摘要
目的 分析老年耐多药肺结核临床特点和不良治疗结局的影响因素,为老年耐多药肺结核临床诊治提供参考.方法 回顾性收集2008-2023年北京胸科医院初次收治的老年耐多药肺结核患者临床数据,对合并症/并发症、药物不良反应、初治和复治耐药情况进行统计描述,并对不良治疗结局影响因素进行x2检验及logistic回归分析.结果 共收集老年耐多药肺结核患者238例,其中出现药物不良反应发生152例(占63.9％),复治耐多药184例(占77.3％),广泛耐药结核(XDR-TB)广泛耐药27例(占11.3％),治愈41例,完成治疗6例,治疗失败39例,死亡6例,失访107例,无法评价31例,治疗未结束8例,治疗成功率20.4％(47/230).治疗不良结局占比79.6％(183/230).单因素分析显示不同年龄、是否有药物不良反应、患者来源对治疗结局的影响具有统计学意义(P＜0.05).以治疗结局良好和不良为因变量对三因素进行logistic回归分析,结果显示年龄70岁及以上、治疗中出现药物不良反应和外埠病人是不良治疗结局的影响因素[OR(95％CI):2.507(1.027～6.121)、3.253(1.635～6.473)、2.563(1.285～5.111)].结论 老年耐多药肺结核患者合并症/并发症多、药物不良反应发生率高、治疗结局不理想.异地就医、高龄、出现药物不良反应是不良治疗结局的危险因素.
Abstract
Objective To analyze the clinical characteristics and factors influencing adverse treatment outcomes in elderly patients with multidrug-resistant pulmonary tuberculosis(MDR-TB)to guide the clinical diagnosis and treatment of elderly MDR-TB patients.Methods Clinical data of elderly patients with multidrug-resistant pulmonary tuberculosis initially treated at Beijing Chest Hospital from 2008 to 2023 were retrospectively collected.Complications/comorbidities,adverse drug reactions,drug resistance during initial treatment,and retreatment were statistically described.Factors influencing adverse treatment outcomes were analyzed using the chi-square test and logistic regression analysis.Results A total of 238 elderly patients with MDR-TB were collected,of which 152(63.9％)had adverse drug reactions,184(77.3％)were retreated MDR-TB,27(11.3％)were extensively drug-resistant tuberculosis(XDR-TB),41 were cured,6 completed treatment,39 failed treatment,6 died,107 lost to follow-up,31 could not be evaluated,8 did not finish treatment,and the treatment success rate was 20.4％(47/230).The adverse outcome of treatment accounted for 79.6％(183/230).Univariate analysis showed that differences in age groups,the occurrence of drug adverse reactions,and patient sources had a statistically significant impact on treatment outcomes(P＜0.05).Logistic regression analysis was performed using good and adverse treatment outcomes as dependent variables for the three factors,which showed that being aged 70 and above,the occurrence of drug adverse reactions during treatment,and being a non-local patient were factors influencing adverse treatment outcomes[OR(95％CI):2.507(1.027-6.121),3.253(1.635-6.473),2.563(1.285-5.111),respectively].Conclusions Elderly patients with MDR-TB exhibit a high prevalence of complications/comorbidities,a high incidence of drug adverse reactions,and unfavorable treatment outcomes.Out-of-town medical treatment,advanced age,and experiencing drug adverse reactions are risk factors for adverse treatment outcomes.
基金项目
北京市科技计划(Z191100006619077)
NETL
NSTL
万方数据