甘肃省贫困及少数民族地区复治涂阳耐药肺结核病人耐药影响因素分析

Analysis of influencing factors of drug-resistance among the re-treatment smear positive tuberculosis patients in poor and minority areas in Gansu

目的了解甘肃省贫困及少数民族地区复治涂阳耐药肺结核病人的耐药性影响因素;有针对性地提出改善甘肃省复治涂阳耐药肺结核病人耐药性发生的措施和建议。方法采用非概率性目的抽样,选取2004年9月至2005年8月进行药敏试验的贫困及少数民族地区,166例复治涂阳肺结核病例进行随访问卷等回顾性调查。结果单因素分析,不同居住地、文化程度、登记分类、初治诊断机构、是否接受宣传教育、累计用药时间、有无合并症、督导者、督导管理方式、既往不规则治疗和中断治疗等对耐药率变化的差异有显著意义(P<0.05)。进一步对P<0.05的变量进行多因素Logistic分析,患者的受教育程度、患者居住地区、有无合并症、患者在化疗过程中所接受的督导方式是甘肃贫困及少数民族地区耐药的主要危险因素。结论结核病的耐药问题已经成为甘肃省贫困及少数民族地区结核病防治的难点。患者自身客观条件和DOT管理的实施是复治耐药的主要影响因素。

Objective To survey the factors influencing of drug-resistance for the re-treatment smear positive patients among poor and minority areas.To carry out the available and suitable methods or stratigies to decrease the drug-resistance of the re-treatment smear positive patients.Methods By non-probability aiming random sampling method,the drug-resistance surveillance areas of the whole year from 2004.9 to 2005.8 were selected.Total 166 drug-resistance surveillance re-treatment smear positive pulmonary tuberculosis patients were eligible.Results The results showed that the risk factors of drug resistance rate were living conditions,education level categorization,first treatment provider,receiving health education or not,the total medication time,having complications or not,supervisor,supervision methods,and past experience of irregular treatment or treatment interrupt（P0.05）.The multi-logistic statistics suggested that living conditions,education level,complications with TB,and supervision methods were major risk factors for drug-resistence.Conclusion TB drug-resistance has been a difficult problem among the patients in poor and minority areas.The main risk factors included knowledge,living conditions and the supervision of DOT during the initial treatment.