486例肺结核患者一线抗结核药物耐药及危险因素分析

Analysis of first-line anti-tuberculosis drug resistance and risk factors in 486 patients with pulmonary tuberculosis

目的 分析486例肺结核患者一线抗结核药物耐药及产生耐药的危险因素。方法 收集2021年1月至2022年6月丽水市中医院结核病实验室486株结核分枝杆菌复合群菌株对链霉素、异烟肼、利福平、乙胺丁醇4种一线抗结核药物敏感性结果,回顾性分析患者一线抗结核药物耐药及产生耐药的危险因素。结果 486株结核分枝杆菌复合群菌株中,364株(74.90%)对4种抗结核药物均敏感,122株(25.10%)耐药菌株中,单耐药50株(10.29%),多耐药28株(5.76%),耐多药44株(9.05%),耐药率从高到底分别为异烟肼、链霉素、利福平、乙胺丁醇;初治患者耐药率21.13%(90/426),复治患者耐药率53.33%(32/60);复治及合并糖尿病患者总耐药率较高,差异有统计学意义(P<0.05);根据多因素Logistic回归分析结果显示,复治、有糖尿病及年龄≤30岁的患者更容易发生耐药。结论 一线抗结核药物耐药率较高,复治肺结核、糖尿病病史、年龄≤30岁是患者发生耐药的危险因素。

Objective To analyze the first-line anti-tuberculosis drug resistance of 486 patients with tuberculosis and the risk factors of drug resistance.Methods The sensitivity results of 486 strains of Mycobacterium tuberculosis complex group strains to four first-line anti-tuberculosis drugs(streptomycin,isoniazid,rifampicin and ethambutol)in tuberculosis laboratory of Lishui Traditional Chinese Medicine Hospital from January 2021 to June 2022 were collected.The drug resistance of patients with first-line anti-tuberculosis drugs and the risk factors of drug resistance were retrospectively analyzed.Results Among 486 strains of Mycobacterium tuberculosis complex group,364 strains(74.90%)were sensitive to four kinds of anti-tuberculosis drugs,122 strains(25.10%)were drug-resistant,50 strains(10.29%)were single drug resistant,28 strains(5.76%)were poly-drug resistant,and 44 strains(9.05%)were multidrug-resistant.The drug resistance rates from high to low were isoniazid,streptomycin,rifampicin and ethambutol.The drug resistance rate was 21.13%(90/426)in initial treatment and 53.33%(32/60)in retreatment.The total drug resistance rate of patients with retreatment and combined diabetes was higher,and the difference was statistically significant(P<0.05).According to the results of multivariate Logistic regression analysis,patients with retreatment,diabetes and age≤30 years were more likely to develop drug resistance.Conclusion The rate of resistance to first-line anti-tuberculosis drugs is high,and the risk factors for drug resistance are retreated tuberculosis,diabetes history and age≤30 years old.