我国耐药结核病的危险因素——2007年全国结核病耐药基线调查资料分析  

Risk factors for drug-resistant tuberculosis in China: analysis of the results of the national drug resistant tuberculosis baseline survey in 2007

作　　者：王胜芬[1] 赵冰[1] 宋媛媛[1] 周杨[1] 欧喜超[1] 李强[1] 夏辉[1] 逄宇[1] 端木宏谨[2] 傅瑜[2] 赵雁林[1] 

机构地区：[1]中国疾病预防控制中心结核病预防控制中心,北京102206 [2]北京市结核病胸部肿瘤研究所

出　　处：《中国防痨杂志》2013年第4期221-226,共6页Chinese Journal of Antituberculosis

基　　金："十一五"国家重大科技专项(2008ZX-10003-009)

摘　　要：目的探索新登记、复治患者发生耐药、耐多药结核病的危险因素。方法2007年4—12月中国进行了全国结核病耐药基线调查,调查覆盖全国31个省、自治区和直辖市,以省分层,采用多阶段整群抽样方法从全国结核病防治系统中随机抽取70个调查点,调查期间每个调查点纳入新登记涂阳新患者51例和复治患者17例。临床医师采用信息表收集患者的相关信息,通过当面询问患者填写治疗史信息,如有可能查阅患者医疗记录进行确认,治疗信息的准确性经另一位临床医师再次询问患者进行复核。采用比例法进行药敏试验,检测药物包括异烟肼、利福平、链霉素、乙胺丁醇、卡那霉素和氧氟沙星。结果多因素分析结果表明,对于新登记、治疗时间少于1个月(OR=1.6,95%CI=1.1～2.1)发生耐药结核病的风险较高;而女性(OR=1.4,95%CI=1.0～2.1)和进行过结核病药物治疗(OR=2.4,95%CI=1.5～3.7)是发生耐多药结核病的危险因素。对于复治患者,女性(OR=1.7,95%CI=1.1～2.7)、既往有过2次及以上治疗且最近1次在结核病专科医院治疗(OR=4.0,95%CI=1.2～14.0)发生耐药结核病的风险较高;而女性(OR=2.3,95%CI=1.5～3.6)、生活在实施DOTS较晚(2000年以后)的地区(OR=1.7,95%CI=1.2～2.4)、既往有过2次及以上治疗且最近1次在结核病专科医院外的其他医疗机构治疗(OR=3.3,95%CI=2.1～5.2)、既往有过2次及以上治疗且最近1次在结核病专科医院治疗(OR=13.0,95%CI=3.9～46.0)是产生耐多药结核病的危险因素。结论进行过结核病治疗的新登记产生耐药、耐多药结核病的风险较高;患者为女性、既往有过2次及以上的结核病治疗史是复治患者产生耐药、耐多药结核病的危险因素。[Abstract] Objective The aim of our study was to identify risk factors associated with drug resistant tuber- culosis（T]3） and Multidrug-resistant TB （MDR-TB） in new and retreatment cases. Methods A national drug re- sistance TB baseline survey was carried out from April 2007 to December 2007, the survey with multistage cluster sampling, stratified by provinces, was conducted in 31 provinces, autonomous regions and municipalities directly under the central government. Seventy clusters representative of the tuberculosis prevention and control system of the country were randomly selected, eligible new diagnosed smear-positive tuberculosis patients including 51 new cases and 17 retreatment patients were recruited into each cluster during the survey. Relevant data of the patients were collected by physician through questionnaire. The patients were asked about the history of treatment through face-to-face interview; if possible, patients~ medical records were reviewed to validate the information. The accuracy of treatment history was confirmed by another physician through re-interviewing. Drug susceptibility testing to isoniazid, rifampicin, streptomycin, etharnbutol, kanamycin and ofloxacin was performed on L/Swenstein-Jensen （L-J） medium according to the proportion method. Results The multivariate analysis results showed that new cases who had TB treatment for less than one month（OR= 1.6, 95% CI= 1.1- 2.1 ）were significantly more likely to have drug resistant TB~ while female gender （OR=I. 4, 95% CI= 1.0--2. l）and TB treatment （OR=2.4, 95% CI 1.5-3.7）were independent risk factors for the presence of MDRTB in new cases. Retreatment patients who were female gender（OR=l. 7, 95% CI=1. 1--2. 7）, who had previously been treated for TB for more than 2 times and the last treatment was provided by TB hospital （OR=4.0, 95% CI= 1.2--14.0）were significantl, y more likely to have drug resistant-TB. While female gender（OR=2.3, 950/oo CI=1.5--3.6）, live in area with later IDTS imple mentation （

关 键 词：结核 抗多种药物性 抗药性 细菌 危险因素 性别因素 抽样研究 

分 类 号：R52[医药卫生—内科学]