217株结核分枝杆菌耐药监测结果及耐多药相关因素分析

Monitoring results of drug resistance of 217 Mycobacterium tuberculosis and analysis of multidrug resistance factors

目的了解廊坊市结核分枝杆菌耐多药特征及产生的影响因素,为有效控制耐多药结核病的流行提供科学依据。方法回顾性分析廊坊市2015年结核分枝杆菌耐药情况,药敏试验采用比例法,对耐多药危险因素进行logistic回归分析。结果 217株结核分枝杆菌总耐药率为53.0%(115/217),总耐多药率为10.1%(22/217);耐药顺位由高到低依次为:利福平(33.2%)、异烟肼(20.7%)、链霉素(14.3%)、乙胺丁醇(6.5%)、氧氟沙星(4.6%)、卡那霉素(0.9%);多因素分析表明病人分类(初治或复治病人)(OR=0.143,95%CI:0.046~0.448)和病变累计肺野≥4(OR=0.069,95%CI:0.069~0.007)与耐多药结核病(MDR-TB)的发生有关。结论廊坊地区耐多药结核病流行严重,发生耐多药结核病(MDR-TB)的危险因素为复治和病变累计肺野≥4的病人。应加强对初治肺结核病人管理,减少复治病人,对减少耐多药肺结核病人有重要意义。

Objective To understand the characteristics and influencing factors of Mycobacterium tuberculosis resistance in Langfang, and to provide scientific basis for effective control of drug - resistant TB epidemic. Methods The drug resistance of Mycobacterium tuberculosis in Langfang 2015 was analyzed retrospectively. The sensitivity test was used to analyze the risk factors of muhidrug resistance by logistic regression. Results In 217 strains of Mycobacterium tuberculosis, the total drug resistance rate was 53.0% （115/217）, total multi drug resistant rate was 10. 1% （22/217）; drug resistance sequence from high to low was： R （33. 2% ）, H（20. 7% ）, S（14. 3% ）, E（6. 5% ）, OFX（4. 6% ）, KM（0. 9% ） ; multivariate analysis showed that the patient classification （initial or retreatment） （OR =0. 143, 95% CI： 0. 046 -0. 448） and lesion cumulative lung field were greater than or equal to 4 （OR=0.069, 95%CI： 0.069-0.007） associated with the occurrence ofMDR -TB. Conclusion The prevalence of MDR-TB in Langfang is serious. The risk factors for MDR - TB were those with recurrent and disease cumulative lung field greater than 4. It is necessary to strengthen the management of patients with primary pulmonary tuberculosis and prevent the production of retreated patients, which is of great significance to reduce the production of muhidrug - resistant tuberculosis patients.