Recurrent pulmonary tuberculosis after treatment success: a population-based retrospective study in China
Recurrent pulmonary tuberculosis after treatment success: a population-based retrospective study in China
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治疗成功后复发性肺结核：中国一项基于人群的回顾性研究。
DOI：
10.1016/j.cmi.2021.09.022
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发表时间：
2022-04-27
影响因子：
14.2
通讯作者：
Zhang, Wen-hong
中科院分区：
文献类型：
--
作者：
Ruan, Qiao-ling;Yang, Qing-luan;Zhang, Wen-hong
目的：治疗后复发仍然是全球控制结核病（TB）的挑战。本研究调查了中国成功治疗的涂阳结核患者的肺结核复发率和复发危险因素的纵向数据。方法：2009年1月1日至2016年12月31日，我们在中国杭州评估了33 441例未经治疗的痰涂片阳性非耐多药结核病患者。我们纳入了9828例成功治疗的结核病患者的数据。结果：复发病例占4.9%(479/9828)，中位观察时间为1565 d。总共有51.1%（245/479）的复发发生在1年内。累计2年和5年复发率分别为3.90%（95%可信区间（CI） 3.3-4.5%）和5.4% （95%CI 4.8-6.0%）。64.7%（6363/9828）患者延长治疗（超过7个月），中位治疗持续时间为242天（四分位数间距为195-348天）。男性（校正危险比（aHR） （95%CI） 1.61 (1.30 ~ 2.00), p < 0.001）、年龄60岁及以上(aHR （95%CI) 2.03 (1.70 ~ 2.44), p < 0.001）、肺部(aHR （95%CI) 1.51 (1.25 ~ 1.82), p < 0.001）、2个月痰液阳性(aHR （95%CI) 1.39 (1.05 ~ 1.81), p < 0.02）均增加结核病复发风险。延长治疗与减少结核病复发率相关(aHR （95%CI) 0.73 (0.61-0.88), p 0.001）。结论：对于成功治疗的痰涂片阳性肺结核患者，复发仍然是一个问题，特别是那些有独立危险因素的患者。需要对长期治疗进行进一步分析。(C) 2021年由Elsevier Ltd代表欧洲临床微生物学和传染病学会出版。
Objectives: Post-treatment recurrence remains a challenge for the global control of tuberculosis (TB). This study investigated longitudinal data on pulmonary TB recurrence rates and risk factors for recurrence among successfully treated smear-positive tuberculosis cases in China.Methods: Between 1st January 2009 and 31st December 2016 we evaluated 33 441 treatment-naive patients diagnosed with sputum-smear-positive, non-multidrug-resistant TB in Hangzhou, China. We included the data of 9828 patients with TB who were treated successfully.Results: A total of 4.9% of the cases were recurrent (479/9828), identified within a median observation period lasting 1565 days. Altogether, 51.1% (245/479) of the recurrences occurred within 1 year. The cumulative 2- and 5-year recurrence rates were 3.90% (95% confidence interval (CI) 3.3-4.5%) and 5.4% (95%CI 4.8-6.0%), respectively. Prolonged treatment (over 7 months) occurred in 64.7% (6363/9828), with a median treatment duration of 242 days (interquartile range 195-348 days). Male sex (adjusted hazard ratio (aHR) (95%CI) 1.61 (1.30-2.00), p < 0.001), age 60 years old or older (aHR (95%CI) 2.03 (1.70 -2.44), p < 0.001), pulmonary cavity (aHR (95%CI) 1.51 (1.25-1.82), p < 0.001) and sputum positivity at 2 months (aHR (95%CI) 1.39 (1.05-1.81), p 0.02) all increased the risk of TB recurrence. Prolonged treatment was associated with reduced TB recurrence (aHR (95%CI) 0.73 (0.61-0.88), p 0.001).Conclusions: Recurrence remains a problem for successfully treated patients with sputum-smear-positive pulmonary TB, especially those with independent risk factors. Further analysis of prolonged treatment is required. (C) 2021 Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.