2016-2018年武汉市东西湖区痰培养阳性肺结核患者耐药情况分析  

Drug resistance of Tuberculosis Patients with Positive Sputum Culture in Dongxihu District From 2016 to 2018

作　　者：黄祥虎 宋金刚 王曼 王齐[1] HUANG Xianghu;SONG Jingang;WANG Man;WANG Qi(School of Public Health,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430040,Hubei province,China;Institute of Tuberculosis Control in Dongxihu District,Wuhan 430040,Hubei province,China)

机构地区：[1]华中科技大学同济医学院公共卫生学院,武汉430040 [2]武汉市东西湖区结核病防治所,武汉430040

出　　处：《预防医学情报杂志》2020年第5期605-608,613,共5页Journal of Preventive Medicine Information

摘　　要：目的了解痰培养阳性肺结核患者耐药现状及其影响因素,为制定耐药结核病防控措施提供科学依据。方法收集2016-01/2018-12武汉市东西湖区痰培养阳性肺结核患者传统药敏试验结果,描述不同治疗分类结核病患者的耐药率,采用χ~2检验和非条件Logistic回归从性别、年龄、治疗史、户籍类型、职业几方面进行耐药影响因素分析。结果武汉市东西湖区痰培养阳性肺结核患者总体耐药率18.0%,耐多药率5.5%。耐药和耐多药单因素分析结果显示,复治患者比初治患者更容易产生耐药(χ~2=10.089 9,P=0.001 5)和耐多药(χ~2=4.255 7,P=0.039 1);不同年龄组患者间的耐药率差异无统计学意义,但耐多药率差异有统计学意义(χ~2=6.558 3,P=0.037 7);不同性别、户籍类型、职业患者间的耐药率、耐多药率差异均无统计学意义。从年龄、治疗史两方面进行多因素Logistic分析,结果显示复治是耐多药的危险因素(OR=4.655,95%CI:1.253~17.296,P=0.022),年龄不是耐多药的危险因素。结论东西湖区痰培养阳性肺结核患者耐药率低于全国平均水平,这可能与初治患者比例较高有关。肺结核患者既往抗结核治疗史是耐药产生的重要因素,需要加强对肺结核患者的规范治疗和管理,以降低耐药/耐多药肺结核疫情。Objective To understand the status of drug resistance and the risk factors of tuberculosis(TB) patients with positive sputum culture in Dongxihu District so as to provide a scientific basis for municipal control strategy for drug resistance. Methods Results of traditional drug susceptibility testing of the culture-positive TB patients were collected from January 2016 to December 2018. The drug resistant rates of TB patients with different treatment method were described. Chi-square tests and logistic regression models were used to explore the risk factors(such as gender, age,treatment history, household registration type and occupation) of drug resistance. Results The total drug resistance rate of TB patients with positive sputum culture was 18.0%, and the multi-drug resistance rate was 5.5%. Retreatment patients were more likely to develop drug resistance (χ~2=10.089 9, P=0.001 5) and multi-drug resistance (χ~2=4.255 7,P=0.039 1) than the newly diagnosed patients. There were no significant differences in the drug resistance rates among patients of different age groups, but the differences in multi-drug resistance rates among patients of different age groups were statistically significant (χ~2=6.558 3,P=0.037 7). There were no significant differences in drug resistance and multi-drug resistance among the patients of different sexes, household registration types and occupations. Logistic regression analysis showed that retreatment was a risk factor of multi-drug resistance(OR=4.655, 95% CI:1.253~17.296, P=0.022), but age was not. Conclusion The drug resistance rate of TB patients with positive sputum culture in Dongxihu District was lower than the national average. This finding may be related to the higher proportion of newly treated TB patients in this study. The history of TB treatment was an important influencing factor of drug resistance. It is necessary to strengthen the standardized treatment and management of TB patients to reduce the drug resistance/multi-drug resistance TB epidemic.

关 键 词：肺结核 结核分枝杆菌 耐药 耐多药 影响因素 

分 类 号：R521[医药卫生—内科学]