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目的 探讨不同初治时长全程化疗方案对新发涂阳肺结核患者的复发率、复发危险因素的影响,为患者后期的干预措施提供新思路.方法 选取2014年10月至2016年10月在本院接受治疗的新发涂阳肺结核患者360例,随机分成四组(A、B、C和D组),每组90例患者,每组使用的药物均为异烟肼、利福平、乙胺丁醇和吡嗪酰胺,其中吡嗪酰胺每组都使用2个月,其他药物A组使用6个月,B组使用9个月,C组使用12个月,D组使用18个月;按照患者治愈标准对痊愈患者进行跟踪调查,患者每3个月到医院检查一次,观察患者体征和痰涂片以确认是否复发,并做详细记录,共复查八次.结果 A组2年复发率为5.8％,B组3.5％,C组7.0％,D组8.0％,组间比较差异有统计学意义(P<0.05).60岁以上患者复发率最高(7.8％),20岁以下患者复发率最低(3.8％),差异有统计学意义(P<0.05).患者家庭经济情况、痰结核的阴转时间、合并症、初治用药副反应、初治用药依从性、痰结核菌培养及药物敏感实验、就诊延误诊治时间及患者年龄等均是涂阳肺结核患者化疗后复发的主要危险因素.结论 新发的涂阳肺结核患者治疗6～9个月后痊愈者复发人数较少,通过后期的强化干预措施可以适当降低新发涂阳肺结核患者的复发情况.“,”Objective To investigate the effect of different initial treatment regimens on relapse rate and relapse risk factors of new smear-positive pulmonary tuberculosis patients in order to provide a theoretical basis for intervention measures in later stage. Methods A total of 360 new smear positive pulmonary tuberculosis patients who were treated in our hospital from October 2014 to October 2016 were randomly divided into four groups(A,B,C and D),with 90 patients in each group. The drugs used were isoniazid,rifampicin,ethambutol and pyrazinamide. Pyrazinamide was used for 2 months in each group,and then other drugs used in group A for 6 months,group B used for 9 months,group C was used for 12 months and group D was used for 18 months. The patients were followed up according to the standard of cure. Patients were checked every 3 months to observe the symptom and test sputum smears to confirm whether they had relapsed. Make detail records and review eight times. Results The recurrence rate was 5.8％ in group A,3.5％ in group B,7.0％ in group C and 8.0％ in group D;the difference was statistically significant(P<0.05). The recurrence rate of 60 years old people was the highest,7.8％,while the recurrence rate of patients under 20 years of age was the lowest,3.8％;the difference was statistically significant (P<0.05). Patients with family economic situation ,the negative conversion time of sputum and tuberculosis,comorbidities,adverse drug reactions,initial drug compliance,sputum TB culture and drug sensitivity test, diagnosis and treatment delay time were the main risk factors for recurrence after treatment in smear-positive pulmonary tuberculosis patients. Conclusion Newly diagnosed smear-positive pulmonary tuberculosis patients recovered after 6～9 months of treatment had a lower recurrent rate. The recurrent rate of new smear-positive pulmonary tuberculosis patients could be appropriately reduced by intensive interventions in the late stage.