我国东部农村五县耐药结核病流行及其社会学和生物学的危险因素  

Prevalence of drug-resistant tuberculosis and its social and biological risk factors in five rural counties of easternChina WULin

作　　者：吴琳琳[1] 胡屹[1] 赵琦[1] 王伟炳[1] 徐飚[1] 

机构地区：[1]复旦大学公共卫生学院流行病学教研室,教育部公共卫生安全重点实验室,上海200032

出　　处：《中华传染病杂志》2011年第12期729-734,共6页Chinese Journal of Infectious Diseases

基　　金：国家自然科学基金资助项目（30771843）;青年科学基金项目（30901223）;上海市重点学科建设项目（B118）

摘　　要：目的了解我国东部农村五县耐药结核病的流行水平，分析影响耐药结核病流行的生物、人口和社会学危险因素。方法以我国东部山东省、江苏省和浙江省农村地区5个县（区）结核病防治所2008年至2009年登记的所有初治和复治的结核病患者为研究对象，收集痰标本、培养分离菌株，并进行问卷调查；对培养获得的结核菌株采用比例法进行一线抗结核药物（利福平、异烟肼、乙胺丁醇和链霉素）的药物敏感试验。以Mantel—Haenszel卡方检验、Fisher精确概率法、方差分析以及非条件Logistic回归方法分析资料。结果在获得的380株结核菌株中，共有105株为耐药菌株，总耐药率为27．6％。初始耐多药结核病率和获得性耐多药结核病率分别为8．4％和23．3％。对研究对象所在区县、性别进行调整后发现，患者即往治疗史（OR-一3．900，95％CI：1．737～8．704）、肺部空洞（OR-1．987，95％CI：1．001～3．942）以及年龄较大（OR一1．020，95％CI：1．010～1．045）与耐多药结核病发生有关。结论我国东部沿海地区结核病患者的耐药结核病和耐多药结核病患病率高于国际平均水平，但低于国内平均水平。既往治疗史和肺部空洞与耐多药结核病发生有关，年龄较大的结核病患者发生耐多药结核病的危险性较高。Objective To investigate the epidemiology of drug resistant tuberculosis （Tt3） in five rural counties of eastern China and analyze the biological, demographic and social risk factors. Methods Subjects of this study were all the diagnosed TB patients registered in the five study sites in Shandong Province, Jiangsu Province and Zhejiang Province during one year of 2008-2009. Questionnaire interview was conducted in all the subjects to acquire the socio-dernographic and clinical information. Sputum samples were collected for culturing and isolating of Mycobacterium tuberculosis （M. TB） strains. All the M. TB isolates were further tested for the susceptibility to first line drugs including rifampin, isoniazid, ethambutol and strepomycin by proportion method. Mantel-Haenszel chi-square test, Fisher＇s exact test, ANOVA and nonconditional Logistic regression modeling were applied for data analysis. Results Among the total 380 M. TB isolates, 105 were resistant to at least one of the first-line drugs. The total drug resistant TB prevalence was 27. 6%. Multidrug-resistant tuberculosis （MDR-TB） was observed in 8.4~ of newly treated TB patients, whereas it was 23.3% in previously treated TIA patients. After adjusted by county, gender and age of the subjects,multivariate analysis showed that previous treatment history （OR=3.900, 95%CI： 1.737-8.704）, tuberculosis cavity （OR = 1. 987, 95 % CI： 1. 001- 3. 942） were independent factors influencing the occurrence of MDR TB. Conclusions The prevalence of drug resistant TB in rural area of eastern China is relatively low compared with the average level in China, while it is still higher than the global average level. The present study highlights that TB patients with previous treatment history, cavitary- TB are correlated with MDR-TB, and elderlv patients are at hieh risk of MDR-TR

关 键 词：耐药结核病 农村地区 危险因素 生物学 社会学 Logistic回归方法 耐多药结核病 结核病患者 

分 类 号：R52[医药卫生—内科学]