异烟肼耐药结核病与耐多药结核病的影响因素研究

Studies on influencing factors of isoniazid-resistant and multi-drug resistant Mycobacterium tuberculosis

目的探讨异烟肼耐药结核病与耐多药结核病的影响因素,为其临床研究提供依据。方法选择160例确诊为肺结核的患者作为研究对象,其中耐多药组33例（20.62%）,耐异烟肼组40例（25.00%）,全敏感组87例（54.38%）。采用回顾性方法记录相关信息,筛选出影响耐药发生的相关因素,采用logistic回归分析进行多因素分析,并随访观察耐多药结核病发生情况。结果耐多药组与全敏感组在年龄、性别、治疗史及痰涂片比较差异有统计学意义（χ2=5.281、11.018、2.211、4.013,P=0.022、0.001、0.027、0.045）;耐异烟肼组与全敏感组在年龄、性别、治疗史、痰涂片及肺部空洞比较差异有统计学意义（χ2=5.970、15.044、2.486、4.770、5.970,P=0.015、0.000、0.013、0.029、0.015）。多因素分析显示复治2次、复治≥3次、痰涂片阳性、肺部空洞是耐异烟肼结核病发生的危险因素[OR=2.611,95%CI（1.323~5.152）;OR=3.522,95%CI（1.220~10.168）;OR=2.014,95%CI（1.104~3.674）;OR=1.784,95%CI（1.193~2.655）,P〈0.05];复治≥3次、痰涂片阳性是耐多药结核病发生的危险因素[OR=3.012,95%CI（1.203~7.541）;OR=2.945,95%CI（1.131~7.824）,P〈0.05]。耐异烟肼结核病患者更容易发展为耐多药结核病,差异有统计学意义（χ2=10.093,P=0.001）。结论复治及痰涂片阳性是耐异烟肼结核病与耐多药结核病发生的危险因素,耐异烟肼结核分枝杆菌有向耐多药结核病演变的风险。

Objective To analyze the influencing factors of isoniazid-resistant and multi-drug resistant Mycobacterium tuberculosis. Methods A total of 160 patients with confirmed tuberculosis were enrolled into the study,including 33（20.62%）with multidrug-resistant TB,40（25.00%）with isoniazid-resistant TB and87（54.38%）with drug sensitive TB.Disease related information was retrieved and factors influencing drug resistance were analyzed. Results The differences of age,gender,medical history and sputum smear were statistically significant between patients with multi-drug resistant TB and patients with drug sensitive TB（χ2=5.281,11.018,2.211,4.013,P=0.022,0.001,0.027,0.045）.The differences of age,gender,medical history,sputum smear and pulmonary cavity were statistically significant between patients with isoniazid resistant TB and patients with drug sensitive TB（χ2=5.970,15.044,2.486,4.770,5.970,P=0.015,0.000,0.013,0.029,0.015）.Multi-factor analysis showed that retreatment,positive sputum smear and pulmonary cavity were risk factors for isoniazid-resistant tuberculosis [OR =2.611,95%CI（1.323~5.152）;OR=3.522,95%CI（1.220~10.168）;OR=2.014,95%CI（1.104~3.674）;OR=1.784,95%CI（1.193~2.655）,P〈0.05],and retreatment,positive sputum smear were risk factors for multidrug resistant tuberculosis [OR=3.012,95%CI（1.203~7.541）;OR=2.945,95%CI（1.131~7.824）,P〈0.05].Patients with isoniazid-resistant TB were more likely to become multi-drug resistant TB（χ2=10.093,P=0.001）. Conclusions Retreatment and positive sputum smear are risk factors of isoniazid-resistant and multi-drug resistant tuberculosis.Isoniazid-resistant bacteria are more easily to become multi-drug resistant ones.