患者基线特征进行描述，采用χ2检验和多因素logisitic回归分析患者治疗转归影响因素，并进行亚组分析。

结果

贵州省2021—2023年STB患者共登记4 406例，不良转归结局190（4.3%）例，治疗成功4 216（95.7%）例。其中男性2 600（59.0%）例，汉族3 069（69.7%）例，农民2 146（48.7%）例，经转诊和追踪发现3 532（80.2%）例。多因素logistic回归分析结果：年龄≥60岁（OR=2.892，95%CI：1.143~7.317）、有合并症（OR=1.632，95%CI：1.114~2.392）、血行播散型肺结核（OR=9.618，95%CI：1.047~88.317）、病原学阳性（OR=2.164，95%CI：1.539~3.043）、复治（OR=5.338，95%CI：2.011~14.167）是STB患者发生不良转归结局的危险因素；基层管理（OR=0.124，95%CI：0.039~0.392）和使用标准方案（OR=0.372，95%CI：0.262~0.527）是其保护因素。治疗方案对STB患者治疗转归的影响在不同合并症和诊断分型亚组中均存在交互作用（交互作用P均<0.05），其中无合并症STB患者（OR=0.229，95%CI：0.15~0.31）和继发性STB患者（OR=0.23，95%CI：0.17~0.31）使用标准方案治疗效果更好。

结论

贵州省亚临床结核患者以男性、青中年人、汉族、农民、继发性肺结核为主，来源主要为被动发现。年龄≥60岁、有合并症、血行播散型肺结核、病原学阳性、复治、无基层管理、未使用标准治疗方案会增加STB患者不良转归结局发生风险。针对以上特征患者，应重点关注其临床治疗转归发生发展，并采取相应治疗和管理措施，减少不良转归结局发生。

亚临床结核病  /  治疗转归  /  影响因素
Objective

To investigate the treatment outcome and influencing factors of subclinical tuberculosis (STB) in Guizhou Province, and to provide a reference for further prevention and treatment of STB.

Methods

The STB patient information in Guizhou Province from 2021 to 2023 was derived from the National Tuberculosis Management Information System. Baseline characteristics of patients were described, and factors influencing patient treatment outcome were analyzed using χ2 test and multivariable logistic regression, and subgroup analysis was performed.

Results

A total of 4 406 STB patients were registered in Guizhou Province from 2021 to 2023, 190 (4.3%) cases had adverse outcomes, and 4 216 (95.7%) cases were successfully treated. Among them, 2 600 (59.0%) were male, 3 069 (69.7%) were Han, and 2 146 (48.7%) were farmers. 3 532 (80.2%) cases were found after referral and follow-up. Multivariable logistic regression analysis showed that age≥60 years old (OR=2.892, 95% CI: 1.143-7.317), comorbidities (OR=1.632, 95% CI: 1.114-2.392), hematogenous pulmonary tuberculosis (OR=9.618, 95% CI: 1.047-88.317), positive etiology (OR=2.164, 95% CI: 1.539-3.043), and retreatment (OR=5.338, 95% CI: 2.011-14.167) were risk factors for adverse outcomes in STB patients. Primary management (OR=0.124, 95% CI: 0.039-0.392) and use of standard protocols (OR=0.372, 95% CI: 0.262-0.527) were protective factors. The impact of treatment regimen on the treatment outcome of STB patients had interactions in different comorbidities and diagnostic subgroups (interaction P<0.05). Among them, patients with STB without comorbidities (OR=0.22, 95% CI: 0.15-0.31) and patients with secondary STB (OR=0.23, 95% CI: 0.17-0.31) had better treatment effects with the standard regimen.

Conclusion

The majority of subclinical tuberculosis patients in Guizhou Province are male, young and middle-aged, Han nationality, farmers, and secondary pulmonary tuberculosis, and the main source is passive detection. Patients with STB aged≥60 years old, comorbidities, hematogenous pulmonary tuberculosis, positive etiology, retreatment, no primary management, and no use of standard treatment options will increase the risk of adverse outcomes. For the above types of patients, we should focus on the occurrence and development of their clinical treatment outcomes, and take corresponding treatment and management measures to reduce the occurrence of adverse outcomes.

