6765例结核分枝杆菌培养阳性肺结核患者耐药及共病分析

Analysis of drug resistance and comorbidity in 6765 patients with culture positive pulmonary tuberculosis

目的了解青岛地区肺结核患者的耐药及共病情况,为青岛地区结核病防控和耐药结核病的管理提供科学依据。方法回顾性研究2016年9月至2021年3月期间青岛市胸科医院住院或门诊临床诊断为肺结核患者的相关资料,通过痰或肺泡灌洗液标本进行痰涂片和培养结核分枝杆菌阳性,同时进行实验室药物敏感试验,依据检测结果将被确诊的6765例肺结核患者分为耐多药/利福平耐药组和对照组(药物敏感肺结核),计算两组共病指数(CCI),分析两组患者的耐药相关因素和合并疾病。结果耐多药/利福平耐药346例患者,药物敏感肺结核例6419例。青岛地区肺结核患者的耐药性与结核病治疗史分类(χ^(2)=47.165,P<0.001)、年龄(χ^(2)=62.531,P<0.001)、地区(χ^(2)=12.671,P<0.001)、高共病相关(χ^(2)=20.983,P<0.001);乡村地区耐多药/利福平耐药患者更易合并高共病。合并疾病从高到低依次为糖尿病、高血压、肺心病、精神类疾病、恶性肿瘤、HIV感染。耐多药/利福平耐药组合并糖尿病(χ^(2)=20.142,P<0.001)、精神类疾病(χ^(2)=6.266,P=0.012)、恶性肿瘤(χ^(2)=6.266,P=0.012)、HIV感染患者(χ^(2)=4.335,P=0.037)均较对照组比例高。结论耐多药/利福平耐药肺结核高危因素为复治、乡村地区、老龄和高共病。耐多药/利福平耐药肺结核患者中高共病占比较对照组高,应加强对高共病患者的干预,从而提高耐多药患者的治愈率。

Objective To investigate the drug resistance and comorbidity of pulmonary tuberculosis patients in Qingdao,and provide scientific basis for the prevention and control of tuberculosis and the management of drug-resistant tuberculosis.Method A retrospective study was conducted on the relevant with pulmonary tuberculosis diagnosed clinically in or out of the Qingdao Thoracic Hospital from September 2016 to March 2021.The sputum smear and culture of the patients with sputum or alveolar lavage fluid were positive.At the same time,the laboratory drug sensitivity test was carried out.According to the test results,6765 patients with pulmonary tuberculosis diagnosed were divided into multi drug/rifampicin resistant group and drug sensitive pulmonary tuberculosis as the control group.The Charlson comorbidity index(CCI)of the two groups was calculated,The drug resistance related factors and comorbidity of the two groups were analyzed.Result Which 346 cases were multidrug/rifampicin resistant and 6419 cases were drug sensitive pulmonary tuberculosis.Drug resistance of pulmonary tuberculosis patients and classification of tuberculosis treatment history(χ^(2)=47.165,P<0.001),age(χ^(2)=62.531,P<0.001),region(χ^(2)=12.671,P<0.001)and high comorbidity(χ^(2)=20.983,P<0.001);MDR/rifampicin resistant patients in rural areas are more likely to be complicated with high comorbidities.The incidence of diabetes from high to low was diabetes,hypertension,pulmonary heart disease,mental illness,malignant tumors and HIV infection.Multidrug resistant/rifampicin resistant combinations were higher than those of non resistant groups in diabetes(χ^(2)=20.142,P<0.001),mental disorders(χ^(2)=6.266,P=0.012),malignant tumors(χ^(2)=6.266,P=0.012)and HIV infection(χ^(2)=4.335,P=0.037).Conclusion The high risk factors of MDR/rifampicin resistant pulmonary tuberculosis are retreatment,rural areas,aging and high comorbidity.The proportion of high comorbidity in MDR/rifampicin resistant pulmonary tuberculosis patients is higher than that in the control group.We should strengthen the intervention of high comorbidity patients,so as to improve the cure rate of MDR patients.