糖尿病与肺结核共病结核分枝杆菌耐药情况分析  

Drug resistance of Mycobacterium tuberculosis co-occurring with diabetes and tuberculosis

作　　者：杨子龙 袁园[2,3] 汪敏 陈玉梅[2,3] 冯治宇 吴迪[2,3] 张宏 陈泽莹[2,3] 黄显林 邝浩斌 YANG Zilong;YUAN Yuan;WANG Min;CHEN Yumei;FENG Zhiyu;WU Di;ZHANG Hong;CHEN Zeying;HUANG Xian-lin;KUANG Haobin(Graduate School,Guangzhou Medical University,Guangzhou 511436,China;不详)

机构地区：[1]广州医科大学研究生院,广州511436 [2]广州市胸科医院结核内科,广州510095 [3]呼吸疾病国家重点实验室,广州510182

出　　处：《实用医学杂志》2023年第11期1359-1363,共5页The Journal of Practical Medicine

基　　金：广东省医学科研基金资助项目(编号:A2022025);广州市医学重点学科(2021-2023)结核病学。

摘　　要：目的探讨糖尿病与肺结核共病(DM-TB)结核分枝杆菌耐药情况。方法以回顾性病例对照研究方法连续收集广州市胸科医院2018年1月至2020年12月住院和门诊确诊的DM-TB患者1948例,其中筛查出具备结核分枝杆菌培养阳性及药敏结果的病例1012例,排除病历资料不完整病例,共获得资料完整病例438例,记录年龄、性别、血红蛋白、白蛋白、糖化血红蛋白(HbA1c)、病灶范围、空洞数量、治疗史、痰菌负荷量、利福平耐药。采用描述法和χ^(2)检验进行组间比较分析1012例MD-TB患者对一、二线抗结核药耐药情况。按利福平是否耐药分为利福平耐药(RR-TB)组86例,并从其余利福平敏感的352例中按随机数字表法随机选择86例作为利福平敏感(RS-TB)组。采用t检验、秩和检验或χ^(2)检验进行组间比较分析,将纳入病例的临床特征作为自变量,利福平是否耐药作为因变量,进行多因素logistic回归分析DM-TB患者利福平耐药发生的相关危险因素。结果1012例TB-DM患者利福平耐药率为13.3%,其中初治利福平耐药率6.8%,复治利福平耐药率45.9%,初复治比较差异有统计学意义(χ^(2)=127.956,P=0.000),耐多药率11.77%,其中初治耐多药率5.5%,复治耐多药率42.9%,两者比较差异有统计学意义(χ^(2)=191.468,P=0.000)。多因素logistic回归分析显示复治(OR=9.517,95%CI:4.333~20.904,P=0.000)为DM-TB患者发生利福平耐药的独立危险因素,年龄增大(OR=0.440,95%CI:0.252~0.771,P=0.004)为独立保护因素。结论DM-TB的利福平耐药患病率偏高,尤其是年轻患者和复治患者。对于DM-TB人群,及时耐药检测能早发现早治疗利福平耐药结核病。Objective To investigate the drug resistance of Mycobacterium tuberculosis in diabetes mellitus and pulmonary tuberculosis comorbidity(DM-TB).Methods A retrospective case-control study was conducted to review and analyze the clinical data of 1948 patients who was diagnosed with DM-TB in the inpatient and outpatient departments of Guangzhou Chest Hospital from January 2018 to December 2020.A total of 1012 cases with positive Mycobacterium tuberculosis culture and drug susceptibility results were screened out.After excluding the cases with incomplete data,438 cases with complete data were included for analyses of age,gender,haemoglobin,albumin,glycatedhaemoglobin(HbA1c),extent of lesions,number of cavities,treatment history,sputum bacterial load and rifampicin resistance.The description method and Pearson Chi-square test(χ^(2))were used to compare analyze the first and second line drug resistance of the strains from the 1012 patients.Among the selected cases,?86 patients who were resistant against rifampicin were assigned as rifampicin-resistant(RR-TB)group,and then another 86 patients were randomly selected from the rest 352 patients sensitive to rifampicin by random digit table method as rifampicin-sensitive(RS-TB)group.The methods of?t-test,rank-sum test or Pearson Chi square test(χ^(2))were used for the analyses.The clinical characteristics of the included cases were taken as independent variables and rifampicin resistance as dependent variables.Multivariate logistic regression analysis was performed to screen out independent risk factors for RR-TB in DM-TB patients.Results Among the 1012 patients with TB-DM,the rate of rifampicin resistance was 13.3%,the rate of initial rifampicin resistance was 6.8%,the rate of retreatment rifampicin resistance was 45.9%,with significant differences(χ^(2)=127.956,P=0.000).The rate of multidrug-resistance was 11.77%,the rate of initial multidrug-resistance was 5.5%,the rate of retreatment multidrug-resistance was 42.9%,with significant difference between the two groups(χ^(

关 键 词：糖尿病 肺结核 结核分杆菌 利福平耐药 危险因素 

分 类 号：R521[医药卫生—内科学]