杭州市余杭区结核病患者耐药特点及其影响因素分析

Drug resistance characteristics and influencing factors of tuberculosis patients in Yuhang District of Hangzhou City

目的初步了解杭州市余杭区结核病患者耐药特点,分析其影响因素。方法以2011年1月—2021年12月杭州市余杭区第二人民医院、第三人民医院门诊收治的痰标本培养阳性778例结核病患者为调查对象,检测其对一线抗结核药物耐药情况,采用单因素及多因素logistic回归分析其结核分枝杆菌耐多药的影响因素。结果778例患者中检出结核分枝杆菌725株(93.19%)。单耐药率由高到低依次为INH、SM、RFP、EMB,合计单药耐药率为12.14%(88/725),合计耐多药率为8.00%(58/725),合计多耐药率为4.41%(30/725)。多因素非条件logistic回归结果显示,年龄≥65岁、居住地为农村、户籍为流动人口、有结核病接触史、复治、有结核空洞、治疗过程存在中断是该地区结核病患者结核分枝杆菌耐多药的风险因素(P<0.05)。结论杭州市余杭区结核病患者耐多药率处于较高水平;结核分枝杆菌耐多药的发生受多种因素影响,需加大结核病相关知识宣传力度、强化医院合理用药以降低耐药率。

Objective This paper aims to investigate the characteristics of drug resistance in tuberculosis patients in Yuhang District of Hangzhou City and analyze its influencing factors.Methods A total of 778 tuberculosis patients with positive sputum culture admitted to outpatients of the Second People's Hospital of Yuhang District and the Third People's Hospital of Yuhang District were selected as the subjects from January 2011 to December 2021.The resistance to first-line antituberculosis drugs was detected,and the influencing factors of multidrug resistance of Mycobacterium tuberculosis were analyzed by univariate and multivariate logistic regression.Results Mycobacterium tuberculosis was detected in 725 strains(93.19%)of the 778 patients.The single drug resistance rate from high to low was INH,SM,RFP and EMB,the total single drug resistance rate was 12.14%(88/725),the total multi-drug resistance rate was 8.00%(58/725),and the total multi-drug resistance rate was 4.41%(30/725).Single factor and multivariate logistic regression analysis showed that age≥65 years old,rural areas,floating population,tuberculosis contact history,relapse,tuberculosis cavity,and interruption of treatment were risk factors for MTB resistance(P<0.05).Conclusion The multidrug resistance rate of TB patients in Yuhang District of Hangzhou City is at a high level.The occurrence of multidrug-resistant Mycobacterium tuberculosis is affected by many factors.It is necessary to intensify publicity on tuberculosis related knowledge and strengthen rational drug use in hospitals to reduce the rate of drug resistance.