耐药肺结核高危人群左氧氟沙星耐药情况及其logistic回归分析

Levofloxacin resistance in high-risk population of drug-resistant pulmonary tuberculosis and its logistic regression analysis

目的分析耐药肺结核高危人群左氧氟沙星耐药情况及左氧氟沙星耐药的影响因素,为耐药结核病防控提供参考。方法选取2018年1月-2020年12月在河北省胸科医院就诊的182例耐药肺结核高危患者为研究对象,统计左氧氟沙星耐药率,并通过单因素、多因素分析左氧氟沙星耐药的影响因素。结果182例耐药肺结核高危患者中40例出现左氧氟沙星耐药,占比21.98%,其中耐多药25例(62.50%),多耐药9例(22.50%),一线药物均敏感5例(12.50%),一线药物单耐药1例(2.50%);左氧氟沙星耐药患者病程、左氧氟沙星应用时间长于非左氧氟沙星耐药患者,空洞及复治占比、双肺受累野数多于非左氧氟沙星耐药患者,差异均有统计学意义(P<0.05);经多因素Logistic回归模型分析发现,空洞、治疗情况、左氧氟沙星应用时间、双肺受累野数、左氧氟沙星剂量是左氧氟沙星耐药的影响因素(P<0.05)。结论耐药肺结核高危人群左氧氟沙星耐药率较高,主要受空洞、治疗情况、左氧氟沙星应用时间、双肺受累野数等因素影响,临床可据此加强耐药结核病防控。

Objective To analyze the status of levofloxacin resistance in high-risk groups of drug-resistant tuberculosis and the influencing factors of levofloxacin resistance,so as to provide references for the prevention and control of drug resistant tuberculosis.Methods A total of 182 high-risk patients with drug-resistant pulmonary tuberculosis in the hospital from January 2018 to December 2020 were selected.The rate of levofloxacin resistance was counted,and the influencing factors of levofloxacin resistance were analyzed by univariate and multivariate analysis.Results During the 182 high-risk drug-resistant tuberculosis people,40 cases developed levofloxacin resistance,accounting for 21.98%,of which 25 cases were multidrug resistant(62.50%),9 cases were multidrug resistant(22.50%),and 5 cases were sensitive to first-line drugs(12.50%),1 case(2.50%)with single-drug resistance to first-line drugs;the course of levofloxacin resistance,levofloxacin application time was longer than that of non-levofloxacin resistant patients,the proportion of cavities and retreatment,and the number of involved lung fields were more than those of non-levofloxacin resistant patients(P<0.05);multivariate logistic regression model analysis found that cavity,treatment status,application time of levofloxacin,number of involved fields in both lungs,and Levofloxacin dosage were the influencing factors of levofloxacin resistance(P<0.05).Conclusion The resistance rate of levofloxacin in the high-risk population of drug-resistant tuberculosis is relatively high,which is mainly affected by factors such as cavitation,treatment status,application time of levofloxacin,and the number of involved fields in both lungs.Clinically,the prevention and control of drug-resistant tuberculosis can be strengthened accordingly.