2014-2017年辽阳市肺结核患者耐药状况分析

Analysis of drug resistance of tuberculosis patients in Liaoyang from 2014 to 2017

目的分析辽阳市结核病耐药状况及影响因素,为进一步制定相关防控策略提供依据。方法待检菌株均来源于2014-2017年辽阳市疾病预防控制中心,由辽宁省疾控中心结防所进行药敏实验和菌型鉴定。最终纳入结核分枝杆菌341株(97.71%),非结核分枝杆菌8株(2.29%)。结果分析应用χ^(2)、χ^(2)_(耐药趋势)检验及二元Logistic回归进行分析,检验水准α=0.05。结果2014-2017年辽阳市总耐药率、总耐多药率、总多耐药率和总广泛耐多药率分别为31.96%(109/341)、9.97%(34/341)、6.16%(21/341)和0.59%(2/341),其中总耐药率、总多耐药率和总广泛耐多药率呈现下降趋势(χ^(2)_(耐药趋势)=5.777,χ^(2)_(耐药趋势)=10.260,χ^(2)_(耐药趋势)=4.615,P<0.05)。异烟肼的复治耐药率为31.37%(32/102)(χ^(2)_(初治趋势)=7.217,P<0.01),链霉素的总耐药率15.19%(62/341)、初治耐药率14.64%(35/239)、复治耐药率26.47%(27/102)分别呈下降趋势(χ^(2)_(初治趋势)=26.287,χ^(2)_(复治趋势)=9.447,χ^(2)_(复治趋势)=16.310,P<0.01)。单耐药以单耐利福平和链霉素为主,耐药率分别为6.45%(22/341)和7.04%(24/341);耐2种药以H+S为主,耐药率为4.99%(17/341);耐3种药以R+H+S为主,耐药率为3.23%(11/341);耐4种药以R+H+S+E为主,耐药率为2.35%(8/341),其中R+H、R+H+S+E的组合耐药率差异有统计学意义(χ^(2)=6.448、7.994,P<0.05)。Logistic回归分析结果显示,复治患者与初治患者相比更容易产生耐药性(OR=0.264,95%CI:0.241~0.680,P<0.05)和耐多药性(OR=0.479,95%CI:0.031~0.205,P<0.05);不同年龄、不同性别对耐药率的影响差异无统计学意义(P>0.05)。结论辽阳市结核病耐药情况在国内处于中等水平,且呈逐年下降趋势,显示辽阳市对耐药结核病的管理防控效果显著。

Objective To analyzed the status and risk factors of drug-resistance tuberculosis in Liaoyang,providing a basis for the further development of relevant prevention and control strategies.Methods All strains to be tested were from the Center for Disease Control and Prevention of Liaoyang from 2014 to 2017 and were subjected to drug-sensitivity testing and strain identification by the Liaoning CDC Tuberculosis Control Institute.341 strains of mycobacterium tuberculosis(97.71%)and 8 strains of non-mycobacterium tuberculosis(2.29%)were included.The count data were analyzed byχ^(2),χ^(2)_(resistance trend)test and Logistic regression analysis,and the test level was 0.05.Results The total drug resistance rate,total multidrug resistance rate,total multiple drug resistance rate and total extensive multidrug resistance rate of tuberculosis in Liaoyang from 2014 to 2017 were 31.96%(109/341),9.97%(34/341),6.16%(21/341)and 0.59%(2/341),respectively,of which the total drug resistance rate,total multiple drug resistance rate and total extensive multidrug resistance rate showed a downward trend(χ^(2)_(resistance trend)=5.777,χ^(2)_(resistance trend)=10.260,χ^(2)_(resistance trend)=4.615,P<0.05).The resistance rate of the retreatment of isoniazid was 31.37%(32/102)(χ^(2)_(resistance trend)=7.217,P<0.01).The total drug resistance rate,resistant rate of initial treatment and resistant rate of the retreatment of streptomycin were 15.19%(62/341),14.64%(35/239)and 26.47%(27/102),respectively,all above of them showed a downward trend(χ^(2)_(resistance trend)=26.287,χ^(2)_(resistance trend)=9.447,χ^(2)_(resistance trend)=16.310,P<0.01).Single drug resistance was dominated by rifampicin and streptomycin,with drug resistance rates of 6.45%(22/341)and 7.04%(24/341),respectively.The two-drug resistant combinations were dominated by H+S,with a resistance rate of 4.99%(17/341).R+H+S was the dominant drug resistance of the three-drug combinations,with a resistance rate of 3.23%(11/341).R+H+S+E was the dominant drug resistance of the four-drug combinations,with a resistance rate of 2.35%(8/341).Among them,the difference in the combined resistance rate of R+H,R+H+S+E was statistically significant(χ=6.448,7.994,P<0.05).The results of Logistic regression analysis showed that compared with the initial treatment patients,the retreatment patients were more likely to develop drug resistance(OR=0.264,95%CI:0.241-0.680,P<0.05)and multi-drug resistance(OR=0.479,95%CI:0.031-0.205,P<0.05).There was no statistically significant difference in the effect of age and gender on the drug resistance rate(P>0.05).Conclusion The drug resistance status of tuberculosis is at a medium level in Liaoyang,showing a downward trend year by year.It shows that the management and prevention of drug-resistant tuberculosis in Liaoyang is effective.