复治涂阳肺结核患者耐药危险因素探讨  

Research on risk factors of anti-tuberculosis drug resistance of previous treated patients with pulmonary tuberculosis

作　　者：赵锦明[1,2] 黄曙海[1] 刘飞鹰[1] 蓝如束[1] 罗丹[1] 蓝兰[1] 区进[1] 张影坤[1] 

机构地区：[1]广西壮族自治区疾病预防控制中心结核病防制所,广西南宁530028 [2]广西医科大学公共卫生学院职业卫生与环境卫生学教研室,广西南宁530021

出　　处：《现代预防医学》2014年第17期3211-3214,3220,共5页Modern Preventive Medicine

基　　金：广西壮族自治区科技攻关项目(桂科攻1140003A-36)

摘　　要：目的探索广西复治涂阳肺结核患者耐药产生的危险因素。方法利用2010-2011年广西结核病耐药性监测数据,统计359例复治涂阳肺结核患者的社会和既往临床诊疗信息、患者痰标本对异烟肼、利福平、乙胺丁醇、链霉素、卡那霉素及氧氟沙星等6种药物的敏感性试验结果,通过logisitic回归法分析患者耐药相关的危险因素。结果多因素逐步回归分析结果显示,女性（OR=1.988）、少数民族（OR=1.538）、接受过2次以上抗结核治疗（OR=4.352）及不联合用药（OR=2.257）等因素可能会导致患者耐药风险增加。40～59岁年龄组（OR=2.855）、低收入家庭（OR=10.846）、接受过2次以上抗结核治疗（OR=5.570）、登记为复发（OR=5.570）或初治失败（OR=14.935）等因素可能是耐多药产生的危险因素。结论女性、40～59岁、少数民族、低收入家庭、多次治疗及不联合用药等因素可能是广西复治患者耐药或耐多药的主要危险因素。Objective To explore risk factors of anti-tuberculosis drug resistance of previous treated patients with pulmonary tuberculosis（TB） in Guangxi. Methods Data on both socioeconomic status and clinic history were collected from 359 previous treated patients with smear positive TB. All patients were recruited in a prospective surveillance of drug resistance from 2011 to 2012 in Guangxi. Sputum specimens were cultivated and then isolates of Mycobacterium tuberculosis were subjected to drug susceptibility test（DST） for isoniazid, rifampicin, ethambutol, streptomycin, kanamycin and ofloxacin. Multi-variable logistic regressions were performed among patient＇s data of socioeconomic status/clinic history and results of DST. Results Higher trends of drug resistance were found in patients with one or more characteristics such as female（OR=1.988）, Zhuang nationality（OR=1.538）, received TB treatment more than one course（OR=4.352）, previous treatment with atypical regimens（OR=2.257）. Higher trends of multi-drug resistance（MDR, resistant at least to both isoniazid and rifampicin） were found in patients with one or more characteristics such as age of 40 to 59（OR=2.855）, low income family（OR=10.846）, received treatment of TB more than once（OR=5.570）, registered category of relapse（OR=5.570） or initial treatment failure（OR=14.935）. Conclusion It is suggested that female, 40-59 years old,Zhuang nationality, TB treatment more than once, treatment with atypical regimens, low income family, as well as registered category of relapse or initial treatment failure are likely to be risk factors contributing to drug resistance and/or MDR among previous treated TB patients in Guangxi.

关 键 词：肺结核 复治患者 耐药 危险因素 LOGISTIC回归分析 

分 类 号：R181.35[医药卫生—流行病学]