某医院广泛耐药结核病住院患者耐药特点及危险因素分析  

Analysis on drug resistance characteristics and risk factors for extensively drug resistant tuberculosis patients

作　　者：贾芳[1] 宋青山[1] 黄海荣[2] JIA Fang;SONG Qing-shan;HUANG Hai-rong(Hetao College of Inner Mongolia,Inner Mongolia 015000,China;Beijing Chest Hospital,Capital Medical liniversity,Beijing 101149,China)

机构地区：[1]内蒙古河套学院,巴彦淖尔015000 [2]首都医科大学附属北京胸科医院,北京101149

出　　处：《中华疾病控制杂志》2019年第3期336-340,共5页Chinese Journal of Disease Control & Prevention

基　　金：国家自然科学基金(81672065);内蒙古自治区高等学校科学研究项目(NJZY17380);河套学院科学技术研究项目(HYZY201823)~~

摘　　要：目的分析广泛耐药结核病(extensively drug-resistant tuberculosis, XDR-TB)患者对一、二线抗结核药物耐药情况及危险因素。方法收集结核分枝杆菌培阳的住院结核患者,采用分枝杆菌微孔板法药敏检测试可信区间剂盒筛出XDR-TB患者,采用Logistic回归分析XDR-TB患者一、二线抗结核药耐药危险因素。结果利福平、异烟肼和利福喷丁耐药率100%,链霉素、利福布汀、乙硫异烟肼、左氧氟沙星和卷曲霉素耐药率90～100%,卡那霉素和对氨基水杨酸耐药率70～80%,阿米卡星耐药率60～70%,丙硫异烟肼耐药率50～60%,乙胺丁醇和莫西沙星耐药率40～50%,克拉霉素耐药率10～20%,氯法齐明耐药率5.2%。XDR-TB中有92.1%的患者对10种以上抗结核药物,耐药种类最少的患者耐6种抗结核药物。Logistic回归分析XDR-TB对一、二线抗结核药物耐药的危险因素包括年龄[20～40岁为(OR=6.318, 95%CI:1.204～33.15,P=0.029;40～60岁为(OR=4.772, 95%CI:0.973～23.392,P>0.05); 60岁以上为(OR=41.366, 95%CI:2.909～588.265,P=0.006)]和抗结核治疗史为复治(OR=28.013, 95%CI:3.357～233.766,P=0.002)。结论 XDR-TB患者耐药情况严重,但有药可治,耐药种类多,其危险因素主要来源于年龄和抗结核治疗史。Objective To analyze the drug resistance profile and risk factors for extensively drug resistant tuberculosis(XDR-TB)patients.Methods XDR-TB cases were identified by sixteen anti-TB drug susceptibility kits among inpatients with a diagnosis of laboratory-confirmed mycobacterium tuberculosis.Single-factor and Logistic analysis were used to analyze the risk factors for drug resistant of the first and second-line anti-TB drugs in XDR-TB patients.Results Resistant rate of rifampin,isoniazid and rifampicin were 100%,Resistant rate of streptomycin,rifampicin and dean,b sulfur isoniazid,levofloxacin and capreomycin were from 90% to 100%,resistant rate of kanamycin and amino salicylic acid were from 70% to 80%,resistant rate of amikacin from 60% to 70%,resistant rate of sulfur isoniazid was from 50% to 60%,resistant rate of ethambutol and moxifloxacin were from 40% to 50%,resistant rate of clarithromycin was from 10% to 20%,resistant rate of clofazimine 5.2%.92.1% of XDR-TB patients were resistant to more than 10 anti-TB drugs,and the least of the patients were resistant to 6 anti-TB drugs.Logistic regression analysis showed the risk factors for XDR-TB first-and second-line anti-tb drugs included age [20-40 year(OR=6.318,95% CI:1.204-33.15,P=0.029;40-60 year(OR=4.772,95% CI:0.973-23.392,P=0.054);60 year(OR=41.366,95% CI:2.909-588.265,P=0.006)] and anti-TB treatment history was retreatment(OR=28.013,95% CI:3.357-233.766,P=0.002).Conclusions XDR-TB patients have serious drug resistance,but there were some drug treatable drug resistance types,and the risk factors mainly come from age and anti-TB treatment history.

关 键 词：XDR-TB 耐药 危险因素 

分 类 号：R181.22[医药卫生—流行病学]