4721例住院肺结核患者耐药状况及危险因素分析

Analysis of the drug-resistant status and risk factors of 4721 cases of hospitalized tuberculosis patients

目的 回顾性分析西安市结核病胸部肿瘤医院结核病患者中结核分枝杆菌耐药状况及危险因素.方法 2008年1月至2012年12月在西安市结核病胸部肿瘤医院就诊的4721例痰培养阳性住院结核病患者,分为“初治”和“复治”患者两组,初治患者4238例（89.77％）,复治患者483例（10.23％）.对这些患者的临床分离株4种一线抗结核药物链霉素（S）、异烟肼（H）、利福平（R）、乙胺丁醇（E）的耐药情况进行分析,用间接绝对浓度法进行药物敏感性试验,采用Excel建立数据库,采用SPSS 16.0统计学软件进行统计学分析,危险因素分析采用logis-tic回归分析,P＜0.05为差异有统计学意义.结果 4721例痰培养阳性患者,总耐药率为31.71％（149/4721）,初治耐药率为27.35％（1159/4238）,复治耐药率为69.98％（338/483）;总体耐多药率为12.20 ％ （576/4721）,初治和复治耐多药率分别为7.74％（328/4238）,51.35％ （248/483）.4种一线抗结核药物的耐药率由高到低分别是H（23.85％,1126/4721）、S（21.75％,1027/4721）、R（12.86％,607/4721）、E（6.93％,327/4721）.耐药类型中,以耐1种药（12.71 ％,600/4721）和耐2种药（9.53％,450/4721）为主.20～岁和40～岁年龄组的耐药率和耐多药率分别为31.13％和11.13％ 、39.86％和18.65％,以＜20岁为对照,x2值分别为12.67和11.31、43.20和38.28,P值均＜0.05,OR值（95％CI）分别为1.4（1.1～1.7）和1.4（1.0～2.1）、2.2（1.7～2.8）和3.2（2.2～4.6）;复治组的耐药率和耐多药率为69.98％和51.35％,以初治组为对照,x2值分别为274.48和715.3,P值均＜0.05,OR值（95％CI）分别为5.9（4.9～7.4）和13.7（10.9～17.2）;未接受DO TS组的耐多药率为11.29％,以接受DOTS组为对照,x2值为11.63,P＜0.05,OR值（95 ％CI）为1.4（1.1～1.6）.结论 西安市结核病胸部肿瘤医院就诊的痰培养阳性的肺结核患者耐药率较高,20～＜60岁的患者及复治患者发生耐药和耐多药的概率较高,未接受DOTS策略的患者发生耐多药的概率较高.

Objective To analyze the situation and risk factors of drug resistance（DR） of Mycobacterium tu- berculosis （Mtb） among patients in Xi＇ an Tuberculosis and Thoracic Tumor Hospital retrospectively. Methods From January 2008 to December 2012, a total of 4721 sputum culture positive patients visited the Xi＇an Tuberculo- sis and Thoracic Tumor Hospital. Among these patients, 4238 （89.77 %） were new patients and 483 （10.23%） were retreatment patients. We analyzed the drug susceptibility situation of their clinically isolated strains for 4 kinds of first line anti-TB drugs, namely streptomycin （S）, isoniazid （H）, rifampin （R）, ethambutol （E）. The drug sus- ceptibility test was carried out by absolute concentration method. Database were established using Excel. Statistical analysis was performed with SPSS 16.0 statistical software. Differences among groups were compared with Z2 test. And the risk factors of total DR and multidrug-resistance （MDR） were also analyzed with Logistic regression analy- sis. P〈0. 05 was considered statistically significance. Results Among the 4721 sputum culture positive patients, the total DR rate, initial DR rate and acquired DR rate were 31.71% （149/4721）, 27.35% （1159/4238） and 69.98% （338/483） respectively; the total MDR rate, initial MDR rate and acquired MDR rate were 12.20% （576/4721）, 7.74% （328/4238） and 51.35% （248/483）. The DR rates of the 4 kinds of first line anti-TB drugs wereH （23.85% ,1126/4721）,S（21.75%,1027/4721）,R（12.86%, 607/4721）,E（6.93%, 327/4721）. In terms of resistance pattern, the majority were single-drug resistant （12.71%, 600/4721） and two kinds drug resistan （9.53G, 450/4721）. DR and MDR rate of 20-- and40 were 31.13%,11. 13%and 39.86%,18.65%, compared with 〈20 years, x2 values were 12.67,11.31 and 43.20,38. 28, P value 〈0. 05, OR value （95 % CI） was 1.4 （ 1.1 -- 1.7）,l.4（1.0--2.1）and 2.2（1.7 2.8）,3.2（2.2--4.6）; DR and MDR rate of retreatment were 69.98% and 51.35%, compared with initial, x2 values were 274.48 and 715.3, P〈0.05,OR values （95GCI） were 5.9（4.9- 7.4）,13.7（10.9 17.2）; MDR of no DOTS was 11.29%,x2 values were 11.63, P〈0.05,0R value （95GCI） were 1.4（1.1--1.6）. ConehlSions The DR rate of Mtb in Xi＇an Tuberculosis and Thoracic Tumor Hospital was relatively high. The patients from 20 to 〈60 were more likely to have DR and MDR and those who hadn＇t received the DOTS strategies were more likely to have MDR.