江苏省社区人群结核杆菌耐药状况及影响因素研究

Prevalence and risk factors for drug resistance tuberculosis in Jiangsu Province: a population based study

目的了解江苏省社区人群结核杆菌耐药状况及其影响因素,为制定耐药结核病防控策略提供依据。方法选择苏南、苏中和苏北各1个地市,于2012年1～6月期间所有涂阳结核病人痰标本进行培养和药敏试验,所有数据用SPSS 17.0软件进行分析,探讨耐药分布特征和影响因素。结果共收集1 003株分枝杆菌阳性菌株,有54株(5.4%)为非结核分枝杆菌,其余949株(94.6%)均为结核分枝杆菌。在949株结核分枝杆菌中,643株(67.8%)对6种抗结核病药全敏感;306株(32.2%)对1种或1种以上药物耐药,其中114株(12.0%)为单耐药菌株,117株(12.3%)为耐多药菌株,10株(1.1%)为广泛耐药菌株,65株(6.8%)为其他类型耐药菌株。初、复治病人的总耐药率分别为22.8%和64.7%,耐多药率分别为5.6%和35.3%,广泛耐药率分别为0.1%和4.2%。多因素Logistic回归分析显示,抗结核治疗史、户籍类型、年龄、性别与耐多药发生关联差异均有统计学意义(均有P<0.05)。结论江苏省结核病耐药形势严峻,社区人群的耐多药率和广泛耐多药率高于世界平均水平并已出现社区传播,必须采取切实措施,控制耐药结核蔓延。

Objective To describe the prevalence and risk factors for drug-resistance tuberculosis （TB） in a pop- ulation based study in Jiangsu Province, so as to provide evidence for prevention and control of drug resistance tuberculosis. Methods Three cities from southern, central and northern area in Jiangsu Province were selected. From 2012 January to June, all sputum smear positive isolates were collected from pulmonary tuberculosis patients and then tested for drug sus- ceptibility testing. Analyses were conducted with SPSS 17. O, and to determine the characters and risk factors of drug resist- ance TB. Results A totally 1 003 culture confirmed strains were collected of which 54 strains were Non myeobacterium tu- berculosis （NTM） and 949 strains were mycobacterium tuberculosis （MTB）. The drug susceptibility tests showed that 643 （67.8%） MTB strains were sensitive to all the six antibiotics and the other 306（32. 2% ） strains were resistant to at least one drug. 22. 8% new cases and 64.7% previous treatment history cases were resistant to at least one drug respectively. The numbers of mono-drug resistance were 114 （ 12.0% ） totally. The prevalence of multidrug resistant （MDR-TB） was 117（ 12. 3% ）, which was significantly different between new cases （5.6%） and those with previous treatment history （35.3%）. The prevalence of extensively drug-resistant tuberculosis （XDR-TB） was 10（ 1.1% ）, which was significantly different between new cases （0. 1% ） and those with previous treatment history （4.2%）. Multiple logistic regression showed that age, sex, treatment history and floating population of patients were significantly associated with the risk of drug resistance （ all P 〈 0.05 ）. Conclusions The high prevalence of drug resistance has been a big challenge for TB control. The rate of MDR-TB and XDR-TB were higher than the world average level. Effective measures of drug-resistant TB should be taken to control the spread of drug-resistant TB.