中国五省市多次抗痨治疗结核病患者诊疗经历及其对耐药影响的研究  

Healthcare-seeking experiences of tuberculosis patients with multiple treatment history and its impact on drug-resistant tuberculosis in five provinces of China

作　　者：李倩[1] 赵琦[1] 钟球[2] 何金戈[3] 李芳[4] 马丽萍[5] 任利平 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 [2]广东省结核病防治研究所 [3]四川省疾病预防控制中心 [4]山东省胸科医院 [5]河南省疾病预防控制中心 [6]内蒙古结核病防治中心

出　　处：《中国预防医学杂志》2013年第5期329-332,共4页Chinese Preventive Medicine

基　　金：全球基金结核病实施性研究项目(TB12-007)

摘　　要：目的了解有多次抗痨治疗史的结核病患者寻求医疗服务的经历与耐药现状,分析就医行为对耐药结局的影响。方法在广东、山东、四川、河南和内蒙古等五个省、自治区分别选择一个开展耐药监测地级市的两个县(区),对前来就诊的、既往有过多次抗痨治疗史的结核病患者进行问卷调查。使用SPSS16.0软件进行χ2检验和多因素logistic回归分析,P<0.05为差异有统计学意义。结果调查328名患者,228例(69.51%)曾经接受过2次抗痨治疗,78例(23.78%)接受过3次及以上的治疗。调查对象中共有240名耐药患者,总耐药率为73.17%。在前两次治疗过程中分别有233例(71.25%)和175例(53.51%)患者接受了国家推荐的标准治疗方案,其治愈率明显高于未采用标准方案的患者(初治:χ2=27.65,P<0.01;复治:χ2=32.29,P<0.01)。研究发现,患者家庭年收入(OR=5.549,95%CI:1.712～17.986)和既往治疗次数(OR=4.618,95%CI:1.675～12.736)与耐药的发生有关。结论既往治疗史与耐药结核病的发生,尤其是MDR密切相关。家庭年收入低的患者发生耐药结核病的危险性较高。Objective To understand the experiences of previously treated TB （tuberculosis） patients seeking health services and to analyze its impact on drug-resistance TB. Methods 10 counties in Guangdong, Shan- dong, Sichuan, Henan, Neimenggu provinces were chosen and a cross-sectional study using questionnaire survey was conducted. SPSS16.0 was used for data analysis. Results Among 328 patients surveyed, 228 （69.51%） had been treated twice, 78 （23.78%） patients had been treated at least 3 times. There were 240 drug-resistant TB patients found with the resistance rate of 73.17%. 233 and 175 patients had received stand- ard regimens in the first and second treatment and the cure rate of these patients was significantly higher than those who didn＇t accept standard regimens （first treatment： x2 = 27.65, P〈0. 001; second treatment： x2= 32.29, P〈0. 001） . Multivariate analysis showed that annual household income （OR= 5. 549, 95% CI： 1. 712-17. 986） and number of treatments （OR：4. 618, 95% CI.. 1. 676-12. 736） were independent factors closely related to the occurrence of drug resistant tuberculosis. Conclusions Previous treatment for TB iscorrelated to drug-resistance, especially to MDR-TB and patients with low annual household income are at high risk of drug resistant TB.

关 键 词：结核 诊疗经历 药物耐受性 

分 类 号：R52[医药卫生—内科学]