福建省复治肺结核患者耐药现况与其影响因素分析  

Analysis on drug resistance of retreated pulmonary tuberculosis cases and risk factor associated with drug resistance in Fujian

作　　者：魏淑贞[1] 梁庆福[1] 林淑芳[1] 赵永[1] 林建[1] 林勇明[1] 陈求扬[1] 

机构地区：[1]福建省疾病预防控制中心结核病防治科,福建福州350001

出　　处：《现代预防医学》2015年第16期3008-3011,3015,共5页Modern Preventive Medicine

基　　金：福建省自然科学基金(2010J01116)

摘　　要：目的了解福建省复治涂阳肺结核患者耐药现状,探讨其耐药的影响因素。方法采用统一的患者信息表收集30个监测点复治涂阳患者的社会经济和既往临床诊疗信息。培养阳性菌株采用比例法进行异烟肼(H)、利福平(R)、乙胺丁醇(E)、链霉素(S)、卡那霉素(Km)、氧氟沙星(Ofx)的耐药性测定。对硝基苯甲酸(PNB)培养法鉴定结核分枝杆菌复合群。采用比值比(OR)评估耐药结核病患者和耐多药(MDR)患者的危险因素。结果复治患者男性居多(占84.15%),总耐药率为37.32%,MDR率为15.89%,广泛耐药(XDR)率为0.35%;任一耐药顺位依次为:R(25.00%),H(21.48%),S(16.55%),E(15.49%),Ofx(7.75%)和Km(4.23%);耐多药结核病(MDR-TB)耐药谱有10种,其中同时对S、H、R和E耐药占46.67%;多耐药谱有14种,以耐二联药物为主(占68.00%);治疗2次以上的患者耐药率和MDR率均明显高于治疗1次的患者OR分别为2.43,3.38;P值分别为0.005,0.001。结论福建省复治结核病患者的耐药及MDR-TB问题仍然严重,反复多次治疗是复治患者耐药及MDR-TB的主要危险因素。Objective The aim of this study was to understand the status of drug resistant among retreated pulmonary tuberculosis patients and analysis the risk factor associated with drug resistance in Fujian. Methods The questionnaire was used to collect information about socioeconomic status and previous therapy history of retreated pulmonary tuberculosis patients enrolled from 30 survey sites. The culture positive isolates were performed with drug susceptibility test for isoniazid, rifampicin, ethambutol,streptomycin, kanamycin and ofloxacin. Mycobacterium tuberculosis complex（MTBC） was identified based on para-nitrobenzoic acid culture test. The risk factors towards drug resistant patients and MDR-TB cases were assessed by OR value. Results The majority of retreated cases were male（84.15%）. The total drug resistance rate（DRR） was 37.32% and the MDR-TB rate（MDRR）was 15.89%. The XDR rate was 0.35%. The DR rate was： R（25.00%）, H（21.48%）, S（16.55%）, E（15.49%）, Ofx（7.75%） and Km（4.23%）. Through the DST of six drugs, ten types of MDR spectrum were showed. Resistance to the four first line drugs of（S、I、R、E） at the same time occupied 46.67%. And 14 types of poly-resistance were found, mainly showed resistance to two drugs（68%）.The DRR for patients with twice and more treatment was higher than that for patients treated once（OR=2.43, P=0.005）. The MDRR for patients with twice and more treatment was higher than that for patients treated once（OR=3.38, P=0.001）. Conclusion The drug resistant TB and MDR-TB was still prevalent in Fujian province, and repeated treatment was the main risk factor for drug resistance and MDR-TB.

关 键 词：肺结核 耐药 复治 影响因素 

分 类 号：R183[医药卫生—流行病学]