780例涂阴培阳肺结核患者耐药特征及影响因素分析

Research on the drug-resistant characteristics and the risk factors of 780 smear-negative pulmonary tuberculosis patients

目的初步了解宁波地区涂阴培阳肺结核患者耐药的流行状况及影响因素,为本地区结核病的有效防控提供科学依据。方法将宁波市2010年-2012年结核病耐药检测资料中的涂阴肺结核培养阳性患者作为研究对象,采用WHO/IUATLD推荐的比例法进行异烟肼(INH)、利福平(RFP)、链霉素(SM)及乙胺丁醇(EMB)4种药物的耐药性测定及菌种鉴定,并运用单因素及多因素logistic回归分析患者耐药的影响因素。结果研究共纳入痰培养阳性涂阴肺结核患者780例,涂阴培阳肺结核患者耐药率、耐多药率分别为24.87%和7.05%。耐药谱以耐异烟肼为最高。治疗情况是涂阴肺结核患者耐药的影响因素。结论宁波地区涂阴肺结核患者耐药现状较为严峻,需进一步加强涂阴肺结核患者的防控工作。

Objective To investigate the prevalence and its influncial factors of drug- resistant smear- negative pulmonary tuberculosis in Ningbo,so as to provide scientific basis for the efficicent prevention control and treatment of drug- resistant tuberculosis. Methods Cases diagnosed as smear- negative pulmonary tuberculosis were collected from the tuberculosis drug- resistant detection in Ningbo from 2010 to 2012. The drug resistance tests and strain identification of isoniazid,rifampicin,streptomycin and ethambutol were performed by the proportion method. Univariate and multivariate analysis were performed to determine the risk factors associated with drug resistance. Results There were 780 cases of positive smear negative pulmonary tuberculosis patients in this research,and the drug resistance rate of smear negative pulmonary tuberculosis and the drug resistance rate were 24. 87% and 7. 05% respectively. The highest resistance spectrum was on isoniazid resistant. The treatment was the influencial factor of the drug resistance of smear negative tuberculosis patients. Conclusion The prevalence of drug- resistant tuberculosis among smear- negative pulmonary patients was relatively high in Ningbo,suggesting the necessity to strengthen the tuberculosis control program for smear- negative pulmonary patients.