德清县耐药肺结核流行情况及危险因素研究

Epidemic Pattern of Drug-Resistant Tuberculosis and its Risk Factors in Deqing County

目的掌握德清县耐药肺结核流行模式及其危险因素,为肺结核的治疗和综合防制提供科学依据。方法收集2004-2005年德清县结防所诊断并报告的肺结核病例,调查病例的一般情况(年龄、性别、职业等)和社会经济状况(既往治疗史、体质指数、患者接触史、个人年收入、家庭年收入等),所有病例均进行痰培养,对分离到的结核菌株进行菌型鉴定和药物敏感试验。结果182例肺结核患者被纳入研究,确定为牛结核分枝杆菌5株(2.7%),结核分枝杆菌177株(97.3%)。总耐药率54.9%(100/182),13例为耐多药肺结核(MDR-TB)。初始MDR-TB率和其他耐药(ODR-TB)率分别为3.8%和46.6%,获得性MDR-TB率和其他耐药率分别为16.3%和51.0%。单因素分析显示,年龄、既往治疗史、肺结核患者接触史、个人和家庭收入与MDR-TB发生有关(P<0.05),性别、职业、肺结核患者接触史与其他耐药有关(P<0.05)。多因素分析表明,年龄(OR=1.22,95%CI:1.12～6.63)、既往治疗史(OR=4.98,95%CI:1.56～8.03)、肺结核患者接触史(OR=7.84,95%CI:1.71～25)和个人收入与MDR-TB发生有关。而肺结核患者接触史(OR=2.9,95%CI:1.13～7.52)与其他耐药结核病发生相关。结论德清县耐多药肺结核流行尚不严重,既往治疗史是MDR-TB发生的重要原因,农村经济状况较差的人群和老年患者是MDR-TB发生的高危人群。

Objective To Objective To understand the epidemic pattern of drug-resistant （DR） tuberculosis and its risk factors and to provide scientific basis for treatment and prevention. Methods Patients diagnosed with tuberculosis from April 1 in 2004 to March 31 in 2005 were face-to-face interviewed about demographic characteristics （age, gender, occupation, etc. ） and socioeconomic status （treatment history, BMI, contact history with tuberculosis patients, annual income, etc）. Each subject was asked to provide three specimens of sputum. All specimens were cultured in 37℃ to discriminate the type of strains, and then susceptibility tests were conducted. Results Of 182 strains isolated, 5 strains were M Boris （2.7%） and 177 strains were M TB （97.3%）. The proportion of drug-resistant strains was 54.9%, and 13 strains （7.1%） of them were multi-drug resistant tuberculosis （MDR-TB）. The rates of initial MDR and other drug-resistant tuberculosis （ODR-TB） were 3.8% and 46.6% respectively, while acquired rates were 16.3 % and 51.0 % respectively. Univariate analysis showed that age, treatment history, contact history with tuberculosis patients, individual and household annual income were significantly associated with MDR-TB （P 〈 0.05）; gender, occupation, and contact history were significantly associated with other resistant tuberculosis. Logistic regression analysis indicated that age （OR = 1.22, 95 % CI： 1.12- 6.63）, treatment history （OR = 4.98, 95% CI： 1.56 - 8.03）, contact history （OR = 7.84, 95%CI： 1.71 -25） and lower individual income were the risk factors of MDR-TB, and contact history （OR = 2.9, 95%CI： 1.13 - 7.52） was the risk factor of other resistant tuberculosis. Conclusion This study implies a low prevalence of MDR-TB in Deqing County. Treatment history is one of the most risk factors of MDR-TB. The poorer and the elder are the high risk population of MDR-TB.