Ruan Qiao-Ling, Yang Qing-Luan, Sun Feng, Liu Wei, Shen Yao-Jie, Wu Jing, Jiang Ning, Zhou Jing-Yu, Shao Ling-Yun, Zhang Wen-Hong
Department of Infectious Diseases, National Medical Centre for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China.
Hangzhou Centre for Disease Control and Prevention, Zhejiang, 310000, China.
Clin Microbiol Infect. 2022 May;28(5):684-689. doi: 10.1016/j.cmi.2021.09.022. Epub 2021 Sep 30.
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.
Between 1st January 2009 and 31st December 2016 we evaluated 33 441 treatment-naïve 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.
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).
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.
治疗后复发仍然是全球结核病控制面临的一项挑战。本研究调查了中国成功治愈的涂片阳性肺结核病例的肺结核复发率纵向数据及复发危险因素。
在2009年1月1日至2016年12月31日期间，我们评估了中国杭州33441例初治的痰涂片阳性、非耐多药肺结核患者。我们纳入了9828例成功治疗的肺结核患者的数据。
共有4.9%的病例复发（479/9828），在中位观察期1565天内被识别。总共51.1%（245/479）的复发发生在1年内。2年和5年累积复发率分别为3.90%（95%置信区间（CI）3.3 - 4.5%）和5.4%（95%CI 4.8 - 6.0%）。64.7%（6363/9828）的患者治疗时间延长（超过7个月），中位治疗时长为242天（四分位间距195 - 348天）。男性（调整后风险比（aHR）（95%CI）1.61（1.30 - 2.00），p < 0.001）、60岁及以上（aHR（95%CI）2.03（1.70 - 2.44），p < 0.001）、肺空洞（aHR（95%CI）1.51（1.25 - 1.82），p < 0.001）以及2个月时痰菌阳性（aHR（95%CI）1.39（1.05 - 1.81），p = 0.02）均增加了肺结核复发风险。治疗时间延长与肺结核复发风险降低相关（aHR（95%CI）0.73（0.61 - 0.88），p = 0.001）。
对于成功治愈的痰涂片阳性肺结核患者，复发仍然是一个问题，尤其是那些具有独立危险因素的患者。需要对治疗时间延长进行进一步分析。
