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目的:探讨江苏省耐多药肺结核患者痰涂片阴转的影响因素。方法:在江苏省徐州、镇江、连云港和南通4个城市选取确诊的耐多药肺结核患者作为研究对象,分析可能对痰阴转产生影响的各种因素。结果:2011年12月—2014年3月共纳入127例耐多药肺结核患者。其中106例(83.5%)患者痰涂片阴转,中位阴转时间为145 d(四分位数间距:102~228 d)。81例(63.8%)耐多药患者治愈;46例(36.2%)耐多药患者治疗失败或死亡。吸烟(HR:0.561,95%CI:0.320~0.984,P=0.044)、氧氟沙星耐药(HR:0.556,95%CI:0.317~0.975,P=0.041)和初始涂片等级>1(HR:0.557,95%CI:0.334~0.928,P=0.025)是痰阴转的危险因素。结论:吸烟、耐氧氟沙星和初始涂片等级偏高是影响耐多药肺结核痰涂片阴转的危险因素。
Objective: To investigate the influencing factors of sputum smear negative conversion in patients with multidrug-resistant pulmonary tuberculosis in Jiangsu Province. Methods: The patients with confirmed multidrug-resistant pulmonary tuberculosis in 4 cities of Xuzhou, Zhenjiang, Lianyungang and Nantong of Jiangsu Province were selected as the research object, and various factors that may have influence on the sputum conversion were analyzed. Results: From December 2011 to March 2014, a total of 127 MDR-TB patients were enrolled. Of the 106 patients (83.5%), sputum smears were negative and the median time to negative conversion was 145 days (interquartile range: 102 to 228 days). 81 (63.8%) MDR patients were cured; 46 (36.2%) MDR patients failed or died of treatment. (HR: 0.561, 95% CI: 0.320-0.984, P = 0.044), ofloxacin resistance (HR: 0.556,95% CI: 0.317-0.975, P = 0.041) and initial smear grade> HR: 0.557, 95% CI: 0.334 ~ 0.928, P = 0.025) was a risk factor for sputum conversion. Conclusion: Smoking, ofloxacin and high initial smear level are the risk factors influencing the negative conversion of multidrug-resistant pulmonary tuberculosis sputum smear.