Zou Liping, Kang Wanli, Guo Chunhui, Du Juan, Chen Qing, Shi Zhengyu, Tang Xianzhen, Liang Li, Tang Peijun, Pan Qing, Zhu Qingdong, Yang Song, Chang Zhanlin, Guo Zhouli, Wu Guihui, Tang Shenjie
Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, People's Republic of China.
Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, People's Republic of China.
Infect Drug Resist. 2024 Aug 28;17:3737-3749. doi: 10.2147/IDR.S467971. eCollection 2024.
Rifampin-resistant tuberculosis (RR-TB) remains a serious global public health concern. We assessed treatment outcomes and associated influencing factors among RR-TB patients in China.
This research enrolled 1339 patients who started RR-TB treatment between May 2018 and April 2020 in China retrospectively. Data were collected from the electronic medical records. Multivariable logistic regression analysis was used to identify the influencing factors related to unfavorable outcomes.
Of the 1339 RR-TB patients, 78.8% (1055/1339) achieved treatment success (cured or treatment completed), 5.1% (68/1339) experienced treatment failure, 1.1% (15/1339) died during treatment, 10.1% (135/1339) were lost to follow-up, and 4.9% (66/1339) were not evaluated. About 67.7% (907/1339) of patients experienced at least one adverse event (AE). The most common AE was hypohepatia (507/1339, 37.9%), followed by hyperuricemia (429/1339, 32.0%), anemia (368/1339, 27.5%), electrolyte disturbance (318/1339, 23.7%), peripheral neuritis (245/1339, 18.3%), and gastrointestinal reactions (203/1339, 15.2%). Multivariate analysis showed that age ≥60 years [adjusted odds ratio (aOR): 1.96, 95% confidence interval (CI): 1.39-2.77], national minority (aOR: 2.36, 95% CI: 1.42-3.93), smoking (aOR: 1.50, 95% CI: 1.10-2.04), cardiopathy (aOR: 2.90, 95% CI: 1.33-6.31), tumors (aOR: 9.84, 95% CI: 2.27-42.67), immunocompromise (aOR: 2.17, 95% CI: 1.21-3.91), re-treated TB (aOR: 1.46, 95% CI: 1.08-1.97), and experienced gastrointestinal reactions (aOR: 2.27, 95% CI: 1.52-3.40) were associated with unfavorable outcomes. Body mass index (BMI) ≥18.5 kg/m regimens containing bedaquiline and experienced adverse events (AEs) such as hypohepatia, leukopenia, peripheral neuritis, and optic neuritis were associated with favorable outcomes.
High rates of treatment success were achieved for RR-TB patients at tertiary tuberculosis hospitals in China. Age ≥60 years, national minority, smoking status, comorbidities, re-treated TB, and experienced gastrointestinal reactions were independent prognostic factors for unfavorable treatment outcomes.
耐利福平结核病（RR-TB）仍然是一个严重的全球公共卫生问题。我们评估了中国RR-TB患者的治疗结局及相关影响因素。
本研究回顾性纳入了2018年5月至2020年4月在中国开始接受RR-TB治疗的1339例患者。数据从电子病历中收集。采用多变量逻辑回归分析来确定与不良结局相关的影响因素。
在1339例RR-TB患者中，78.8%（1055/1339）获得治疗成功（治愈或完成治疗），5.1%（68/1339）治疗失败，1.1%（15/1339）在治疗期间死亡，10.1%（135/1339）失访，4.9%（66/1339）未进行评估。约67.7%（907/1339）的患者经历了至少一次不良事件（AE）。最常见的AE是肝功能减退（507/1339，37.9%），其次是高尿酸血症（429/1339，32.0%）、贫血（368/1339，27.5%）、电解质紊乱（318/1339，23.7%）、周围神经炎（245/1339，18.3%）和胃肠道反应（203/1339，15.2%）。多变量分析显示，年龄≥60岁[调整优势比（aOR）：1.96，95%置信区间（CI）：1.39-2.77]、少数民族（aOR：2.36，95%CI：1.42-3.93）、吸烟（aOR：1.50，95%CI：1.10-2.04）、心脏病（aOR：2.90，95%CI：1.33-6.31）、肿瘤（aOR：9.84，95%CI：2.27-42.67）、免疫功能低下（aOR：2.17，95%CI：1.21-3.91）、复治结核病（aOR：1.46，95%CI：1.08-1.97）以及经历过胃肠道反应（aOR：2.27，95%CI：1.52-3.40）与不良结局相关。体重指数（BMI）≥18.5kg/m²、使用含贝达喹啉的方案以及经历过如肝功能减退、白细胞减少、周围神经炎和视神经炎等不良事件与良好结局相关。
中国三级结核病医院的RR-TB患者治疗成功率较高。年龄≥60岁、少数民族、吸烟状况、合并症、复治结核病以及经历过胃肠道反应是不良治疗结局的独立预后因素。
