肺结核患者产生耐多药危险因素的研究

Study on risk factors of multi-drug resistance in pulmonary tuberculosis patients

目的探讨产生耐多药肺结核患者的危险因素。方法选取2011年7月1日至2014年6月30日湖北省荆州市传染病医院收住入院的肺结核患者507例，其中耐多药肺结核患者171例。对507例患者进行了问卷调查，其中耐多药组发放问卷171份，回收有效问卷163份，对照组发放问卷336份，回收有效问卷329份。采用EpiData3．0和SPSS19．0软件进行数据录入及统计学分析。先进行非条件单因素logistic回归分析，以a=0．15水平筛检出可疑因素，再以可疑因素为自变量进行非条件多因素logistic回归分析。结果单因素logistic回归分析筛检出差异有统计学意义的因素有：年龄（“30～岁”耐多药组66例，占40．5％，OR=2．49，95％CI-1．48～4．22，P=0．001；“45～岁”耐多药组43例，占26。3％，OR=0．85，95％CI=0．51～1．44，P=0．553；“≥60岁”耐多药组13例，占8．O％，OR=0．44，95％CI=0．12～0．49，P〈0．001）、复治患者（耐多药组132例，占81．O％，OR：10．65，95％CI=6．73～16．84，P〈0．001）、既往抗结核治疗次数（“1～2次”耐多药组81例，占49．7％，OR=6．82，95％CI=4．22~11．03，P〈0．001；“3次及以上”耐多药组51例，占31．3％，OR=96．65，95％CI=32．68~285．87，P〈0．001）、不规律服药（耐多药组63例，占38．7％，OR=5．38，95％CI=3．59～8．08，P〈0．001）、中断服药（耐多药组56例，占34．4％，OR=6．10，95％CI=3．65~10．21，P〈0．001）；抗结核治疗疗程（“疗程过短”耐多药组有33例，占20．2％，OR=4．38，95％CI=2．52～7．60，PG0．001；“疗程过长”耐多药组75例，占46．1％，0R=16．38，95％CI=9．59~29．20，PG0．001）、不良反应（耐多药组21例，占12．9％，OR=2．71，95％CI=1．39～5．30，P=0．003）。多因素非条件logistic回归分析显示：既往抗结核治疗次数多（“1～2次”OR=5．59，95％CI=2．53～12．35，PGO．001；“3次及以上”0R=20．61，95％CI=4．41~96．32，P〈0．001）、不规律服药（oR：2．96，95％CI=1.72～5．10，P〈0.001）和吸烟（OR—L83，95％CI=1．06～3．16，P=0．03）耐多药发生的风险较高；年OR=0．09，95％CI=0．04～0．24，PG0．001）耐多药发生的风险较低。结论抗结核治疗次数、龄大（“45～岁”OR=0．31，95％CI=0．14～O．66，P=0．002；“≥60岁”不规律服药、吸烟可能是是耐多药肺结核发生的危险因素，年龄可能是耐多药肺结核的保护因素。

Objective To investigate the risk factors of multi-drug resistant tuberculosis （MDR-TB） in Jingzhou. Methods Five hundred and seven pulmonary tuberculosis patients hospitalized in Jingzhou Infectious Disease Hospital from 1 July 2011 to 30 June 2014 were enrolled, among whom there were 171 MDR-TB cases. The questionnaire was designed and the related information was collected by interviewing the patients. One hundred and sixty three questionnaires were collected from 171 MDR-TB cases in case group and 329 questionnaires were collected from 336 non-MDR TB patients in control group. Epidata 3.0 and SPSS 19. 0 software were used to input and analyze the data. Univariate unconditional logistic regression analysis was conducted to screen out suspicious factors with a= 0.15, then unconditional multivariate regression analysis was conducted with the suspicious factors as independent variable. Results Univariate logistic regression analysis showed that the influence factors of MDR-TB included age （In case group, 66 patients aged 30 and above accounted for 40.5%, OR=2.49, 95%C1 （1.48~4. 22）, P%0. 001; 43 patients aged 45 and above accounted for 26. 3%, OR ~ O. 85, 95% CI （0. 51 1.44）, P〈0. 553; 13 patients aged 60 and above accounted for 8.0%, OR=O. 44, 95%CI （0.12~0.49）, P〈 0. 001）, previous treatment （132 MDR-TB cases, accounted for 81.00%, OR= 10. 65, 95%CI （6.73~16.84）, P〈 0. 001）, number of treatment （81 MDR-TB cases were treated once or twice, accounted for 49.7%, OR= 6.82, 95%CI （4. 22~11.03）, P〈0. 001; 51 MDR-TB cases were treated three times and above, accounted for 31.3%, OR= 96.65, 95%CI （32.68~285.870, P〈0. 001）, 38. 7%, OR=5.38, 95%CI （3.59~8.08）, P〈0. 001）, irregular treatment （63 MDR-TB cases, accounted for interruption of therapy （56 MDR-TB patients, accounted for 34. 4%, OR=6.10, 95%CI （3.65~10. 21）, P〈0. 001）, treatment course （33 MDR-TB cases with shorter course, accounted for 20. 2 %, OR = 4.38, 95 G CI （2.52 ~ 7.60）, P % 0. 001; 75 MDR-TB cases with longer course, accounted for 46.1%, OR=16.38, 95%CI （9.59~29.20）, P%0. 001）, adverse reaction （21 MDR-TB cases, accounted for 12.9 %, OR = 2.71, 95 % CI （ 1.39 ~ 5.30）, P -= 0. 003） Multivariate logistic regression analysis showed that TB patients with more number of treatment （＂once twice＂ OR = 5.59, 95%CI （2.53 12.35）, P%0. 001; ＂three times and above＂ OR=20.61, 95%CI （4.41~96.32）, P〈0. 001）, irregular treatment （OR=2.96, 95%CI （1.72~5.10）, P〈0. 001） and smoking （OR= 1.83, 95~CI （1.06~3.16）, P=0.03） had higher risk of MDR-TB. TB patients with higher age （＂45~＂ OR = 0.31, 95% CI （0. 14 ~ 0. 66）, P = 0. 002; ＂≥60＂ OR=0. 09, 95%CI （0. 04~0. 24）, P〈0. 001） had lower risk of MDR-TB. Conclusion Number of treat- ment, irregular treatment and smoking are risk factors of MDR-TB, and age is a protective factors.