肺结核患者结核杆菌耐药情况及耐多药结核病的危险因素

Drug resistance of Mycobacterium tuberculosis and risk factors of multidrug-resistant tuberculosis in patients with pulmonary tuberculosis

目的明确肺结核患者的耐药情况,探索耐多药结核病(MDR-TB)的危险因素,为MDR-TB的防治提供依据。方法收集肺结核患者468例,分为初治患者365例和复治患者103例。采用比例法检测结核分枝杆菌对抗结核药物的敏感性。应用单因素及多因素logistic回归分析MDR-TB发生的危险因素。结果468例患者的总耐药率、耐多药率和广泛耐药率分别为25.85%、11.97%、3.21%。复治患者总耐药率(49.51%)、耐多药率(34.95%)和广泛耐药率(10.68%)高于初治患者(分别为19.18%、5.48%、1.10%),差异均有统计学意义(P<0.05)。6种抗结核药中,总体耐药顺位由高至低依次为:异烟肼(INH)>利福平(RFP)>氧氟沙星(OFX)>乙胺丁醇(EMB)>链霉素(SM)>卡那霉素(KM)。单因素及多因素logistic回归分析显示,居住农村(OR=2.316,95%CI:1.604~5.118)、复治(OR=6.150,95%CI:4.728~13.824)、有结核空洞(OR=3.219,95%CI:2.405~8.627)、治疗过程中断(OR=5.826,95%CI:4.610~12.507)及首次治疗未联合用药(OR=2.508,95%CI:1.813~5.646)是MDR-TB的危险因素。结论肺结核患者耐药率较高,影响MDR-TB发生的危险因素较多,需积极采取干预措施,控制MDR-TB的发生。

Objective To clarify the drug resistance of patients with pulmonary tuberculosis,explore the risk factors for multidrug-resistant tuberculosis(MDR-TB),and provide basis for the prevention and treatment of MDR-TB.Methods 468 patients with pulmonary tuberculosis were collected,including 365 newly treated patients and 103 retreated patients.Susceptibility of Mycobacterium tuberculosis to antituberculous drugs was detected by proportion method.Univariate analysis and multivariate logistic regression analysis were adopted to analyze the risk factors for MDR-TB.Results The overall drug resistance rate,multidrug resistance rate and extensive drug resis-tance rate of 468 patients were 25.85%,11.97%,and 3.21%,respectively.The overall drug resistance rate,multi-drug resistance rate and extensive drug resistance rate in retreated patients were all significantly higher than those in newly treated patients(49.51%vs 19.18%;34.95%vs 5.48%;10.68%vs 1.10%,respectively,all P<0.05).The overall drug resistance from high to low was as follows:isoniazide(INH)>rifampicin(RFP)>oxfloxacin(OFX)>ethambutol(EMB)>streptomycin(SM)>kanamycin(KM).Univariate and multivariate logistic regression analysis showed that living in rural areas(OR=2.316,95%CI:1.604-5.118),retreatment(OR=6.150,95%CI:4.728-13.824),tuberculosis cavity(OR=3.219,95%CI:2.405-8.627),treatment interruption(OR=5.826,95%CI:4.610-12.507)and initial treatment without combined medication(OR=2.508,95%CI:1.813-5.646)were risk factors for the occurrence of MDR-TB.Conclusion Drug resistance rate of pulmonary tuberculosis patients is high,and there are multiple risk factors affecting the occurrence of MDR-TB,active intervention mea-sures should be taken to control the occurrence of MDR-TB.