辽宁省肺结核患者耐药状况及相关因素分析

Drug resistance situation and related factors of pulmonary tuberculosis in Liaoning

目的调查辽宁省结核分枝杆菌耐药现状,为制定有效的防控对策和策略提供科学依据。方法在2012年1月1日—2012年6月30日全省耐药监测点连续纳入的998例涂阳患者作为研究对象。对其痰标本进行培养分离菌株,菌型鉴定,获得912例结核分枝杆菌完整病例资料,采用比例法对利福平(R)、异烟肼(H)、链霉素(S)、乙胺丁醇(E)4种药物进行药物敏感性试验。采用χ~2检验进行率的比较及多因素logistic回归分析耐药特点及影响耐药和耐多药的相关因素。结果 912株结核分枝杆菌总耐药率为38.16%(348/912),初治患者耐药率33.63%(228/678),复治患者耐药率51.28%(120/234);总耐多药率、多耐药率分别为11.84%(108/912)、10.09%(92/912),复治患者的总耐药率、耐多药率和多耐药率均明显高于初治患者,差异有统计学意义(P<0.001)。耐药顺位链霉素的耐药率最高,异烟肼列第二位,耐多药、多耐药中包含二者的耐药谱耐药率较高,而单耐药中利福平(3.07%)耐药排在第二位。经多因素logistic回归分析,复治患者更易产生耐药(OR=2.08,95%CI=1.53~2.82,P<0.05);20~39岁(OR=2.63,95%CI=1.04~6.66,P<0.05)和40~59岁(OR=2.55,95%CI=1.02~6.34,P<0.05)年龄组患者与耐药有关。结论辽宁省耐药水平仍然较高,耐药结核病防治形势依然严峻,需采取更全面的防控措施降低耐药结核病的流行。

Objective To understand the situation of Mycobacterium tuberculosis drug-resistance in Liaoning Province,and obtain the total drug resistance rate,multidrug resistance rate and poly-drug resistance rate,so as to provide the evidence for formulating the effective prevention and control countermeasures and strategies. Methods A total of 998 smear positive TB patients were drawn continuously as objects of study from January 1st,2012 to June 30 th,2012,and 912 complete cases were obtained after sputum culture and species identification. All of them were screened with drug susceptibility test of proportion method [rifampicin（R）,isoniazid（H）,streptomycin（S） and ethambutol（E）]. χ^2 test and multiple logistic regression analysis were used to compare the rates,drug resistance character and factors which affected the drug resistance and multidrug resistance,and a P value of 〈0.05 was considered statistically significant. Results The total drug resistance rate of 912 strains was 38.16%（348/912）,and 33.63%（228/678） for initial treatment patients and 51.28%（120/234） for retreatment patients. The total multidrug-resistance rate was 11.84%（108/912） and the poly-drug-resistance rate was 10.09%（92/912）.The total drug resistance rate,multi-drug resistance rate and poly-drug-resistance rate of the retreatment patients were all significantly higher than those of initial treatment patients（all P〈0.001）. As to the sequence of the drug resistance rate,streptomycin was the highest one,isoniazid was the second one,and both of them were also the majority in the multidrugresistance rate and poly-drug-resistance rate,but rifampicin（3.07%） was the second one in the single drug resistance rate.The multiple logistic regression analysis showed that retreatment patients trended to produce drug resistance（OR=2.08,95%CI=1.53-2.82,P〈0.05）,and those patients aged from 20 to 39 years（OR=2.63,95%CI=1.04-6.66,P〈0.05）and 40 to 59years（OR=2.55,95%CI=1.02-6.34,P〈0.05） were related to drug resistance. Conclusion The drug resistance level is still higher in Liaoning Province,and the situation of drug resistant tuberculosis is still severe,and therefore,more comprehensive prevention and control measurements should be taken to reduce the prevalence of drug resistant tuberculosis.