摘要
目的分析复治耐多药/利福平耐药肺结核复发的影响因素。方法选择2018年6月至2023年12月我院收治的78例复治敏感肺结核发生耐多药/利福平耐药患者,采用贝德利方案治疗12个月。出院后结核复发者31例为观察组,未复发者47例为对照组。收集患者临床资料,采用单因素和多因素回归分析出院后复发影响因素,绘制列线图。结果观察组糖尿病史18例(58.06%)、肺部空洞25例(80.65%)、不规范治疗26例(83.87%)高于对照组糖尿病史13例(27.66%)、肺部空洞10例(21.27%)、不规范治疗9例(19.15%)(χ^(2)=7.211、26.615、31.632,P<0.05)。糖尿病(OR=1.957,95%CI:1.403~2.729)、肺部空洞(OR=1.302,95%CI:1.111~1.526)、肺结核患者不规范治疗(OR=1.197,95%CI:1.112~1.288)为复治耐多药/利福平耐药肺结核出院后复发影响因素(P<0.05),方差膨胀因子检验法(variance inflation factor,VIF)显示3个指标无共线性(VIF=1.022,1.046,1.053)。78例按7︰3拆分训练集54例,验证集24例,训练集和验证集预测出院后1年复发受试者工作特征曲线(receiver operating characteristic,ROC)的曲线下面积(area under curve,AUC)(95%CI)分别为0.83(0.73~0.94)和0.90(0.79~1.00)。78例患者随访半年后,生存者67例(85.90%),死亡者11例(14.10%),死因为肺部严重病变4例,耐药菌反复感染4例,咯血3例。决策曲线分析(decision curve analysis,DCA)显示列线图概率阈值20%~100%,正向净收益高。结论复治耐多药/利福平耐药肺结核复发率高,糖尿病、肺部空洞、肺结核不规范治疗为复发影响因素,列线图具有临床意义。
Objective To analyze the influencing factors of recurrence in retreatment multidrug-resistant/rifampicin-resistant tuberculosis.Methods A total of 78 patients with retreatment-sensitive tuberculosis who developed multidrug-resistant/rifampicin-resistant tuberculosis at our hospital from June 2018 to December 2023 were selected and treated with the Bedaquiline regimen for 12 months.Among them,31 patients with recurrence after discharge were assigned to the observation group,and 47 patients without recurrence served as the control group.Clinical data were collected,and univariate and multivariate regression analyses were performed to identify factors influencing post-discharge recurrence.A nomogram model was constructed.Results It was higher diabetes history 18 cases(58.06%),pulmonary cavities 25 cases(80.65%),and irregular treatment(26 cases,83.87%)in the observation group compared to the control group 13 cases(27.66%),10 cases(21.27%),and 9 cases(19.15%),respectively;χ^(2)=7.211,26.615,31.632,P<0.05.Diabetes(OR=1.957,95%CI:1.403~2.729),pulmonary cavities(OR=1.302,95%CI:1.111~1.526),and irregular treatment(OR=1.197,95%CI:1.112~1.288)were identified as independent risk factors for recurrence(P<0.05).Variance inflation factor(VIF)analysis showed no multicollinearity among the three indicators(VIF=1.022,1.046,1.053).The 78 patients were split into a training set 54 cases and a validation set(24 cases)by 7︰3 ratio.The area under the receiver operating characteristic(ROC)curve(AUC)(95%CI)for predicting 1-year recurrence post-discharge was 0.83(0.73~0.94)in the training set and 0.90(0.79~1.00)in the validation set.At 6-month follow-up,67 patients(85.90%)survived,while 11 cases(14.10%)died due to severe pulmonary lesions(4 cases),recurrent drug-resistant infections(4 cases),and hemoptysis(3 cases).Decision curve analysis(DCA)indicated high net benefit for nomogram probability thresholds of 20%~100%.Conclusion Retreatment multidrug-resistant/rifampicin-resistant tuberculosis has a high recurrence rate,with diabetes,pulmonary cavities,and irregular treatment as key influencing factors.The nomogram model demonstrates significant predictive value.
作者
张鸣凤
侯莉莉
党萍
马清艳
康冠楠
李志强
陈倩倩
张盼盼
陈莹莹
张楠楠
Zhang Mingfeng;Hou Lili;Dang Ping;Ma Qingyan;Kang Guannan;Li Zhiqiang;Chen Qianqian;Zhang Panpan;Chen Yingying;Zhang Nannan(Department of TuberculosisⅢ,Cangzhou Third Hospital,Cangzhou 061000,China;Department of TuberculosisⅣ,Hebei Provincial Chest Hospital,Shijiazhuang 050041,China)
出处
《中华肺部疾病杂志(电子版)》
2025年第3期406-410,共5页
Chinese Journal of Lung Diseases(Electronic Edition)
基金
河北省卫生厅科研基金项目(20200817)。
关键词
肺结核
耐多药
复发
影响因素
列线图
Tuberculosis
Multidrug resistance
Recurrence
Influencing factors
Nomograph
作者简介
通信作者:侯莉莉,Email:37658660qq.com。
