上海市流动人口肺结核耐药情况及影响因素

Prevalence and Risk Factors of Drug-resistant Tuberculosis among Migratory Population in Shanghai,China

[目的]了解并掌握上海市流动人口肺结核耐药流行状况及其影响因素,为制定和实施针对流动人口肺结核的防治措施和提高管理水平提供依据。[方法]将2006年1—12月在上海市肺结核定点医院诊治的流动人口中痰培养阳性肺结核患者作为研究对象,收集其相关基本情况、流行病学和管理信息,进行菌型鉴定及利福平(R)、异烟肼(H)、链霉素(S)和乙胺丁醇(E)敏感性测试,分析本市流动人口肺结核耐药流行状况及其影响因素。[结果]共入选585例痰培养阳性肺结核患者。这些患者多为新发初治、青壮年、医疗保障不足,普遍存在就诊延误,部分患者因返乡治疗而流失,直接面视下短程督导化疗(DOTS)管理率、痰菌阴转率和治愈率都较低。总耐药率为20.00%,耐多药率为4.10%;初始耐药率为17.14%,初始耐多药率为3.43%;获得性耐药率为45.00%,获得性耐多药率为10.00%。4种药物中,S和H的耐药率最高(分别为14.87%和10.94%)。30～49岁组总耐药率最高,为8.72%;15～29岁组初始耐药率最高,为8.57%。经单因素和多因素分析,复治患者是流动人口耐药肺结核的相关因素。[结论]上海市流动人口肺结核耐药现象较为严重,今后要根据流动人口肺结核耐药流行病学特点加强防治措施。

[ Objective ] To determine the prevalence and risk factors of drug-resistant tuberculosis （ DRTB ） among migratory population in Shanghai, so as to provide the basis for developing and implementing measures for DRTB prevention and control, suppressing the epidemic and improving the management level. [ Methods ] All DRTB sputum culture positive patients, confirmed at any district （ county ） tuberculosis dispensary in Shanghai from Jan to Dec of 2006 were enrolled. Basic information, epidemiological and management data of each case were collected. Bacterial-type and susceptibility to rifampin, isoniazid, streptomycin and ethambutol were also identified. Univariate and multivariate analysis were performed to determine the relevance between risk factors and drug-resistance. [ Results ] A total of 585 patients were enrolled in this study. Most of these cases were first diagnosed and treated, mainly young adults. Their medical insurance was obviously insufficient, thus, led to the postponement of treatment. Some patients were lost follow-up. The full course directly observed treatment, the short course（ DOTS ）management rate, the sputum conversion rate and the cure rate were relatively poor. The total drug resistance rate was 20.00%, the multiple drug resistance rate was 4.10%, the initial drug resistance rate was 17.14% and the initial rate of multiple drug resistance was 3.43%. The acquired drug resistance rate was 45.00% and the acquired rate of multiple drug resistance was 10.00%. The resistance rates of streptomycin and isoniazid were leading drug resistances observed（ 14.87% and 10.94% respectively ）. The total drug resistance rate in the 30-49 year group was the highest （ 8.72% ）and the initial drug resistance rate of the 15-29 year group was the highest （ 8.57% ）. Overall, the drug resistance was associated with retreated cases among migratory population in Shanghai. [ Conclusion ] The prevalence and risk factors of drug-resistant tuberculosis among migratory population are relatively high in Shanghai. It indicates the necessity to enforce the tuberculosis control program for migratory population.