2019—2020年达州市结核分枝杆菌分离株一线药物耐药状况及其影响因素分析  

Analysis of first-line drug resistance and its influencing factors of mycobacterium tuberculosis isolated in Dazhou City from 2019 to 2020

作　　者：李红[1] 丁敏[1] 谭柯 周汉洪[1] 邹依霖 陈松[1] 陈杨[3] LI Hong;DING min;TAN Ke;ZHOU Han-hong;ZOU Yi-lin;CHEN Song;CHEN Yang(Dazhou Center for Disease Control and Prevention,Dazhou 635002,Sichuan Province,China;Sichuan Yuanda Shuyang Pharmaceutical Co.,Ltd,Chengdu 610214,Sichuan Province,China;West China Fourth Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)

机构地区：[1]达州市疾病预防控制中心,四川达州635002 [2]四川远大蜀阳药业责任有限公司,成都610214 [3]四川大学华西第四医院,成都610041

出　　处：《预防医学情报杂志》2022年第7期977-981,共5页Journal of Preventive Medicine Information

基　　金：《关于印发四川省遏制结核病行动实施方案(2019—2022年)的通知》(川卫发〔2019〕48号)。

摘　　要：目的了解达州市结核分枝杆菌分离株一线药物耐药状况及其影响因素,为预防和控制耐药结核病提供基础科学依据。方法选取2019—2020年达州市从结核病患者痰标本中分离培养的446株结核分枝杆菌(MTB),采用比例法检测MTB对一线抗结核药物异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)和链霉素(SM)的敏感性,结合病例背景资料分析相关影响因素。所得数据采用SPSS 22.0软件分单因素分析采用卡方检验、多因素分析采用非二分类Logistic回归分析,检验水准α=0.05。结果共检测446株结核分枝杆菌,对INH、RFP、EMB和SM的单耐药率分别为29.37%、34.75%、15.70%和21.75%,单耐药率和耐多药率(MDR)分别为43.95%和23.99%。男性患者耐药率高于女性患者(46.78%对比32.58%,P=0.016);复治患者耐药率高于初治患者(80.95%对比42.12%,P<0.001);不同年龄段患者的耐药率有差异,且年龄越大耐药率越高(P<0.001);主要生活在农村的患者单耐药率明显高于城镇患者(46.09%对比33.33%,P=0.042);项目县的患者单耐药率和MDR率远低于非项目县(91.11%对比23.47%,58.62%对比9.00%,P<0.001);不同文化程度的患者之间耐药率无差异(P=0.614)。多因素分析结果显示,年龄、病例类型和地区与结核分枝杆菌产生耐药相关。发生耐药的风险比较,年龄增高风险越大,复治病例是初治病例的8.851倍(95%CI,2.556~30.646),非项目县是项目县的38.884倍(95%CI,19.519~77.465)。结论达州市耐药情况较为严重,加强对农村老年人群,特别是复治人群的结核病耐药性监测和规范化管理力度,预防疾病复发,同时扩大监测项目范围,有利于预防和控制耐药结核病。Objective To understand the status and influencing factors of first-line drug resistance of Mycobacterium tuberculosis isolates in Dazhou City,to provide basic scientific basis for preventing and controlling drug-resistant tuberculosis.Methods A total of 446 strains of Mycobacterium tuberculosis(MTB)isolated from sputum specimens of patients with tuberculosis in Dazhou from 2019-2020 were selected.The sensitivity of MTB to 4 kinds of first-line anti tuberculosis drugs,isoniazid(INH),rifampicin(RFP),ethambutol(EMB)and streptomycin(SM)was detected by proportional method.The date were analyzed by SPSS 22.0 software,Chi-square test was used for univariate analysis,Logistic regression analysis was used for multivariate analysis,and test level wasα=0.05.Results A total of 446 strains of Mycobacterium tuberculosis were detected.The single drug resistance rates to INH,RFP,EMB and SM were 29.37%,34.75%,15.70%and 21.75%respectively.The total drug resistance rate and multidrug resistance rate(MDR)were 43.95%and 23.99%respectively.The drug resistance rate of male patients was higher than that of female patients(46.78%vs.32.58%,P=0.016);The drug resistance rate of retreated patients was higher than that of untreated patients(80.95%vs.42.12%,P<0.001);The drug resistance rate was different in patients of different ages,and the older the age,the higher the drug resistance rate(P<0.001);The total drug resistance rate of patients mainly living in rural areas was significantly higher than that of urban patients(46.09%vs.33.33%,P=0.042);The total drug resistance rate and MDR rate of patients in pilot areas were much lower than those in non pilot counties(91.11%vs.23.47%,58.62%vs.9.00%,P<0.001);There was no difference in drug resistance rate among patients with different educational levels(P=0.614).Multivariate analysis showed that age,case type and region were associated with drug resistance of Mycobacterium tuberculosis.The risk of drug resistance increases with age.The drug resistance of Mycobacterium tuberculosis in retreated ca

关 键 词：结核分枝杆菌 耐药 一线抗结核药物 药敏定性试验 

分 类 号：R446/5[医药卫生—诊断学]