Abstract:
Objective
To analyze the influencing factors of recurrence in retreatment multidrugresistant/rifampicin-resistant tuberculosis.
Methods
A total of 78 patients with retreatment-sensitive tuberculosis who developed multidrug-resistant/rifampicin-resistant tuberculosis at our hospital from June 2018 to December 2023 were selected and treated with the Bedaquiline regimen for 12 months. Among them，31 patients with recurrence after discharge were assigned to the observation group，and 47 patients without recurrence served as the control group. Clinical data were collected，and univariate and multivariate regression analyses were performed to identify factors influencing post-discharge recurrence. A nomogram model was constructed.
Results
It was higher diabetes history 18 cases （58.06%），pulmonary cavities 25 cases（80.65%），and irregular treatment （26 cases，83.87%） in the observation group compared to the control group 13 cases （27.66%），10 cases （21.27%），and 9 cases （19.15%），respectively； χ2=7.211，26.615，31.632，P＜0.05. Diabetes （OR=1.957，95% CI：1.403 ～2.729），pulmonary cavities （OR=1.302，95% CI：1.111～1.526），and irregular treatment （OR=1.197，95% CI：1.112～1.288） were identified as independent risk factors for recurrence （P＜0.05）. Variance inflation factor （VIF） analysis showed no multicollinearity among the three indicators （VIF = 1.022，1.046，1.053）. The 78 patients were split into a training set（54 cases and a validation set （24 cases） by 7∶3 ratio. The area under the receiver operating characteristic（ROC） curve （AUC） （95%CI） for predicting 1-year recurrence post-discharge was 0.83 （0.73～0.94） in the training set and 0.90（0.79～1.00） in the validation set. At 6-month follow-up，67 patients （85.90%） survived，while 11 cases（14.10%） died due to severe pulmonary lesions （4 cases），recurrent drug-resistant infections（4 cases），and hemoptysis （3 cases）. Decision curve analysis （DCA） indicated high net benefit for nomogram probability thresholds of 20% ～100%.
Conclusion
Retreatment multidrug-resistant/rifampicin-resistant tuberculosis has a high recurrence rate，with diabetes，pulmonary cavities，and irregular treatment as key influencing factors. The nomogram model demonstrates significant predictive value.
Key words:
Tuberculosis,
Multidrug resistance,
Recurrence,
Influencing factors,
Nomograph
Mingfeng Zhang, Lili Hou, Ping Dang, Qingyan Ma, Guannan Kang, Zhiqiang Li, Qianqian Chen, Panpan Zhang, Yingying Chen, Nannan Zhang. Discussion on influencing factors of recurrence of multidrug-resistant/rifampicin-resistant pulmonary tuberculosis after re-treatment[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(03): 406-410.