青岛地区耐药结核病流行现状及危险因素分析

Prevalence and risk factors of multidrug-resistant tuberculosis in Qingdao region

目的了解青岛地区结核分枝杆菌耐药情况及耐药产生的影响因素，为结核病的防治提供科学依据。方法以青岛市2013年结防所新登记的490例结核分枝杆菌感染的涂阳肺结核病人为研究对象，采用WHO／IUATLD推荐的比例法进行耐药性检测；多因素分析采用多因素logistic回归分析；统计软件为SPSS18．0。结果青岛地区结核分枝杆菌总耐药率为22．45％，初治肺结核患者耐药率为21．75％，复治肺结核患者耐药率为38．09％，耐多药率为4．69％；多因素logistic结果显示，治疗依从性差（OR=9．97，95％CI=5．16—19．28）、居住地为农村（OR=6．22，95％CI=3．27～11．83）、年龄（OR=1．77，95％ CI=1．30～2．39）是青岛市肺结核发生耐药的主要危险因素。结论青岛地区耐药结核病疫情相对严重，且既往治疗史、治疗过程中依从性、居住地是影响肺结核发病的主要的非生物学因素。

Objective To investigate the prevalence and risk factors of the multidrug-resistant（MDR） tuberculosis （TB） and to provide evidences for the prevention of MDR-TB. Methods All new registered sputum smear-positive pa- tients in TB sentinel surveillance sites of Qingdao municipality were collected in 2013. Identification and susceptibility tests were done for all culture positive samples. Proportion method was used to conduct drug sensitivity test according to the guidelines for surveillance of drug resistance（DR） in tuberculosis of World Health Organization/International Union Against Tuberculosis and Lung Disease（ WHO/IUATLD）. Logistic regression was used in multivariate analyses. The data were analyzed with SPSS 18. 0. Results The total resistance rate was 22. 45 %, while the initial was 21.75 % and the retreatment was 38.09%, and the MDR rate was 4. 69%. Logistic regression analyses indicated that weak medication ad- herence of the patient （ odds ratio [ OR ] = 9. 97,95 % confidence interval E 95 % CI ] ： 5.16 - 19. 28 ）, with a rural residence （ OR = 6. 22,95 % CI： 3.27 - 11.83 P 〈 0. 05 ）, and aged 20 - 40 years （ OR = 1.77,95 % CI： 1.30 - 2. 39） were risk fac- tors of MDR-TB. Conclusion The prevalence of the MDR-TB is relatively high in Qingdao region and treatment histo- ry, compliance to medication, and residence are the major abiological influencing factors TB incidence.