Deaths among tuberculosis cases in Shanghai, China: who is at risk?
Deaths among tuberculosis cases in Shanghai, China: who is at risk?
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DOI：
10.1186/1471-2334-9-95
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发表时间：
2009-06-17
影响因子：
3.7
通讯作者：
Mei J
中科院分区：
文献类型：
--
作者：
Shen X;Deriemer K;Yuan Z;Shen M;Xia Z;Gui X;Wang L;Mei J
了解与结核病引起的死亡或结核病死亡相关的风险因素，将有助于改善结核病患者的临床护理并挽救生命。本研究旨在确定上海抗结核治疗期间死亡风险增加的相关特征，上海是中国结核病死亡率最高的城市之一。我们评估了2000-2004年上海确诊并开始抗结核治疗的培养阳性肺结核病例的死亡情况。通过强制性报告系统定期收集人口统计学、临床、分枝杆菌学信息和治疗结局。在研究期间报告了7，999例培养阳性肺病例。总病死率为5.5%（440例），约一半（50.5%）的死亡归因于结核病以外的原因。86%的死亡病例为年龄≥ 60岁的结核病病例。抗结核治疗期间死亡率的重要独立危险因素是年龄增长、男性、痰涂片阳性和合并症的存在。结核病控制项目和其他公共卫生项目更有力的临床管理和预防策略对于改善结核病治疗结果至关重要。早期怀疑、诊断和治疗结核病，特别是在60岁以上的老年人和患有合并症的人中，可以减少结核病患者的死亡。
Information about the risk factors associated with death caused by tuberculosis (TB) or death with TB would allow improvements in the clinical care of TB patients and save lives. The present study sought to identify characteristics associated with increased risk of death during anti-TB treatment in Shanghai, a city in China with one of the country's highest TB mortality rates. We evaluated deaths among culture positive pulmonary TB cases that were diagnosed in Shanghai during 2000–2004 and initiated anti-TB therapy. Demographic, clinical, mycobacteriological information and treatment outcomes were routinely collected through a mandatory reporting system. There were 7,999 culture positive pulmonary cases reported during the study period. The overall case fatality rate was 5.5% (440 cases), and approximately half (50.5%) of the deaths were attributed to causes other than TB. Eighty-six percent of the deaths were among TB cases age ≥ 60 years. The significant independent risk factors for mortality during anti-TB treatment were advancing age, male sex, sputum smear positivity, and the presence of a comorbidity. More vigorous clinical management and prevention strategies by both the TB control program and other public health programs are essential to improve TB treatment outcomes. Earlier suspicion, diagnosis and treatment of TB, especially among persons older than 60 years of age and those with a comorbid condition, could reduce deaths among TB patients.
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