Liu Huicong, Zou Liping, Yu JiaJia, Zhu Qingdong, Yang Song, Kang Wanli, Ma Jiaojie, Chen Qing, Shi Zhengyu, Tang Xianzhen, Liang Li, Tang Peijun, Pan Qing, Guo Chunhui, Du Juan, Chang Zhanlin, Guo Zhouli, Wu Guihui, Tang Shenjie
Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101149, China.
Department of Tuberculosis, Public Health Clinical Center of Chengdu, No. 377 Jingming Road, Jingjiang District, Chengdu, Sichuan, 610061, China.
BMC Infect Dis. 2025 Sep 1;25(1):1086. doi: 10.1186/s12879-025-11491-4.
Rifampicin-resistant tuberculosis (RR-TB) remains a significant global public health concern. The elderly population is not only at high risk and among the primary victims of RR-TB but also plays a crucial role in the transmission chain of RR-TB. Their biological particularities, treatment complexities, and social vulnerabilities collectively present substantial challenges to global tuberculosis control. This study aimed to evaluate treatment outcomes and identify predictors of unfavorable outcomes among elderly patients with RR-TB in China.
A multicenter retrospective cohort study was conducted, including 248 elderly RR-TB patients treated across eight tertiary hospitals in China from May 2018 to April 2020. Multivariate logistic regression and Propensity Score Matching (PSM) analyses were performed to identify factors associated with unfavorable outcomes. Statistical analyses were performed using SPSS.
Among 248 patients, 65.7% (163/248) achieved treatment success (cured or completed treatment), while 34.3% (85/248) experienced unfavorable outcomes, including treatment failure (10.5%), death (2.4%), loss to follow-up (15.7%), and non-evaluation (5.6%). Adverse events (AEs) were reported in 56.0% (139/248) of patients, among which anemia was the most common (25.8%). And the use of bedaquiline and linezolid was significantly associated with the occurrence of QT interval prolongation and optic neuritis (p < 0.05). Multivariate analysis revealed that BMI < 18.5 kg/m²(aOR: 3.66, 95% CI: 1.89-7.08, p < 0.01), advanced drug resistance (aOR: 2.25, 95% CI: 1.14-4.45, p = 0.020), pre-treatment anemia (aOR: 4.16, 95% CI: 2.01-8.61, p < 0.001) were independent predictors of unfavorable outcomes. Adjunctive immunotherapy was associated with favorable outcomes (aOR: 0.23, 95% CI: 0.09-0.55, p < 0.001). After PSM, pre-treatment anemia remained significantly correlated with unfavorable outcomes (aOR: 3.5; 95% CI: 1.41-8.67, p = 0.007).
A relatively low rates of treatment success were achieved for RR-TB patients in the elderly at tertiary tuberculosis hospitals in China. Low BMI, advanced drug resistance, and pre-treatment anemia were independent prognostic factors for unfavorable treatment outcomes. Adjunctive immunotherapy was prognostic factors for unfavorable treatment outcomes of elderly RR-TB patients. In tuberculosis management, special consideration should be given to elderly patients.
耐利福平结核病（RR-TB）仍然是一个重大的全球公共卫生问题。老年人群不仅是RR-TB的高危人群和主要受害者，而且在RR-TB的传播链中起着关键作用。他们的生物学特殊性、治疗复杂性和社会脆弱性共同给全球结核病控制带来了巨大挑战。本研究旨在评估中国老年RR-TB患者的治疗结局，并确定不良结局的预测因素。
进行了一项多中心回顾性队列研究，纳入了2018年5月至2020年4月在中国8家三级医院接受治疗的248例老年RR-TB患者。采用多因素逻辑回归和倾向得分匹配（PSM）分析来确定与不良结局相关的因素。使用SPSS进行统计分析。
248例患者中，65.7%（163/248）获得治疗成功（治愈或完成治疗），而34.3%（85/248）经历了不良结局，包括治疗失败（10.5%）、死亡（2.4%）、失访（15.7%）和未评估（5.6%）。56.0%（139/248）的患者报告了不良事件（AE），其中贫血最为常见（25.8%）。并且使用贝达喹啉和利奈唑胺与QT间期延长和视神经炎的发生显著相关（p<0.05）。多因素分析显示，BMI<18.5kg/m²（调整后比值比[aOR]：3.66，95%置信区间[CI]：1.89-7.08，p<0.01）、广泛耐药（aOR：2.25，95%CI：1.14-4.45，p=0.020）、治疗前贫血（aOR：4.16，95%CI：2.01-8.61，p<0.001）是不良结局的独立预测因素。辅助免疫治疗与良好结局相关（aOR：0.23，95%CI：0.09-0.55，p<0.001）。PSM后，治疗前贫血仍与不良结局显著相关（aOR：3.5；95%CI：1.41-8.67，p=0.007）。
中国三级结核病医院老年RR-TB患者的治疗成功率相对较低。低BMI、广泛耐药和治疗前贫血是不良治疗结局的独立预后因素。辅助免疫治疗是老年RR-TB患者不良治疗结局的预后因素。在结核病管理中，应特别关注老年患者。
