厦门市肺结核耐药流行情况及相关因素分析  

Analysis on epidemic and relevant factors for drug-resistant tuberculosis in Xiamen city

作　　者：柯然[1] 郑蓉蓉[1] 张向东[2] 杨艺明[1] 林香莲[1] 黄成基[1] 黄巧君[1] 

机构地区：[1]厦门市疾病预防控制中心结核病防治科,361021 [2]厦门市疾病预防控制中心办公室

出　　处：《中国防痨杂志》2014年第2期93-97,共5页Chinese Journal of Antituberculosis

基　　金：福建省卫生厅青年科研课题（2011-2-73）

摘　　要：目的了解近年来厦门市肺结核患者耐药现状，分析影响耐药结核病产生的因素，以期为制定本地区行之有效的结核病防控措施提供科学的参考依据。方法采用横断面调查，对2011年7月1日至2012年6月30日在厦门市各结核病定点医院门诊登记的所有痰涂片阳性的肺结核患者共776例进行调查。收集患者的基本情况和诊疗信息。收集痰标本培养，培养阳性菌株采用比例法进行药物敏感性试验（异烟肼、利福平、链霉素、乙胺丁醇等）；采用对硝基苯甲酸（PNB）培养法鉴定结核分枝杆菌复合群。排除痰菌培养阴性，菌株污染和非结核分枝杆菌感染47例，最终获得药物敏感性试验结果的729例。利用SPSS18．0软件中非条件logistic回归模型分析结核病耐药发生的可能影响因素。结果厦门市总耐药率为27．2％（198／729），总耐多药率为9．7％（71／729），初治耐药率为23．4％（134／573），复治耐药率为41．0％（64／156），初治耐多药率为7．3％（42／573），复治耐多药率为18．6％（29／156）；对四种抗结核药物的耐药率最高的为异烟肼16．5％（120／729），最低的为乙胺丁醇6．9％（50／729）；复治患者的耐药率显著高于初治患者（X2值为19．286，P〈0．01），是耐药结核病的危险因素（OR=2．154，95％CI=1．467-3．163，Wald X^2=15．319，P〈0．001）。结论厦门市耐药结核病疫情不容乐观，复治化疗史是耐药结核病产生的重要影响因素。Objective To understand the epidemic status of drug-resistant tuberculosis （TB） in Xiamen city in the recent years, to identify the risk factors for drug-resistance and to provide scientific evidences for developing effective local policies and measures on TB control. Methods A cross sectional study was carried out. All smearpositive TB patients notified in the designated TB hospitals of Xiamen from July 1st, 2011 to Jun 30th, 2012 were enrolled in this study. The basic information, relevant medical information and sputum specimens were collected on every enrolled patient. Culture was performed on all subjects; drug susceptibility testing （DST） of 4 first-line anti TB drugs （INH, RFP, Sm, EMB） was performed using proportion method; Mycol）acterium tuberculosis （Mtb） iden tification was done using p-nitrobenzoie acid （PNB） cultivation. Unconditional logistic regression model was used with SPSS 18.0 to identify the potential risk factors for drug-resistance. Results The total number of the subjects was 776 cases. The overall drug-resistant TB （DR TB） rate in Xiamen was 27.2%（198/729）and the overall multi- dru^resistant TB （MDR-TB） rate was 9.7%（71/729）. The drug-resistance rates for initial treatment TB patients and retreatment TB patients were 23.4% （134/573） and 41.0% （64/156） respectively. The multidrug-resistance rate for initial treatment TB patients was 7.3% （42/573） and it was 18.6% （29/1,56） for retreatment TB patients. Of 4 first-line anti-TB drugs tested in this study, the INH-resistance rate was 16.5% （120/729）, ranking the first; the lowest drug-resistance rate was EMB （6.9%, 50/729）. The drug-resistance rate among retreatment TB patients was significantly higher than that among initial treatment TB patients （He = 19. 286, P〈0.01）. Previous treatment was identified as the major risk factor of drug resistance （OR=2. 154, 95%CI=1. 467--3. 163, Wald X2 =15. 319, P〈0. 001）. Conclusion The situation of drug resistant TB in Xiamen is not

关 键 词：结核 肺 流行病学 抗药性 细菌 LOGISTIC模型 厦门市 

分 类 号：R521[医药卫生—内科学]