2020—2023年乐山市耐药肺结核患者流行病学特征及其影响因素分析  

Epidemiological characteristics and influencing factors of drug-resistant tuberculosis patients in Leshan City from 2020 to 2023

作　　者：李庭龙 章乐霞 雷霄[2] 赵鸿鹰[1] 刘琳琳[1] LI Tinglong;ZHANG Lexia;LEI Xiao;ZHAO Hongying;LIU Linlin(Leshan People's Hospital,Leshan 614000,Sichuan Province,China;Leshan Center for Disease Control and Prevention,Leshan 614000,Sichuan Province,China)

机构地区：[1]乐山市人民医院,四川乐山614000 [2]乐山市疾病预防控制中心,四川乐山614000

出　　处：《寄生虫病与感染性疾病》2025年第1期8-18,共11页Parasitoses and Infectious Diseases

摘　　要：目的了解2020—2023年乐山市耐药肺结核患者流行病学特征及其影响因素,为进一步加强耐药肺结核防治工作提供理论依据。方法利用中国疾病预防控制信息系统-结核病病案管理系统,导出2020—2023年现住址为乐山市并经实验室药敏试验结果综合判定为肺结核病原学阳性患者的病案登记信息,耐药变化趋势分析使用卡方趋势检验,采用卡方检验与二元Logistic回归对耐药肺结核患者的时间、空间和人群特点等进行单、多因素统计分析,以P<0.05为差异有统计学意义。结果2020—2023年乐山市利福平耐药率无上升趋势(χ_(趋势)^(2)=3.257,P=0.071),异烟肼耐药率呈逐年下降趋势(χ_(趋势)^(2)=4.716,P=0.030);少年儿童组耐多药率相对较高(χ^(2)=7.890,P=0.048);异烟肼耐药率(6.73%)高于利福平耐药率(4.34%);初治患者异烟肼耐药率高于复治患者(χ^(2)=5.589,P=0.018)。复治患者(OR=12.466,95%CI:7.545~20.597)、少数民族地区(OR=2.118,95%CI:1.328~3.376),中年人(35~59岁)(OR=1.788,95%CI:1.134~2.818)、精神病院患者(OR=52.401,95%CI:3.764~729.590)是利福平耐药的危险因素。结论2020—2023年乐山市肺结核耐药率在国内及省内处于中低水平。应在加强异烟肼耐药患者发现的同时重视传染源的管控、社区防控和规范治疗;应关注少年儿童中的耐多药防控;需特别重视肺结核病人的规范全程治疗管理,以及少数民族地区、中年人群和精神病患者的利福平耐药结核的防治。Objective To understand the epidemiological characteristics and influencing factors of drugresistant tuberculosis patients in Leshan City from 2020 to 2023,and to provide theoretical basis for further strengthening the prevention and treatment of drug-resistant tuberculosis.Methods Through the Tuberculosis Case Management System of the China Disease Prevention and Control Information System,the medical record registration information of patients with current address in Leshan City and comprehensive determination of positive etiology of tuberculosis by laboratory drug susceptibility test results from 2020 to 2023 was derived.Trends in drug resistance changes were analyzed by Chisquare trend test.Chi-square test and binary Logistic regression were used to conduct univariate and multivariate statistical analyses of time,space and population characteristics of patients with drugresistant tuberculosis,and P<0.05 was considered statistically significant.Results From 2020 to2023,rifampicin resistance rate in Leshan City did not increase(χ_(trend)^(2)=3.257,P=0.071).The isoniazid resistance rate decreased annually(χ_(trend)^(2)=4.716,P=0.030).The multi-drug resistance rate was relatively high in children and adolescents(χ^(2)=7.890,P=0.048).The isoniazid resistance rate(6.73%)was higher than rifampicin resistance rate(4.34%).The rate of isoniazid resistance was higher in newly treated patients than that in re-treated patients(χ^(2)=5.589,P=0.018).Re-treatment(OR=12.466,95%CI:7.545-20.597),ethnic minority areas(OR=2.118,95%CI:1.328-3.376),middle-aged people(35-59 years old)(OR=1.788,95%CI:1.134-2.818)and psychiatric hospital patients(OR=52.401,95%CI:3.764-729.590)were risk factors for rifampin resistance.Conclusions The tuberculosis resistance rate in Leshan City from 2020 to 2023 was at a medium and low level both in China and in Sichuan Province.The discovery of isoniazid-resistant patients should be strengthened,and attention should be paid to the control of infection sources,community prevention and control and st

关 键 词：肺结核 耐药 影响因素 流行病学 

分 类 号：R521[医药卫生—内科学] R181.3[医药卫生—临床医学]