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目的利用Cox比例风险模型探讨直接督导短程化疗(DOTS)策略下初治肺结核患者中断取药治疗(简称中断治疗)的影响因素。方法以山东省滕州市2013—2014年管理治疗的357例初治肺结核患者为研究对象,使用Epi Data 3.1软件建立数据库,用SPSS 19.0软件对初治肺结核患者中断治疗分别进行Kaplan-Meier和Cox比例风险模型的单因素和多因素分析。结果初治肺结核患者中断治疗率为29.7%(106/357),平均治疗中位数时间为58.63 d,Log-rank单因素检验显示,分析的29个因素中,有性别、年龄、文化水平、生活满意度、工作性质、健康状况自评、药物不良反应、规律服药、经济状况、治疗期间外出打工及医疗支出费用11个因素有统计学意义(P<0.05);Cox回归模型多因素分析,有药物不良反应、治疗期间外出打工、服药不规律、经济状况差和生活满意度低5个因素是影响初治肺结核患者中断治疗的危险因素,OR分别为:2.798、2.534、2.508、2.000和1.690。结论 Cox模型应用于肺结核患者中断治疗的研究在国内尚属首次,经实证分析具有较高的使用价值和借鉴意义。
Objective To explore the influencing factors of discontinuation of drug treatment in patients with newly diagnosed pulmonary tuberculosis (DOTS) under direct supervision of short-course chemotherapy (DOTS) using the Cox proportional hazards model. Methods Totally 357 newly diagnosed pulmonary tuberculosis patients managed and managed in Tengzhou City, Shandong Province from 2013 to 2014 were selected as the research objects. Epi Data 3.1 software was used to establish the database. The Kaplan-Meier and Cox proportions of patients with newly diagnosed pulmonary tuberculosis were treated with SPSS 19.0 software. Single factor and multivariate analysis of risk model. Results The treatment rate of first trimester pulmonary tuberculosis patients was 29.7% (106/357), and the average median time to treatment was 58.63 days. Log-rank single factor test showed that among the 29 factors analyzed, gender, age, education level, 11 factors including life satisfaction, nature of work, self-assessment of health condition, adverse drug reactions, regular medication, economic status, out-migrant workers during workout and medical expenses were statistically significant (P <0.05) There were 5 risk factors of adverse drug reaction, outpatient work during treatment, irregular medication, poor economic status and low life satisfaction, which were the risk factors of discontinuing treatment for newly diagnosed patients with pulmonary tuberculosis, OR were 2.798, 2.534, 2.508, 2.000 and 1.690 respectively . Conclusion It is the first time that Cox model is used in the treatment of patients with pulmonary tuberculosis in China. Empirical analysis has high value and reference value.