巴楚医学

目的:分析宜昌市菌阳肺结核患者耐药状况及影响因素,为宜昌市耐药结核病防治措施的制定提供参考依据。方法:对2017～2018年宜昌市2 372例菌阳肺结核患者进行药物敏感试验和耐药影响因素统计分析,计数资料运用χ²检验,采用非条件logistic回归进行耐药影响因素分析。结果:2017～2018年菌阳结核病患者的异烟肼耐药率为16.23%,利福平耐药率为7.55%,耐多药率为4.72%。复治患者的异烟肼耐药率、利福平耐药率和耐多药率均高于初治患者,差异均有统计学意义(χ²=49.354,P<0.001;χ²=131.774,P<0.001;χ²=76.318,P<0.001)。男性利福平耐药率和耐多药率均高于女性,差异有统计学意义(χ²=9.873,P=0.002;χ²=4.016,P=0.045)。多因素logistic分析结果显示,复治患者发生异烟肼耐药的风险较高(OR=2.416,95%CI:1.874～3.115,P<0.001),复治、男性及40～59岁年龄组患者发生利福平耐药风险较高(OR=5.473,95%CI:3.972～7.540,P<0.001;OR=1.640,95%CI:1.107～2.429,P=0.014;OR=1.506,95%CI:1.058～2.143,P=0.023),而复治、40～59岁年龄组患者发生耐多药风险较高(OR=4.927,95%CI:3.327～7.298,P<0.001;OR=1.699,95%CI:1.103～2.616,P=0.016)。结论:应加强复治、男性以及40～59岁结核病患者的治疗管理,以降低全市耐药结核病疫情。

Objective:To analysis the status and influential factors of drug resistance in patients with bacteriological positive pulmonary tuberculosis,and provide evidences for prevention of drug-resistant tuberculosis in Yichang city.Methods:A total of 2 372 cases of bacteriological positive pulmonary tuberculosis were performed drug susceptibility testing,and influential factors of drug-resistant tuberculosis were analyzed statistically.The counting data were analyzed usingχ² test,and the influential factors of drug-resistance were estimated using unconditional logistic regression model.Results:The isoniazid,rifampicin and multi-drug resistance rate of positive pulmonary tuberculosis from 2017 to 2018 was 16.23%,7.55%,and 4.72%,respectively.The isoniazid,rifampicin and multi-drug resistance rate of re-treated patients were significantly higher than those of initially-treated patients(χ²=49.354,P<0.001;χ²=131.774,P<0.001;χ²=76.318,P<0.001).The rifampicin and multi-drug resistance rate of male were significantly higher than those of female(χ²=9.873,P=0.002;χ²=4.016,P =0.045).Multivariate logistic regression analysis suggested that retreated patients were more likely to have isoniazid resistance than initially-treated patients(OR=2.416,95%CI:1.874～3.115,P<0.001).The patients who were re-treated and male aged from 40 to 59 years old had high risk for rifampicin resistance(OR=5.473,95%CI:3.972～7.540,P<0.001;OR=1.640,95%CI:1.107～2.429,P=0.014;OR=1.506,95%CI:1.058～2.143,P=0.023).In addition,the patients who were re-treated and aged from 40 to 59 years old had high risk for multi-drug resistance(OR=4.927,95%CI:3.327～7.298,P<0.001;OR=1.699,95%CI:1.103～2.616,P=0.016).Conclusion:The treatment and management of male retreated tuberculosis patients aged 40 to 59 years old should be strengthened to reduce epidemic situation of drug-resistant tuberculosis in the whole city.