上海市流动人口的结核病耐药状况及相关因素分析

目的了解上海市流动人口的结核病耐药状况及相关因素，为制定流动人口的结核病控制策略提供依据。方法将上海市各区县结核病定点医院2004年2月至2005年1月诊治的流动人口中所有新发及复治的痰培养阳性肺结核病例作为研究对象，并对所有分离培养阳性菌株进行菌型鉴定及利福平、异烟肼、链霉素及乙胺丁醇敏感性测试，分析流动人口耐药结核病的流行状况及相关因素。结果共入选493例培养阳性肺结核患者，最后获得431例（占87．4％）患者的菌型鉴定及药敏结果，其中结核分枝杆菌427例（占99．1％），非结核分枝杆菌4例（占0．9％）。肺结核患者的总耐药率为18．3％（78／427），耐多药率为5．9％（25／427）；新发患者的耐药率为16．0％（62／387），耐多药率为4．1％（16／387）；复治患者的耐药率为40．0％（16／40），耐多药率为22．5％（9／40）。经单因素及多因素分析，45—60岁年龄组及复治病例是耐药及耐多药结核病的相关因素。结论上海市流动人口的结核病耐药率较高，今后要根据流动人口的特点加强防治措施。

The prevalence and risk factors of drug-resistant tuberculosis among migratory population in Shanghai, China

OBJECTIVE: To determine the prevalence of and risk factors for drug-resistant tuberculosis among migratory population in Shanghai. METHODS: All sputum culture positive patients among migratory population, confirmed at any district (county) tuberculosis dispensary in Shanghai from February 2004 to January 2005, were enrolled. The drug susceptibility test was performed by the proportion method. Univariate and multivariate analysis were performed to determine the risk factors associated with drug resistance. RESULTS: 493 patients were enrolled during the study period, among whom 431 patients had bacterial identification and drug susceptibility results. Of the 431 strains, 427 (99.1%) strains were Mycobacterium tuberculosis and 4 (0.9%) strains were Mycobacterium non-tuberculosis. The prevalence of drug-resistant tuberculosis among new cases and re-treatment cases was 16.0% (62/387) and 40.0% (16/40), respectively. The prevalence of MDR-tuberculosis among new cases and re-treatment cases was 4.1% (16/387) and 22.5% (9/40), respectively. A history of previous treatment for tuberculosis and age group of 45 - 60 years were significantly associated with drug resistance. CONCLUSION: The prevalence of drug-resistant tuberculosis among migratory population was relatively high in Shanghai, suggesting the necessity to strengthen the tuberculosis control program for migratory population.