烟台市肺结核患者利福平和异烟肼耐药的影响因素分析  

Influencing factors of resistance to isoniazid and rifampicin in tuberculosis patients in Yantai

作　　者：朱思谨 孙聪 王曰雷[3] 初天慈 靳晓翔 胡乃宝[1] Zhu Sijin;Sun Cong;Wang YueLei;Chu Tianci;Jin Xiaoxiang;Hu Naibao(School of Public Health,Binzhou Medical University,Yantai 264003,China;Yantai Zhifu District Center for Disease Control and Prevention,Yantai 264001,China;Yantai Center for Disease Control and Prevention,Yantai 264003,China)

机构地区：[1]滨州医学院公共卫生学院,山东烟台264003 [2]烟台市芝罘区疾病预防控制中心,山东烟台264001 [3]烟台市疾病预防控制中心,山东烟台264003

出　　处：《中国医院统计》2023年第6期422-425,430,共5页Chinese Journal of Hospital Statistics

摘　　要：目的分析2013—2019年山东省烟台市肺结核患者利福平与异烟肼的耐药情况。方法在中国疾病预防控制信息系统中收集病原学阳性肺结核患者相关资料。耐药变化趋势分析使用卡方趋势检验。耐药影响因素的单因素和多因素分析分别采用卡方检验与多因素logistic回归。结果共有4977例病原学阳性肺结核患者纳入本次研究,对利福平和(或)异烟肼耐药者共有226例(4.5%),其中仅对利福平耐药37例(0.7%),仅对异烟肼耐药140例(2.8%),耐多药49例(1.0%)。随年份增加,患者耐药率总体呈上升趋势(χ^(2)_(趋势)=9.111,P=0.003)。单因素分析的结果显示,在不同患者来源、治疗分类、治疗管理方式与是否合并糖尿病上,耐药率差异有统计学意义(P<0.05)。logistic回归分析结果表明,复治患者(OR=3.691,95%CI:2.737~4.978)、合并糖尿病(OR=1.703,95%CI:1.055~2.748)为肺结核耐药的危险因素。结论2013—2019年烟台市病原学阳性肺结核患者对利福平和(或)异烟肼耐药率较低,耐药变化趋势提示未来仍要加强防控,复治患者和合并糖尿病患者的耐药风险更高。Objective To analyze the drug resistance of rifampicin and isoniazid in patients with tuberculosis in Yantai City,Shandong Province,from 2013 to 2019.Methods Data related to pathogenetically positive tuberculosis patients were collected in the China Disease Control and Prevention Information System.Trends in drug resistance changes were analyzed using the chi-square trend test.The unifactorial and multifactorial analyses of drug resistance influencing factors were performed using the chi-square test and multifactorial logistic regression,respectively.Results Totally 4977 patients with pathogenetically positive tuberculosis were enrolled in this study,and 226(4.5%)were resistant to rifampicin and/or isoniazid,of which 37(0.7%)were resistant to rifampicin only,140(2.8%)to isoniazid only,and 49(1.0%)were multidrug resistant.There was an overall increasing trend in patient resistance rates with increasing years(χ^(2)=9.111,P=0.003).The results of univariate analysis showed that there were differences in drug resistance rates in terms of patient origin,therapeutic classification,level of therapeutic management and whether or not there was comorbid diabetes mellitus(P<0.05).Logistic regression analysis showed that retreatment(OR=3.691,95%CI:2.737-4.978)and the combination with diabetes mellitus(OR=1.703,95%CI:1.055-2.748)were risk factors for tuberculosis drug resistance.Conclusion The rate of resistance to rifampicin and/or isoniazid was low among patients with pathogenetically positive tuberculosis in Yantai City from 2013 to 2019,the trend of change in resistance suggests that prevention and control should still be strengthened in the future,and the risk of resistance was higher in patients who were retreated and complicated with diabetes mellitus.

关 键 词：肺结核 耐药 异烟肼 利福平 影响因素 

分 类 号：R521[医药卫生—内科学]