内蒙古地区结核病的耐药现状及影响因素研究

Status quo and influencing factors of drug resistance of tuberculosis in Inner Mongolia

目的了解内蒙古地区结核病的耐药现状及影响因素,为耐药结核精准防控提供参考依据。方法采用随机抽样法,分析内蒙古地区结核定点诊治医院就诊的符合纳入标准的结核患者的临床资料,对耐药菌株进行鉴定和表型药敏检测,计算耐药谱和耐药率,并采用Logistic回归模型分析结核病患者耐药的影响因素。结果一共纳入1321株结核患者,男性936例,女性385例,平均年龄(52.65±18.09)岁;单耐药、耐多药、多耐药及总耐药率分别为19.00%、11.58%、11.66%、42.24%,耐药率较高的是链霉素(7.27%)、异烟肼(4.69%)和异烟肼+链霉素(4.47%),耐药谱呈现多样性和复杂性;相较于女性,男性患者耐药比例较高(P<0.001);抗结核药物敏感患者比例随着年龄的增加而增加(P<0.05);20~40岁、40~60岁、60岁及以上耐多药患者比例均高于0~20岁(P<0.05),而20~40岁以及40~60岁耐多药患者比例高于60岁及以上(P<0.05);复治患者的耐多药、多耐药比例均高于初治患者(P<0.001);多因素Logistic回归分析显示,男性(OR=1.48,95%CI:1.02~2.14)、20~40岁(OR=2.64,95%CI:1.05~6.60)、复治(OR=2.34,95%CI:1.70~3.22)、门诊随访患者(OR=1.56,95%CI:1.05~2.33)是耐药结核发生的危险因素。结论内蒙古地区结核患者耐多药及总耐药率较高,耐药谱呈现多样性以及复杂性,男性、20~40岁、复治、门诊随访是结核耐药发生的独立危险因素。应当进一步完善临床诊疗工作,合理使用抗结核一线药物、注重个体化治疗,加强健康教育、完善医保制度和患者管理模式,以提高患者的依从性。

Objective To investigate the status quo of drug resistance and influencing factors of tuberculosis in Inner Mongolia,and to provide reference for accurate prevention and control of drug-resistant tuberculosis.Methods Random sampling was used in this study.TB patients from Tuberculosis designated hospital in Inner Mongolia were included,according to the rules and drug-resistant strains were identified and tested according to relevant norms.Composition ratio or rate was calculated for statistical description,and Logistic regression model was used to analyze the influencing factors of drug resistance in TB patients.Results Among 1321 patients,there were 936 males and 385 females,with an average age of(52.65±18.09)years.The rates of mono-resistant,multidrug-resistant(MDR),extensively drug-resistant(XDR)and total drug resistance were 19.00%,11.58%,11.66%and 42.24%,respectively.The highest resistance rates were observed for streptomycin(7.27%),isoniazid(4.69%),and isoniazid+streptomycin(4.47%).The drug resistance spectrum presented diversity and complexity.Compared to females,males had a higher proportion of drug resistance,and the difference was statistically significant(P<0.001).The proportion of patients who were sensitive to anti-tuberculosis drugs increased with age(P<0.05).Among different age groups,the proportion of drug-resistant patients was higher in the 20-40 age group,40-60 age group,and 60 and above age group compared to the 0-20 age group(P<0.05).Additionally,the proportion of drug-resistant patients was higher in the 20-40 age group and 40-60 age group compared to the 60 and above age group(P<0.05).Moreover,the proportion of drug-resistant and multi-drug resistant patients was higher among patients undergoing retreatment compared to those undergoing initial treatment(P<0.001).Multivariate Logistic regression analysis showed that male gender(OR=1.48,95%CI:1.02-2.14),age 20-40 years(OR=2.64,95%CI:1.05-6.60),retreatment(OR=2.34,95%CI:1.70-3.22),and outpatient follow-up(OR=1.56,95%CI:1.05-2.33)were independent risk factors for drug-resistant tuberculosis.Conclusion Inner Mongolia has a high prevalence of MDR and overall drug-resistant tuberculosis among patients.The drug resistance profile exhibits diversity and complexity.Risk factors that contribute to drug resistance include being male,aged between 20 and 40,undergoing retreatment,and receiving outpatient follow-up.Therefore,it is necessary to further improve clinical diagnosis and treatment,promote rational use of first-line anti-tuberculosis drugs,prioritize individualized treatment,enhance health education,improve the medical insurance system,and optimize patient management approaches in order to enhance patient compliance.