2017-2018年西安市结核病耐药流行状况及相关因素分析  

Prevalence and correlated factors of multidrug-resistant tuberculosis in Xian,2017-2018

作　　者：李于于[1] 曾令城[1] 柳巍[1] LI Yu-yu;ZENG Ling-cheng;LIU Wei(Xian City Center for Disease,Xian,Shanxi 710054,China)

机构地区：[1]西安市疾病预防控制中心结核病预防控制科

出　　处：《现代预防医学》2019年第21期4001-4004,4032,共5页Modern Preventive Medicine

基　　金：西安市科技局项目(J201903057)

摘　　要：目的了解西安市结核分枝杆菌耐药情况及耐药产生的影响因素,为结核病的防治提供科学依据。方法将2017-2018年西安市14个区(县)结核病门诊和西安市胸科医院所有初治及复治痰结核分枝杆菌培养阳性的病例作为研究对象,进行4种一线抗结核药物的敏感性试验。采用χ2检验和Fisher精确概率法对初治组和复治组的耐药率进行比较,用非条件Logistic模型进行相关因素分析。结果西安市结核分枝杆菌总耐药率为39.0%,初治组耐药率为34.9%,复治组耐药率为73.8%;耐多药率为24.4%,初治组耐多药率为19.3%,复治组耐多药率为68.6%;耐药率与耐多药率均为复治组明显高于初治组,差异有统计学意义(耐药率:χ2=98.145,P<0.001;耐多药率:χ2=202.891,P<0.001)。结论西安市结核分枝杆菌耐药水平较高,特别是耐多药患者的增多,耐药形势依然严峻,有必要加强抗结核药物耐药性的监测,并采取有效的措施控制耐药菌的传播;经多因素非条件Logistic逐步回归分析,年龄、性别、民族、职业及治疗史都是影响西安市结核患者耐药的独立因素。Objective To investigate the baseline of drug-resistant mycobacterium tuberculosis in Xian,so as to provide a scientific basis for prevention and control of drug-resistant tuberculosis.Methods All primary and acquired treated cases with positive smear registered at the Centers for Disease Control and Prevention(CDC)from 14 counties and chest hospital in Xian from 2017 January to 2018 December were enrolled as study population.Sputum specimens were susceptibility test with four first-line anti-mycobacterium tuberculosis drugs.χ2 test and Fisher's exact probability method were used to compare the drug resistance rates between the primary treatment group and the retreatment group,and unconditional Logistic model was used to analyze the related factors.Results The overall drug resistance(DR)of all the mycobacterium tuberculosis in the study was 39.0%.The multidrug resistance(MDR)was 24.4%.The primary drug resistance and multi-drug resistance were 34.9%and 19.3%.The acquired drug resistance and multi-drug resistance were 73.85%and 68.6%.The drug resistance and multi-drug resistance were higher in previously treated cases than in new cases,which was significant difference(DR:χ2=98.145,P<0.001,MDR:χ2=202.891,P<0.001).Conclusion The level of drug resistance of Mycobacterium tuberculosis in Xi'an is high,especially the increase of multi-drug resistant patients.The situation of drug resistance is still serious.It is necessary to strengthen the monitoring of anti-tuberculosis drugs and take effective measures to control the spread of drug-resistant bacteria.Logistic regression analyses indicate that age,sex,nation,profession and medical history are independent factors of DR-TB in Xian.

关 键 词：结核杆菌 耐药 相关因素 西安地区 

分 类 号：R181.3[医药卫生—流行病学]