Subclinical tuberculosis  /  Treatment outcomes  /  Influencing factors
赵鹏, 何昱颖, 荀梦君, 黄爱菊, 王秉萍, 李进岚. 贵州省2021—2023年亚临床结核病治疗转归结局及其影响因素分析. 现代预防医学, 2026 , 53 (7) : 1330 -1336 . DOI: 10.20043/j.cnki.MPM.202512026
Peng ZHAO, Yu-ying HE, Meng-jun XUN, Ai-ju HUANG, Bing-ping WANG, Jin-lan LI. Outcomes and influencing factors of subclinical tuberculosis treatment in Guizhou Province from 2021 to 2023[J]. Modern Preventive Medicine, 2026 , 53 (7) : 1330 -1336 . DOI: 10.20043/j.cnki.MPM.202512026
正文
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结核病是严重危害公众健康的全球性公共卫生问题。2023年，全球有1 080万新发结核患者，发病率134/10万，而中国结核病发病率为52/10万，发病数在30个结核高负担国家中排第三位[1]。据全国传染病信息管理系统显示，2023年贵州省报告发病率83/10万，全国排行第四位，是我国结核病高流行省份之一。
结核病的发生发展是一个连续动态发展的过程，每个阶段的持续时间因人而异，亚临床结核病（subclinical tuberculosis，STB）是介于结核分枝杆菌潜伏感染与活动性结核病之间的一种疾病状态，又称为无症状结核[2-3]。根据我国2010年结核病流行病学抽样调查研究发现，43.1%的结核患者为STB[4]；Frascella等[5]的结核病流行调查meta分析发现，STB患者占全球所有活动性结核病患者数量一半，预示着STB负担严重。STB患者虽然无持续咳嗽、咳痰、发热等典型结核病临床症状，但有相关研究表明，其仍然具有传播性，会危害人群健康[6]。以往研究多是关注活动性结核病的临床表现、传播特点、实验室检测等方面[3]，对STB的流行病学和临床转归结局研究较少，加之贵州省是我国结核病高负担省份，结核病防控形势严峻，为实现世界卫生组织提出的终止结核病流行目标，需探索出针对STB的有效防控措施。
鉴于此，本研究旨在通过回顾性分析贵州省STB患者治疗转归结局及其影响因素，为进一步探索STB防治策略提供参考。
1　资料与方法
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1.1　资料来源
通过“全国结核病管理信息系统”导出贵州省2021—2023年STB患者病案资料，包括患者基线特征、临床特征、治疗管理情况等。纳入标准：符合STB诊断定义的病例，且接受抗结核治疗。排除标准：病案状态为在治，临床诊断变更。
1.2　相关定义
1.2.1　亚临床结核病
是指无咳嗽、咳痰或咳嗽、咳痰2周的结核病例[7]。
1.2.2　治疗转归
包括治疗成功和不良结局，其中治疗成功被定义为治愈和完成治疗；不良结局被定义为治疗失败、死亡、失访、不良反应、转入利福平耐药治疗[8]。
1.2.3　诊断延迟
指患者首次到医疗机构就诊时间至确诊时间的间隔天数≥14 d[9]。
1.2.4　血行播散型肺结核
是指结核分枝杆菌进入血液随血流播散到人体内肺部及其它各个器官所引起的病理、生理学改变以及临床表现等，包括急性、亚急性和慢性血行播散型肺结核[10]。
1.2.5　初治结核病和复治结核病
按照治疗史划分，初治结核病患者是指符合下列情况之一者：从未应用过抗结核药物治疗；正进行标准化治疗方案治疗而未满疗程；不规则化疗未满1个月。复治结核病患者是指不规则抗结核药物治疗≥1个月或者初治失败以及复发患者[8]。
1.2.6　基层管理
是指肺结核患者出院转入门诊后，所属地基层医疗卫生机构须按照要求，落实患者健康访视管理，包括第一次入户访视、督导服药和日常访视管理工作等[8]。
