云南省各地州复治结核病患者对一线抗结核药物的耐药情况及相关因素分析

First-line Anti-tuberculosis Drug Resistance and Related Factors in Retreated Tuberculosis Patients in Different Prefectures of Yunnan Province

目的探讨云南省各地州结核病复治患者对一线抗结核药物的耐药性及其影响因素。方法收集2012-01/2018-12昆明市第三人民医院收治的云南省各地州结核病复治患者标本培养分离的结核分枝杆菌280株,并进行链霉素(SM)、异烟肼(INH)、利福平(RIF)、乙胺丁醇(EMB)的药敏试验,采用SPSS 19.0软件,计数资料采用率进行描述分析,影响因素分析采用单因素x^2分析及多因素Logistic回归分析,以P<0.05表示差异有统计学意义。结果 280株中对一线抗结核药物耐药的有160株,总耐药率为57.1%,耐多药率为36.1%。对一线抗结核药物的耐药率由高到低依次为INH(47.1%)、RIF(41.1%)、SM(32.1%)、EMB(17.5%)。流动户籍(OR=1.709,95%CI:1.055~2.768)、未规律用药(OR=2.424,95%CI:1.102~5.329)是结核病复治患者耐药的危险因素。结论云南省各地州结核病病复治患者对一线抗结核药物的耐药疫情严峻,需加强耐药性监测,重点关注流动人口及规律用药的监管。

Objective To investigate the first-line anti-tuberculosis drug resistance and influencing factors in retreated tuberculosis patients in Yunnan provinces.Methods From January 2012 to December 2018,280 strains of Mycobacterium tuberculosis were isolated from the sample collected from the retreated tuberculosis patients in Yunnan Province.The drug sensitivity tests of streptomycin(SM),isoniazid(INH),rifampicin(RIF)and ethambutol(EMB)were carried out.All the data was analyzed by SPSS 19.0 software.Descriptive analysis was used to show the rate of counting,and the influencing factors were analyzed by using single factorχ~2 analysis and multivariate logistic regression analysis.When P<0.05,the difference was statistically significant.Results Among the280 strains,160 were resistant to first-line antituberculosis drugs,with a total resistance rate of 57.1%,and the multi-drug resistance rate was 36.1%.The drug resistance rates of first-line anti-tuberculosis drugs from high to low were INH(47.1%),RIF(41.1%),SM(32.1%)and EMB(17.5%).Floating household registration(OR=1.709,95%CI:1.055~2.768)and irregular drug use(OR=2.424,95%CI:1.102~5.329)were the risk factors of drug resistance in patients with retreatment of tuberculosis.Conclusion The epidemic situation of first-line anti-tuberculosis drug resistance among retreated tuberculosis patients in various prefectures of Yunnan Province is severe.It is necessary to strengthen drug resistance monitoring,focusing on the supervision of floating population and regular drug use.