无锡市城区登记肺结核患者一线抗结核药物耐药特征和相关因素分析  

The drug-resistant characteristics of first line anti-tuberculosis drugs and its related factors among patients with pulmonary tuberculosis registered in Wuxi City

作　　者：黄捷晖[1] 沈小芳 郑建[1] 白金梅[1] 刘君[1] 高爱霞[1] 

机构地区：[1]无锡市第五人民医院,江苏无锡214007

出　　处：《现代预防医学》2015年第3期530-532,共3页Modern Preventive Medicine

摘　　要：目的分析2011-2012年无锡市城区登记的肺结核患者的耐药情况和相关因素。方法 2011-2012年无锡市城区结核病防治机构登记的所有初治和复治肺结核患者,对痰结核菌培养阳性的标本进行一线抗结核药物(异烟肼,利福平,链霉素,乙胺丁醇)体外敏感试验,分析耐药结果。将患者性别、既往化疗史、糖尿病与肺结核耐药发生的关系用非条件Logistic多因素回归分析。将患者的年龄分布与肺结核耐药发生的关系用非条件Logistic单因素分析。结果2011-2012年无锡市城区共登记痰培养阳性的肺结核患者总耐药率14.9%,耐多药率4.7%,原发性耐药率11.5%,原发性耐多药率2.5%,获得性耐药率26.8%,获得性耐多药率13.4%。对一线抗结核药物的耐药顺位依次是:利福平,链霉素,异烟肼,乙胺丁醇。既往结核病治疗史患者发生耐药的危险约是无结核病治疗史患者的3.5倍,70岁以上的老年患者比低年龄患者更易产生耐药(OR=1.191)。结论本地区耐药结核病的流行处于国内较低水平。但是耐多药率,尤其是获得性耐多药率仍处于较高水平,利福平耐药是本地区一线抗结核药物耐药首位,既往结核病治疗史是产生结核病耐药的高危因素,老年结核病的防治重点是增加患者治疗的依从性。Objective To investigate the factors associated with drug-resistant characteristics of patients with pulmonary tuberculosis registered in Wuxi City from 2011 to 2012. Methods First-line anti-tuberculosis drug sensitive test in vitro chemotherapy sensitivity test（isoniazide, rifampicin, streptomycin and ethambutol） were taken for the patients with pulmonary tuberculosis registered in Wuxi City, showing positive results on Phlegm cultivation of n/med tuberculosis bacterium. We analyzed the results of drug resistance. The relations between gender, history of previous chemotherapy, diabetes and tuberculosis patients with drug-resistant were analyzed by multivariate logistic regression analysis. The relationship between the age distribution and drug-resistant tuberculosis patients was analyzed by simple logistic regression analysis. Results Total drug-resistant rate was 14.9%in tuberculosis patients with positive sputum culture. The resistant rates of multi-drug, primary drug, primary multi-drug, acquired drug and acquired multi-drug were 4.7%, 11.5%, 2.5%, 26.8% and 13.4%, respectively. The resistant rank of the first-line anti-tuberculosis drug was rifampicin, streptomycin, isoniazide and ethambutol. Patients with previous history of tuberculosis treatment had higher risk of resistance, and the risk was 3.5 times that of non-treatment patients. Patients over 70 years were easier to produce drug resistance than younger patients（OR=1.191）. Conclusion The local prevalence of drug-resistance for tuberculosis was at a lower level. Rifampin was the first first-line drug showing drug resistance in this area. Previous treatment history is a risk factor for tuberculosis drug resistance. The key of prevention and treatment of senile tuberculosis was to increase patients＇ compliance, and to reduce the incidence of drug resistance.

关 键 词：结核 肺 抗多种药物性 抗结核药 危险因素 

分 类 号：R195[医药卫生—卫生统计学]