1.2.7　治疗方案
标准化治疗方案：根据《中国结核病防治工作技术指南（2021年版）》中涉及的方案，包括（1）利福平和异烟肼敏感或耐药状况未知肺结核患者治疗方案为2HRZE/4HR（H：异烟肼，R：利福平，Z：吡嗪酰胺，E：乙胺丁醇）；（2）结核性胸膜炎患者治疗方案为2HRZE/7-10HRE；（3）重症肺结核患者治疗方案为2HRZE/10HRE；（4）异烟肼单耐药患者治疗方案为6-9RZELfx（Lfx：左氧氟沙星），已知或怀疑Lfx耐药患者方案为6-9RZE[8]。
个体化治疗方案：除上述治疗方案的其他方案[11]。
1.3　统计方法
使用Excel 2023对导出的患者病案资料进行汇总整理，计数资料以n（%）表示，采用SPSS 22.0进行统计分析，检验水准α=0.05，χ2检验筛选影响因素，将筛选出的变量进行多因素logistic回归分析。使用R（R4.0.5）软件的“jstable”包进行亚组分析。
2　结果
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2.1　STB患者基线特征
本次研究共纳入贵州省2021—2023年STB患者4 406例，年龄中位数33（21，54）岁；男性2 600（59.0%）例，女性1 806（41.0%）例；汉族3 069（69.7%）例，少数民族1 337（30.3%）例；农民2 146（48.7%）例；经转诊和追踪发现3 532（80.2%）例；病原学阳性患者1 889（42.9%）例。见表1。
2.2　转归结局
不良转归结局190（4.3%）例，治疗成功4 216（95.7%）例。不同性别、年龄、民族、人群分类、职业、患者来源、HIV检查结果、合并症、抗结核治疗史、诊断分型、病原学结果、治疗分类、基层管理、固定剂量复合制剂（fixed-dose combination，FDC）服用、使用标准方案治疗等特征的STB患者的成功治疗率的差异均具有统计学意义（P均<0.05）。见表1。
2.3　不良转归结局的多因素logistic回归分析
以STB患者临床转归结局作为因变量，不同性别、年龄、民族、人群分类、职业、患者来源、HIV检查结果、合并症、抗结核治疗史、诊断分型、病原学结果、治疗分类、基层管理、FDC服用、使用标准方案治疗等特征为自变量进行logistic回归分析，变量赋值见表2。结果显示，年龄≥60岁、有合并症、血行播散型肺结核、病原学阳性、复治是STB患者不良转归结局的危险因素（P均<0.05）；基层管理和使用标准方案是其保护因素（P均<0.05）。见表3。
2.4　亚组分析
为探索治疗方案对STB患者治疗转归影响，对其实施亚组分析，结果显示在STB患者中，标准化治疗方案较个体化治疗方案能降低不良转归结局发生风险（OR=0.24，95%CI：0.17~0.32，P<0.001）。治疗方案对STB患者治疗转归影响在不同合并症和诊断分型亚组中均存在交互作用（交互作用P均<0.05），其中无合并症STB患者和继发性STB患者使用标准化治疗方案后，发生不良转归风险显著低于接受个体化治疗方案（OR=0.22，95%CI：0.15~0.31，P<0.001；OR=0.23，95%CI：0.17~0.31，P<0.001）。此外，在不同年龄、病原学结果、治疗分类、基层管理亚组中，治疗方案对STB患者的治疗转归影响尚未发现存在交互作用（交互作用P均>0.05）。见图1。
3　讨论
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本次研究表明，STB患者多为男性，与国内一项研究结果一致[12]，一方面可能是由于男性社会流动层面较广，受到结核感染机会增多；另一方面是存在烟酒过度、劳动强度大，身体抵抗力较差的情况，增加男性患病风险[13]。STB患者年龄中位数33（21，54）岁，主要为青中年人，可能是参与社会活动多，劳动强度大，导致受感染概率增多[14]。STB患者农民约占一半，或许与农民自身健康防护意识欠缺、农村地区基础医疗设施配套欠全，生活条件相对较差有关[12]。STB患者来源主要为被动发现，可能由于STB症状不明显或者无症状，导致患者被漏诊或者延迟诊断。
