| Objective:The recurrence of tuberculosis(TB)after successful treatment has become one of the major problems in TB prevention and control.Identifying the factors which influenced the risk of TB recurrence after cure or completion of treatment is very urgent.This study was aimed to know the prevalence of pulmonary tuberculosis(PTB)recurrence in Anqing area and to explore the influencing factors of recurrence.Methods:17297 new cured PTB patients and 11318 new completed treatment PTB patients registered in Anqing Center for Diseases Prevention and Control from 2005 to 2014 were selected in our study.The deadline for the study was December 31,2015,so patients who relapsed during this period were selected in case group,while those who did not relapsed until December 31,2015 were enrolled in control group.The recurrence of TB patients was evaluated by descriptive statistical analysis.The demographic characteristics and treatment information between case and control group were compared by Chi-square test and Fisher exact probability.Univariate and multivariate Cox regression model were used to determine factors associated with recurrence.Statistical analysis was performed by SPSS 18.0,the recurrence curve was drawn by GraphPad Prism 5.P<0.05 was considered to indicate a statistically significant difference.Results:A total of 614 PTB patients relapsed during the study period among 17297 cured patients.The median time of recurrence was 625.5 days(interquartile range(IQR):258-1160 days).Of the 11318 completed treatment PTB patients,160 patients relapsed.The median time of recurrence was 568.5 days(IQR:272.5-1055.5 days).The recurrence rate of 17297 cured PTB patients was significantly higher than that of the 11318 completed treatment patients(χ2=72.005,P<0.001).Among cured patients,the recurrence rates of males and patients with cavity in chest X ray were higher than those of females and patients without cavity in chest X ray,respectively(χ2=10.830,P=0.001;χ2=21.712,P<0.001,respectively);in addition,the recurrence curve was significantly different when analyzed according to age-group,occupation,residence and treatment regimen(χ2=58.753,P<0.001;χ2=28.497,P<0.001;χ2=142.885,P<0.001;χ2=11.791,P=0.038,respectively).However,among completed treatment patients,significant difference of the recurrence curve was only found in patients with and without cavity in chest X ray(χ2=15.081,P<0.001).In multivariate Cox regression analysis,among cured PTB patients,males were more likely to relapse than females(HR=1.369,95%CI 1.124-1.668,P=0.002);farmers were more likely to relapse than students(HR=1.454,95%CI 1.158-1.825,P=0.001);patients lived in Huaining,Susong and Tongcheng had more possibility to relapse than those lived in Zongyang(HR=1.728,95%CI 1.356-2.201,P<0.001;HR=2.362,95%CI 1.900-2.935,P<0.001;HR=2.916,95%CI 2.372-3.584,P<0.001,respectively);patients detected by contact examination had more possibility to relapse than those detected via health examination(HR=6.652,95%CI 1.651-26.801,P=0.008);patients with cavity in chest X ray were more likely to relapse than those without cavity in chest X ray(HR=1.645,95%CI 1.353-2.000,P<0.001);and patients treated with "2HRZE/4HR”were less likely to relapse than those treated with "2H3R3Z3/4H3R3"(HR=0.560,95%CI 0.340-0.920,P=0.022).Moreover,among completed treatment patients,patients lived in Huaining,Susong and Tongcheng had more possibility to relapse than those lived in Zongyang(HR=1.992,95%CI 1.285-3.088,P=0.002;HR=1.682,95%CI 1.102-2.566,P=0.016;HR=1.885,95%CI 1.201-2.959,P=0.006,respectively);patients with cavity in chest X ray were more likely to relapse than those without cavity in chest X ray(HR=2.319,95%CI 1.499-3.586,P<0.001).Conclusion:The recurrence rate of cured PTB patients was significantly higher than that of the completed treatment patients.Factors associated with recurrence between cured and completed treatment patients were different.Living in Huaining,Susong and Tongcheng,having cavity in chest X ray were risk factors of recurrence in both cured and completed treatment patients.In addition,males,farmers and contact examination were risk factors of recurrence in cured patients;while treatment regimen "2HRZE/4HR" was their protective factor. |
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