大连市耐多药结核危险因素分析

Risk factors for MDR- TB and XDR- TB in Dalian patients

目的探索耐多药结核危险因素。方法回顾性分析2012年1月1日—2014年1月1日间大连市(市内四区)结核病医院所有同时有痰结核菌涂片及培养结果的患者954例的临床资料。利用临床相关因素比较及单因素危险因素分析,多因素危险因素分析统计耐药结核(MDR-TB)和广泛耐药结核(XDR-TB)的发生情况,致MDR和XDR的高危因素。结果初治者中耐多药肺结核MDR为4.69%,广泛耐多药肺结核XDR为0.88%。复治者中MDR为26.57%,XDR为6.27%。导致MDR/XDR的危险因素包括治疗方案不完整,剂量不足,应用喹诺酮或注射剂,依从性,糖尿病。结论治疗不规范,糖尿病是导致耐多药结核发生的重要因素,耐药机制复杂,需进一步探索。

Objective To explore the risk factors for MDR- TB and XDR- TB in Dalian patients. Methods We retrospectively analyzed the clinical records of 954 TB Patients with sputum and culture- proven MDR- or XDR- TB,who were registered from January 1,2012 to January 1,2014 in the Dalian Tuberculosis Hospital. Results All TB patients were culture-positive for M. tuberculosis complex and had positive sputum- smear microscopy results. Among first- time patients,4. 69%were MDR- TB and 0. 88% were XDR- TB. In recurrent patients,MDR- TB and XDR- TB were 26. 57% and 6. 27 %,respectively. Significant risk factors for MDR / XDR- TB included incomplete treatment regimen,inadequate doses,previous use of a fluoroquinolone and injectable agent,poor compliance,and diabetes. Conclusion Inadequate initial regimen and diabetes are important risks of drug resistance. The mechanisms of TB drug- resistance are complex and need further studies.