本研究发现，年龄≥60岁、有合并症、血行播散型肺结核、病原学阳性、复治是STB患者发生不良转归结局的危险因素。随着老年肺结核患者年龄增大，治愈率显著降低[15]，可能是随着患者年龄增高，机体免疫功能减弱，药物代谢功能减退，不良反应发生率高等导致治疗失败[16]，今后应加强老年人治疗管理力度，探索更适合老年人的个性化治疗方案。合并有糖尿病、HIV/AIDS、尘肺病、精神病等疾病的STB患者治疗成功率显著低于无合并症患者，与我省2017—2022年肺结核患者转归影响因素研究结果一致[17]。合并症会使得患者病情更加复杂，增加不良反应发生的风险，从而使得治疗难度增大，易造成治疗失败。本研究表明血行播散STB相较原发性STB成功治疗率显著下降，可能是血行播散型肺结核患者易使得体内结核分枝杆菌进入血液循环，并造成肺部弥漫性病变以及相应的病理生理改变和临床表现，从而演变为重症肺结核，导致不良转归结局发生[18]。本研究显示病原学阳性STB患者不良转归结局发生风险是病原学阴性和无结果的2.16倍，其原因可能是由于病原学阳性患者带菌量高，发生不良结局风险增高。复治的STB患者发生不良转归结局的风险约是是初治患者的5倍，可能是因为该类患者多存在结核菌耐药、机体免疫力更弱、治疗难度更大以及治疗依从性差有关[8,19-20]。
纳入基层管理的STB患者成功治疗率显著高于非纳入患者（95.8% vs. 76.0%），其原因可能是纳入基层管理后，基层医疗卫生机构按照职责对患者服药的强化期内每10天随访一次，继续期内每1个月随访一次，能够督导患者及时、足量、规律、全程服药，提高成功治疗率[8]。使用标准方案的患者，发生不良转归结局的风险显著低于未使用标准方案者，提示可根据患者抗结核药物敏感情况和病情严重程度等，选择对应的标准治疗方案。亚组分析发现，治疗方案对治疗转归的影响在有无合并症患者中存在差异，无合并症患者使用标准治疗方案较使用个体化治疗方案效果更好，能减少78%的不良转归风险，有合并症患者使用不同治疗方案的转归影响未见显著差异；同时，研究还发现治疗方案对转归结局的影响在不同诊断分型患者中存在差异，其中继发性STB患者选择标准化治疗方案更佳。表明在对STB患者进行治疗时，应详细询问患者合并症情况，精准识别诊断分型，针对无合并症患者和继发性STB患者制定标准化治疗方案，以期减少不良转归结局发生风险。
本研究还存在一定的局限性，数据仅来源于结核病管理信息系统，获取变量有限，缺乏患者经济因素、临床相关检查和健康素养等信息。
综上所述，我省STB患者总体治疗转归情况较好，其中年龄≥60岁、有合并症、血行播散型肺结核、病原学阳性、复治、无基层管理、未使用标准治疗方案会增加亚临床结核患者不良转归结局发生风险。因此，需加强对男性老年人和农村地区的结核病主动筛查工作，早期发现STB患者；针对STB治疗转归不良结局高危人群，重点关注其临床转归发生发展，并采取相应治疗和管理措施，减少不良转归结局发生，以推动终结结核病流行目标的实现。

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2026年第53卷第7期
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doi: 10.20043/j.cnki.MPM.202512026
  • 接收时间：2025-12-02
  • 首发时间：2026-11-02
  • 出版时间：2026-04-10
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  • 收稿日期：2025-12-02
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    贵州省疾病预防控制中心结防所，贵州　贵阳　550004

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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