發(fā)布時間：2018-04-04 21:06

  本文選題：結核　切入點：肺　出處：《內蒙古醫(yī)科大學》2017年碩士論文

【摘要】：目的:1中國復治肺結核治療失敗危險因素的Meta分析本研究采用Meta分析的方法系統(tǒng)評價復治肺結核患者發(fā)生治療失敗的危險因素。2中國復治肺結核患者治療效果的風險評估及危險因素分析通過對復治肺結核治療成功與失敗患者的資料進行分析,探索影響復治肺結核患者治療失敗的因素,進而評估影響復治肺結核治療失敗因素的風險,為采取相關防治措施提供科學的理論依據(jù)。方法:1中國復治肺結核治療失敗危險因素的Meta分析計算機檢索CNKI、VIP、CBM和WanFang Data數(shù)據(jù)庫,搜集關于復治肺結核患者出現(xiàn)治療失敗影響因素的研究,檢索時限均為從建庫至2015年11月15日。2中國復治肺結核患者治療效果的風險評估及危險因素分析根據(jù)納入排除標準,選取2009年7月至2011年5月參與我國復治肺結核治療方案研究確診并接受治療的395例復治肺結核患者作為實驗隊列。采用單因素和多因素Logistic回歸評估個人基本信息、健康相關行為、既往抗結核治療情況、本次治療情況等臨床特征方面與復治肺結核治療結局的相關性。采用優(yōu)化的弗明翰風險評分模型計算影響復治肺結核治療效果因素的風險分值,評估復治肺結核患者治療失敗的風險。以2013年1月至2015年12月參與我國復治肺結核高劑量驗證方案研究的231例復治肺結核患者作為驗證隊列,驗證風險預測模型對復治肺結核患者治療失敗的預測效果。結果:1中國復治肺結核治療失敗危險因素的Meta分析最終納入13個研究。Meta分析結果顯示:在單因素分析中,標準復治方案、耐藥、耐多藥、肺部有空洞、合并糖尿病、痰菌含量2+與復治肺結核治療失敗相關;在多因素分析中,合并糖尿病是復治肺結核治療失敗的獨立危險因素。2中國復治肺結核患者治療效果的風險評估及危險因素分析395例復治涂陽肺結核患者中,99(25.1%)例被診斷為治療失敗,296(74.9%)例為治療成功。多因素分析結果顯示,影響復治肺結核患者治療失敗的獨立危險因素包括耐藥、采用國標方案、二月末痰涂片陽性、BMI18.5、高中及以下文化程度、首次服藥地點(其他)、既往治療時間6個月以及其他復治類型(返回、丟失)。根據(jù)Logistic回歸分析中獨立危險因素構建的風險評分模型對治療失敗有較好的預測效果[AUC=0.774,95%CI:0.715,0.883]。驗證隊列回帶入風險評分模型,結果發(fā)現(xiàn),驗證隊列的預測靈敏度為60.5%,驗證隊列外部效度驗證結果為AUC=0.781[95%CI:0.695,0.866]。結論:1中國復治肺結核治療失敗危險因素的Meta分析現(xiàn)有證據(jù)表明,合并糖尿病、標準復治方案、耐藥、耐多藥、肺部有空洞、痰菌含量2+均是復治肺結核患者發(fā)生治療失敗的危險因素,尤其對于合并糖尿病的患者需要加強管理,從而降低復治失敗率。2中國復治肺結核患者治療效果的風險評估及危險因素分析影響復治肺結核患者治療效果的因素主要包括BMI、文化程度、首次服藥地點、既往治療時間、復治類型、耐藥情況、治療方案以及二月末痰涂片陰轉情況。風險預測模型對復治肺結核患者治療失敗具有較好的預測效果,且復治肺結核治療失敗的風險評分可以提高治療失敗的早期診斷特別是在使用國標方案的地區(qū)。
[Abstract]:Objective: through the analysis of pulmonary tuberculosis patients with treatment success and failure analysis of risk assessment and risk this study adopts the method of Meta analysis system evaluation of pulmonary tuberculosis patients with.2 risk factors for treatment failure Chinese retreatment treatment effect of patients with pulmonary tuberculosis and 1 Factors Chinese pulmonary tuberculosis risk factors for treatment failure Meta analysis, explore the factors affecting treatment failure in retreatment of pulmonary tuberculosis patients, and evaluate the effect of risk factors of pulmonary tuberculosis treatment failure, to take preventive measures to provide scientific and theoretical basis. Methods: 1 Chinese pulmonary tuberculosis risk factors for treatment failure of Meta VIP, databases of CNKI, CBM and WanFang Data database to collect information on retreatment of pulmonary tuberculosis patients with treatment failure factors, were searched from inception to November 15, 2015.2 China retreatment of pulmonary tuberculosis Risk assessment and risk factors of patients with treatment effect analysis according to the inclusion criteria, from July 2009 to May 2011, China's participation in the retreatment of pulmonary tuberculosis treatment on diagnosis and treatment of 395 cases of pulmonary tuberculosis patients as the experimental cohort. Using univariate and multivariate Logistic regression to evaluate the basic personal information, health related behavior, previous anti tuberculosis treatment, the treatment of the clinical features and treatment outcome of pulmonary tuberculosis retreatment correlation. The treatment effect factors by the Framingham risk score optimization model to calculate the impact of pulmonary tuberculosis risk