上海市耐多药结核病患者二线药物耐药情况及危险因素分析

Prevalence and risk factors on the resistance related to second-line drugs among multi-drug resistant tuberculosis cases in Shanghai, China

目的分析上海市耐多药结核病（MDR—TB）患者二线药物耐药分布情况及危险因素。方法收集2009年上海市各区（县）结核病定点医院痰培养阳性菌株，进行菌型鉴定和一线抗结核药物（异烟肼、利福平、链霉素及乙胺丁醇）敏感性检测，对耐多药菌株进行二线抗结核药物（卡那霉素、阿米卡星、卷曲霉素、氧氟沙星、对氨基水杨酸及丙硫异烟胺）敏感性检测，结合患者特征及实验室信息，采用多因素分析上海市MDR-TB患者二线药物耐药的危险因素。结果2009年上海市确诊的1867例结核病病例中，112例（6．0％）为MDR-TB患者，其中58例（51．8％）至少耐1种二线抗结核药物，10例为广泛耐药结核病。多因素分析显示，MDR．TB患者中，45～59岁年龄组（aOR=4．76，P=0．001）及痰涂片阳性（aOR=6．51，P=0．026）与二线药物耐药相关。结论上海市MDR-TB患者二线抗结核药物耐药情况严重，45～59岁年龄组和痰涂片阳性是MDR—TB患者二线药物耐药相关的危险因素。

Objective To determine the prevalence and risk factors on second-line drug resistance in patients with multidrug resistant tuberculosis （MDR-TB） in Shanghai, China. Methods All pulmonary TB patients with sputum culture positivity detected in Shanghai during January to December, 2009, were enrolled. All of the pretreatment sputum-positive cultures samples were tested for routine specimen identification and routine drug susceptibility testing for first-line drugs （Isoniazid, Rrifampin, Ethambutol and Streptomycin）. Drug susceptibility testing on second-line anti-TB drugs （Ofloxcin, Amikacin, Kanamycin, Capreomycin, P-aminosalicylic acid and Prothionamide） was routinely performed on isolates of Mycobacterium （M.） TB with MDR. Logistic regression analysis was conducted to determine the risk factors regarding second-line drug resistance. Results A total of 1867 patients infected with M. TB isolates were diagnosed at the TB hospitals/ clinics in Shanghai during the study period, of whom 112 （6.0%） were MDR-TB, in which 58 cases （51.8%） showed resistant to at least one of the second-line drugs tested and 10 cases belonged to extensively drug-resistant. In the multivariate analyses, MDR-TB patients who were aged 45-59 years （aOR=4.76, P=0.001） , with sputum smear positivity （aOR=6.51, P=0.026） were significantly more likely to show resistance to second-line drugs. Conclusion The prevalence of second-line drug resistance among MDR-TB patients was high in Shanghai. MDR-TB patients who were under age of 45-59 years and with sputum smear positivity would represent important common risk factors for the resistance to second-line drugs.