377例复治肺结核患者耐药的危险因素研究  

Risk factor analysis on drug resistance among 377 retreated patients with pulmonary TB

作　　者：马艳[1] 杜建[1] 高微微[1] 舒薇[1] 钟球 傅衍勇 陈玲[4] 李波[5] 林明贵 黎友伦 梁煊[8] 尚好珍[9] 马丽萍[10] 闫兴录[11] 王晓萌[12] 纪滨英 高飞 陈森林 吴湘[16] 崔爱东 张朋[18] 孙瑞敏[19] 曹文丽[20] 张海晴[21] 陈东进[22] MA Yah;DU Jian;GAO Wei-wei;SHU Wei;ZHONG Qiu;FU Yan-yong;CHEN Ling;I.I Bo;LIN Ming gui;LI You-lun;LIANG Xuan;SHANG Hao-zhen;MA Li-ping;YAN Xing lu;WANG Xiao-meng;JI Bin-ying;GAO Fei;CHEN Sen-lint WU Xiang;CUI Ai dong;ZHANG Peng;SUN Rui-min;CAO Wen-lit ZHANG Hai-qing;CHEN Dong-jin(Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing 101149,China)

机构地区：[1]北京结核病胸部肿瘤研究所,首都医科大学附属北京胸科医院,中国疾病预防控制中心结核病临床中心,北京101149 [2]广东省结核病控制中心 [3]天津市结核病控制中心 [4]遵义医学院附属医院 [5]北京结核病控制研究所 [6]解放军第三〇九医院 [7]重庆医科大学附属第一医院 [8]沈阳市胸科医院 [9]新乡医学院第一附属医院 [10]河南省疾病预防控制中心 [11]黑龙江省结核病防治所 [12]浙江省疾病预防控制中心 [13]哈尔滨市胸科医院 [14]内蒙古自治区第四医院 [15]荆州市传染病医院 [16]荆门市疾病预防控制中心 [17]包头市第三人民医院 [18]唐山市第四医院 [19]秦皇岛市第三医院 [20]北京老年医院 [21]徐州市传染病医院 [22]北京京煤集团总医院

出　　处：《中国预防医学杂志》2018年第9期641-646,共6页Chinese Preventive Medicine

基　　金：“十一五”国家科技重大专项项目(2008ZX10003-015)

摘　　要：目的探讨复治肺结核患者耐药情况及相关危险因素,为制定肺结核防治策略提供相关参考依据。方法统一设计的调查问卷,选择全国22家医疗机构2009-2012年确诊的复治肺结核患者377例,按是否耐药分为耐药组和敏感组,比较两组在基本情况,首次治疗情况及既往史方面的差异,分析复治肺结核患者耐药的相关危险因素。结果复治肺结核患者中共148例耐药患者,耐药率为39.26%(148/377),经单因素分析结果表明结核病接触史(χ~2=6.375,P=0.012);治疗前症状及体征评分(χ~2=11.899,P=0.005);既往治疗次数(χ~2=10.209,P=0.001);既往用药个数(χ~2=3.986,P=0.046)及既往用药不良反应(χ~2=4.468,P=0.035)差异有统计学意义。多因素非条件logistic回归分析表明治疗前症状及体征评分≥6分和既往治疗>2次是耐药发生的独立危险因素,OR (95%CI)分别为1.894 (1.228~2.922)和2.166(1.074~4.370)。结论复治肺结核患者耐药率较高,服药不规律及既往治疗次数增多增加了复治肺结核患者耐药风险。Objective To understand the drug resistance among retreated patients with pulmonary TB, and to explore its related risk factors. Methods A retrospective study was conducted among 377 retreated TB cases in 22 medical institutions from 2009 to 2012 using a unified questionnaire survey. Patients were divided into drug resistant group and drug-sensitive group. Data were statistically analyzed and compared. Results A total of 148 patients were found to be drug resistant cases with the drug resistance rate of 39.26%（148/377）, Univariate analysis showed significant statistical differences between drug resistant case group and drug sensi rive case group in TB contact history （χ^2=6. 375, P=0. 012）, scores of symptoms or signs before treatment （χ^2=11.899, P=0.005）, previous treatment times （χ^2=10. 209, P=0.001）, previous number of medications （χ^2==3.986, P=0.046） and previous drug adverse reactions （χ^2=4.468, P=0.035）.Multivariate lo- gistic regression analysis revealed that scores of 6 or more on symptoms or signs before treatment （OR = 1. 894, 95, CI： 1. 228-2. 922） and previous treatment over 2 times （OR=2. 166, 95%CI： 1. 074-4. 370） were independent risk factors ok drug-resistance. Conclusions The drug resistance rate is relatively high among retreated TB patients, irregular medication and repeated treatment increase the risk for drug resistance.

关 键 词：肺结核 复治 耐药 危险因素 

分 类 号：R521[医药卫生—内科学]