score, risk assessment of failure in retreatment in treatment of pulmonary tuberculosis patients. In 231 cases from January 2013 to December 2015 in China Study on high dose verification scheme of pulmonary tuberculosis retreatment of pulmonary tuberculosis patients as a validation cohort, validation of risk prediction model for pulmonary tuberculosis patients The prediction effect of treatment failure. Results: Meta analysis of 1 China pulmonary tuberculosis risk factors for treatment failure and ultimately into the 13.Meta analysis results showed that: in univariate analysis, standard retreatment regimen, drug resistance, multidrug resistance, lung cavity, diabetes, sputum and retreatment of pulmonary 2+ content tuberculosis treatment failure; in multivariate analysis, risk assessment and risk of diabetes mellitus is.2 independent risk factors of pulmonary tuberculosis treatment failure China retreatment treatment effect of patients with pulmonary tuberculosis factors analysis of 395 cases of smear positive pulmonary tuberculosis patients, 99 (25.1%) cases were diagnosed as treatment failure (296 74.9%) cases were treated successfully. The results of multivariate analysis showed that independent risk factors of re treatment failure in treatment of patients with pulmonary tuberculosis including drug resistance, using the national standard scheme at the end of February, sputum smear positive, BMI18.5, high school and the cultural level, for the first time of taking medicine Some (other), the previous 6 months of treatment and retreatment type (return loss, time). According to the risk score model Logistic regression analysis of independent risk factors to construct the prediction effect of [AUC=0.774,95%CI:0.715,0.883]. back into the validation cohort better risk scoring model, the failure of treatment results show that the predictive sensitivity validation cohort of 60.5% verification external validation results for the queue AUC=0.781[95%CI:0.695,0.866]. conclusion: 1 Chinese pulmonary tuberculosis risk factors for Meta failure analysis of the existing evidence that diabetes mellitus, standard retreatment regimen, drug resistance, multidrug resistance, lung cavity, sputum content of 2+ were pulmonary tuberculosis patients with risk factors for treatment failure, especially for patients with diabetes need to strengthen management, so as to reduce the relapse rate of.2 failure risk assessment Chinese retreatment treatment effect of patients with pulmonary tuberculosis and Analysis of the factors influencing the risk factors of the retreatment patients in the treatment of pulmonary tuberculosis mainly include BMI, culture degree, for the first time taking place, previous treatment time, treatment type, drug resistance, treatment and at the end of February sputum conversion. A risk prediction model for the retreatment of pulmonary tuberculosis has good prediction of failure in the treatment of patients with nuclear. And retreatment of pulmonary tuberculosis treatment failure risk score can improve the early diagnosis of treatment failure especially in the scheme use GB area.

【學位授予單位】：內蒙古醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R521

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