2014-2018年杭州市肺结核患者的耐药情况及其影响因素分析  

Analysis of drug resistance of tuberculosis patients and its influencing factors in Hangzhou from 2014 to 2018

作　　者：范大鹏[1] 岳永宁[1] 张艳[1] 陈园园[2] 鲍志坚[2] 朱敏[2] 蔡龙[1] FAN Da-peng;YUE Yong-ning;ZHANG Yan;CHEN Yuan-yuan;BAO Zhi-jian;ZHU Min;CAI Long(Clinical Laboratory Center of Integrated Chinese and Western Medicine Hospital of Zhejiang Province,Hangzhou 310003,China)

机构地区：[1]浙江省中西医结合医院临床检验实验中心,杭州310003 [2]浙江省中西医结合医院结核科,杭州310003

出　　处：《中国防痨杂志》2021年第1期72-79,共8页Chinese Journal of Antituberculosis

基　　金：杭州市医学重点专病专科项目(20140733Q22);杭州市科委主动设计项目(20162013A04)。

摘　　要：目的分析2014—2018年杭州市肺结核患者对一线抗结核药品的耐药特征及其影响因素,为杭州市防治耐药结核病提供科学依据。方法收集2014—2018年浙江省中西医结合医院结核病诊疗中心就诊的杭州市全部常住人口中的活动性肺结核患者,共12 851例,纳入结核分枝杆菌培养阳性且对一线抗结核药品药物敏感性试验(简称"药敏试验")信息全面的3807例患者。通过国家结核病信息管理系统和结核病实验室信息系统(laboratory information system,LIS)收集所有患者的性别、年龄、户籍、职业、治疗分类(初治和复治)、肺部有无空洞、患者来源及现居住地、结核分枝杆菌培养及药敏试验结果。运用单因素和多因素非条件logistic回归分析的方法研究杭州市耐药肺结核患者耐药特征及其影响因素。结果 3807株菌株中,907株(23.82%)对4种一线抗结核药品耐药,耐药顺位依次为异烟肼(18.57%,707例)、链霉素(18.41%,701例)、利福平(12.03%,458例)、乙胺丁醇(6.41%,244例);所有患者的耐多药率和多耐药率分别为11.11%(423/3807)和4.44%(169/3807)。2014—2018年不同年份肺结核患者耐药率分别为22.87%(185/809)、25.55%(198/775)、25.60%(181/707)、23.04%(188/816)、22.14%(155/700),差异无统计学意义(χ_(趋势)^(2)=4.275,P=0.370);耐多药率分别为11.12%(90/809)、13.16%(102/775)、11.88%(84/707)、11.40%(93/816)、7.71%(54/700),差异有统计学意义(χ_(趋势)^(2)=11.276,P=0.024)。多因素条件logistic回归分析显示,相对于男性和初治患者,女性和复治肺结核患者是发生耐药的危险因素[OR(95%CI)=1.308(1.111~1.540);OR(95%CI)=4.281(3.498~5.238)];相对于下沙区,居住在其他6个区的结核病患者发生耐药的可能性较大,萧山区和富阳区的风险更高[OR(95%CI)=4.400(2.559~7.565);OR(95%CI)=3.803(2.037~7.098)]。相对于男性、<40岁、初治患者,女性、≥40岁、复治的肺结核患者是产生耐多药的危险因素[OR(95%CIObjective To analyze the characteristics and influencing factors of tuberculosis patients’ resistance to first-line anti-tuberculosis drugs in Hangzhou from 2014 to 2018,and to provide scientific basis for the prevention and treatment of drug-resistant tuberculosis in Hangzhou. Methods A total of 12 851 active tuberculosis patients were collected from the permanent residents of Hangzhou who visited the Tuberculosis Diagnosis and Treatment Center of Integrated Chinese and Western Medicine Hospital of Zhejiang Province from2014 to 2018.All of 3807 patients with positive Mycobacterium tuberculosis culture and comprehensive information of drug sensitivity test("drug susceptibility test")for first-line anti-tuberculosis drugs were enrolled.Through the National Tuberculosis Information Management Systemand the Tuberculosis Laboratory Information Systemto collect the sex,age,household registration,occupation,classification of treatment(initial and retreated),pulmonary cavity,case sources and current residence of the patients,Mycobacterium tuberculosis culture and drug susceptibility test results.Drug resistance characteristics and influencing factors of drug-resistant pulmonary tuberculosis patients in Hangzhou were studied by univariate and multi-factor logistic regression analysis. Results Of the 3807 strains,907 strains(23.82%)were resistant to four first-line anti-tuberculosis drugs.The drug resistance sequence was isoniazid(18.57%,707 cases),streptomycin(18.41%,701 cases),rifampicin(12.03%,458 cases)and ethambutol(6.41%,244 cases).The multidrug-resistance and polyresistance rates were 11.11%(423/3807)and4.44%(169/3807).Of the tuberculosis patients in different years from 2014 to 2018,the drug resistance rates were 22.87%(185/809),25.55%(198/775),25.60%(181/707),23.04%(188/816)and 22.14%(155/700),respectively,with no significant difference (χ_(trend)^(2) =4.275,P=0.370).The multidrug-resistance rates(11.12%(90/809),13.16%(102/775),11.88%(84/707),11.40%(93/816)and 7.71%(54/700))had statistically significant differ

关 键 词：结核 肺 结核 抗多种药物性 数据说明 统计 因素分析 统计学 小地区分析 

分 类 号：R521[医药卫生—内科学] R446.5[医药卫生—临床医学]