346例肺结核患者结核分枝杆菌耐药性调查及耐多药结核病影响因素分析

Survey on drug resistant pulmonary tuberculosis of 346 patients and analysis of risk factors to multi-drug resistant tuber- culosis

目的了解当今结核分枝杆菌的耐药情况，并探讨引起耐多药结核病患者产生的危险因素。方法收集我院2014年112月346例肺结核患者临床诊疗信息及其临床分离株，其中男209例，女137例，年龄14~87岁，平均年龄（36．98土0．97）岁。采用比例法检测结核分枝杆菌对抗结核药物（异烟肼、利福平、乙胺丁醇、链霉素、氧氟沙星、卡那霉素）的敏感性，采用多因素非条件logistic回归分析耐多药肺结核患者的相关影响因素。P〈O．05为差异有统计学意义。结果346株结核分枝杆菌菌株中，耐药率为28．0％（97／346）；初治患者耐药率为20．1％（54／268），复治患者耐药率为55．1％（43／78），复治患者耐药率明显高于初治耐药率（X2=28．71，P〈0．01）。耐多药率为15．0％（52／346）；复治患者耐多药率为44．9％（35／78），初治患者耐多药率为6．3％（17／268），复治患者耐多药率明显高于初治耐多药率（y。一70．299，P〈O．01）。广泛耐药率为2．6％（9／346）；复治患者广泛耐药率E6．4％（5／78）]高于初治患者广泛耐药率[1．5％（4／268）]（X2=5．767，P〈O．05）。患者耐多药单因素分析表明，不同性别、年龄组耐多药率差异无统计学意义（7。值分别为0．635、3．110，P值均〉o．05）。患者耐多药多因素分析表明，复治患者耐多药率高于初治患者（OR=9．439，95％CI=4．317～20．639，X2=70．299，P〈o．01）、结核病合并糖尿病的患者耐多药率高于非合并糖尿病患者（OR--4．018，95％CI：1．038～15．551，X2=6．630，P〈O．05）、不规律用药的患者耐多药率高于规律用药患者（OR--3．91，95％CI=1．385～11．041，X2=18．492，P〈O．01）。结论当前石家庄市耐多药结核疫情处于全国较高水平。合并糖尿病、反复多次治疗及不规律用药等可能是导致患者耐多药的毹盼因素．

Objective To understand the drug resistance status of Mycobacterium tuberculosis （Mtb） strains and to explore the risk factors for multidrug resistant tuberculosis （MDR-TB） strains. Methods In this study, 346 Mycobacterium tuberculosis strains were isolated from the TB patients treated during 2014, and the corresponding clinical background information was collected. Two hundred and nine cases were male, and 137 cases were female; they were aged 14--87 years, and the mean age were （36.98＋0.97） years. The drug susceptibility testing of the first-line anti-TB drug （isoniazid, rifampin, ethambuto, streptomycin, ofloxacin, kanamycin） was performed using the L-J proportion method. The multivariate unconditioned logistic regression analysis was applied to explore the risk factors for MDR-TB. P〈0.05 was considered statistically significant. Results Three hundred and forty-six isolates were identified as MTB strains. Among them, 28.0~ （97/346） were resistant to at least one of the anti-TB drugs. The drug resistant rate of the new cases and the retreatment cases were 20.1% （54/268） and 55.1% （43/78）, respectively, which was statistically higher than that of the new cases （X2 =70. 299, P〈0.01）. The mul tidrug resistant rate was 15.0% （52/346）, and those of the new cases and the retreatment cases were 6.3~ （17/268） and 44.9% （35/78） respectively. The MDR-TB rate of retreatment cases was significantly higher than that of new cases （Z2= 70. 299, P〈0.01）. The extremely drug resistant tuberculosis （XDR TB） accounted for 2.6~ （9/346）, 1.5~ （4/268） of new cases and 6.4~ （5/78） of retreatment cases were XDR-TB cases. TheXDR-TB rate of retreatment cases was significantly higher than that of new cases （Z2- 5. 767, P%0. 05）. Single variate analysis showed that there was no statistical difference between different gender and different age in drug re- sistant rate （;g2--0. 635 and 3. 110, P~〉0.05）. Multivariate analysis showed that the drug resistant rate of retreat- ment cases was significantly higher than that of new cases （OR= 9. 439, 95%CI= 4. 317-20. 639, Z2 = 70. 299, P%0. 01）. TB patients with diabetes had a statistically higher drug resistant rate than TB patients without diabetes （OR=4. 018, 95%CI= 1. 038--15. 551, X2=6. 630, P〈0.05）. Patients with irregular medication possessed a higher drug resistant rate than patients with regular medication （OR = 3.91, 95% CI = 1. 385 -- 11. 041, X2 = 18. 492, P%0. 01）. Conclusion The Mtb multi drug resistant rate in Shijiazhuang is higher than the national lev el. The occurrence of diabetes, repeatedly drug treatment and irregular medication may be the risk factors contribu- ting to the development of MDR-TB.