Lv Luyi, Ye Ling, Lan Jianhua, Wang Tao, Wu Zhiyu, Wu Shugen, Lu Weili, Peng Chunxian, Lu Tao
The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University (Quzhou People's Hospital), Quzhou, Zhejiang Province, China.
Medicine (Baltimore). 2025 Jul 18;104(29):e43262. doi: 10.1097/MD.0000000000043262.
This study analyzes the risk factors of unfavorable treatment outcomes in rifampicin-sensitive pulmonary tuberculosis (PTB) patients. Clinical data of 694 patients with rifampicin-sensitive PTB admitted to Quzhou Hospital Affiliated to Wenzhou Medical University from January 2020 to December 2021 were retrospectively analyzed. Univariate and multivariate logistic regression were used to analyze the related risk factors, and the predictive value was assessed using the receiver operating characteristic curve. Among 66 patients with unfavorable treatment outcomes, 42 died from non-tuberculosis causes, 16 died from tuberculosis, and 8 had failed treatment. Multivariate Logistic regression analysis showed that retreatment of PTB (odds ratio [OR] = 2.750, 95% confidence interval [CI] 1.253-6.033), chronic obstructive pulmonary disease (OR = 3.229, 95% CI 1.678-6.212), respiratory failure (OR = 7.388, 95% CI 2.420-22.560), elevated C-reactive protein (CRP) (OR = 1.006, 95% CI 1.000-1.011), hypoproteinemia (OR = 0.902, 95% CI 0.839-0.969), and low body mass index (BMI) (OR = 0.976, 95% CI 0.959-0.992) were independent risk factors for unfavorable treatment outcomes in rifampicin-sensitive PTB patients (P < .05); retreated of PTB (OR = 5.347, 95% CI 1.355-21.099), respiratory failure (OR = 17.046, 95% CI 3.080-94.354), hypoalbuminemia (OR = 0.795, 95% CI 0.702-0.902), and low BMI (OR = 0.748, 95% CI 0.584-0.959) were independent risk factors for poor prognosis in rifampicin-sensitive PTB patients (P < .05). The area under the curve of CRP, serum albumin, and BMI combined to predict unfavorable treatment outcomes in PTB patients was 0.798 (95% CI 0.749-0.847), with a sensitivity of 92.4% and specificity of 51.4%. The area under the curve of serum albumin and BMI combined to predict the prognosis of PTB patients was 0.923 (95% CI 0.862-0.984), with a sensitivity of 93.8% and a specificity of 89.3%. The low BMI, hypoproteinemia, elevated CRP level, comorbidities, and retreatment are risk factors for unfavorable treatment outcomes and poor prognosis in patients with rifampicin-sensitive PTB. Serum albumin and BMI were good indicators for evaluating unfavorable treatment responses in rifampicin-sensitive PTB patients, and their combination could improve the accuracy of prognostic assessment.
本研究分析了利福平敏感型肺结核（PTB）患者治疗效果不佳的危险因素。回顾性分析了2020年1月至2021年12月在温州医科大学附属衢州医院收治的694例利福平敏感型PTB患者的临床资料。采用单因素和多因素logistic回归分析相关危险因素，并通过受试者工作特征曲线评估预测价值。在66例治疗效果不佳的患者中，42例死于非结核原因，16例死于结核病，8例治疗失败。多因素logistic回归分析显示，PTB复治（比值比[OR]=2.750，95%置信区间[CI]1.253 - 6.033）、慢性阻塞性肺疾病（OR=3.229，95%CI 1.678 - 6.212）、呼吸衰竭（OR=7.388，95%CI 2.420 - 22.560）、C反应蛋白（CRP）升高（OR=1.006，95%CI 1.000 - 1.011）、低蛋白血症（OR=0.902，95%CI 0.839 - 0.969）和低体重指数（BMI）（OR=0.976，95%CI 0.959 - 0.992）是利福平敏感型PTB患者治疗效果不佳的独立危险因素（P<0.05）；PTB复治（OR=5.347，95%CI 1.355 - 21.099）、呼吸衰竭（OR=17.046，95%CI 3.080 - 94.354）、低白蛋白血症（OR=0.795，95%CI 0.702 - 0.902）和低BMI（OR=0.748，95%CI 0.584 - 0.959）是利福平敏感型PTB患者预后不良的独立危险因素（P<0.05）。CRP、血清白蛋白和BMI联合预测PTB患者治疗效果不佳的曲线下面积为0.798（95%CI 0.749 - 0.847），敏感性为92.4%，特异性为51.4%。血清白蛋白和BMI联合预测PTB患者预后的曲线下面积为0.923（95%CI 0.862 - 0.984），敏感性为93.8%，特异性为89.3%。低BMI、低蛋白血症、CRP水平升高、合并症和复治是利福平敏感型PTB患者治疗效果不佳和预后不良的危险因素。血清白蛋白和BMI是评估利福平敏感型PTB患者治疗反应不佳的良好指标，它们的联合使用可提高预后评估的准确性。
