The Treatment Results And Influencing Factors Of Rifampicin-resistant Pulmonary Tuberculosis Patients Under The Comprehensive Mode Of "medical Defense Cooperation"

ObjectiveIn order to carry out the scientific basis and reference ideas of the Multidrug-Resistant Tuberculosis(MDR-TB)control program which is suit for the Chinese situation,the treatment outcome and factors and long-term recurrence are analysed based on the comprehensive programme which provided universal access to diagnosis,treatment and follow-up for MDR-TB in four Chinese cities and conditions that patients are treated with standard chemical therapy of domestic anti-TB drugs and their 90%medical expense are reduced.MethodsThe four medium third-tier cities were chosen as the study sites based on the comprehensive programme of China-Gates TB Project and economic development status.One hundred and sixty-eight Rifampicin-Resistant Tuberculosis patients were enrolled in the comprehensive programme.The questionnaires were designed by expert consultation and preceding investigation.We collect and analyse the information about treatment effects and factors of Rifampicin-Resistant Tuberculosis patients who were enrolled in the comprehensive programme through cross-sectional study with questionnaire survey.We collect and analyse the information about recurrence of patients who have accomplished the course of treatment after 2 years through prospective cohort study that patients filled in questionnaires for live.All status was analyzed by SAS 9.3 and was made the descriptive statistics according to the statistical charts and index.The categorical variables was studied by using ?2 tests,when the theoretical frequency<1,Fisher exact test was used,Inspection level of a= 0.10.The influence factors which were statistically significant were carried out for multivariate analysis by logistic regression and make statistical and case description of recurrent patients.ResultOne hundred and sixty-eight Rifampicin-Resistant Tuberculosis patients were involved in the analysis.There were 127 males(75.60%),the highest numbers of patients 71 was in the 45-59 age groups(42.26%),the rural population(82.14%),135 patients with recurrent(80.36%).only for rifampicin and isoniazid resistant,a total of 83 patients with drug resistance(49.40%).The median hospitalization time was 34 days(IQR:24-52),the median time is 720 days(IQR:240-732).The number of sputum negative conversion was 43(25.90%).After treatment for 3 months,the number of sputum negative conversion was 112(67.26%).After treatment for 6 months,the sputum of patients which turned negative after treatment for 3 months was still negative after 6 months.The success rate in patients was 46.43%,the failure rate was 23.21%and more than 69.23%because of adverse effect.The loss rate was 19.64%and more than 51.52%,because of economic reasons such as going out work,family economic difficulties and health issues.6 cases(3.58%)was not evaluated because of impound and emigration.129 patients whose treatment results were divided into success and poor were involved in the analysis.Many factors have statistical significance to influence the effect including age groups(?2=12.7956,P=0.0051),educational backgrounds(?2=6.3449,P=0.0960),initial treating/retreating(?2=2.7454,P=0.0975),the type of drug-resistant(P=0.0010),the time of the first diagnosis-treatment for TB(?2=7.6621,P=0.0535),whether use the second-line anti-TB drugs(?2=8.9923,P=0.0027),the times of receiving different types of treatment(?2=9.5727,P=0.0083),treatment time(P<0.0001),timely follow-up(?2=6.7809,P=0.0092)and whether accepted DOT in time(?2=6.6608,P=0.0099),different RR-TB treatment therapeutic regimen(P=0.0167).The time of the first diagnosis-treatment for TB(OR=2.45,90%CI:1.27-4.74),treatment time which is less than 730 days(OR=4.79,90%CI:1.72-13.31),whether use the second-line anti-TB drugs(OR=3.32,90%CI:1.81-6.11),the times of receiving different types of treatment(OR=2.86,90%CI:1.41-5.88)were illustrated as the risk factors of poor treatment effects by multiple logistic regression analysis.78 patients were treated successfully after finishing their full treatments,there were 2 recurred patients and recurrence rate was 2.56%through 2-year follow-up.ConclusionThere was a low short-time success rate and a high failure rate but a low long-term recurrence rate.Age of patients,educational backgrounds,whether use the second-line anti-TB drugs,the time of the first diagnosis-treatment for TB,the times of receiving different types of treatment;treatment time,timely follow-up and whether accepted DOT in time were all influence factors of treatment effects.The time of the first diagnosis-treatment for TB,treatment time which is less than 730 days,whether use the second-line anti-TB drugs,the times of receiving different types of treatment were risk factors of poor treatment effects.The conditions of patients should be attached importance early,because the sputum culture after treatment for 3 or 6 months could reflect overall outcomes of patients.Possible reasons of lower treatment success rate included economic problems and most of them were recurrent or multi-drug resistant pulmonary tuberculosis patients,there was a little choice of drugs for such patients and domestic drug dose was lower;the patients with poor compliance led to a higher loss rate.Isoniazid should be used in time for those who were RR-TB patients or did not know whether they were resistant to Isoniazid.