武汉市首次复治涂阳病例耐药及影响因素分析

摘要目的：了解武汉市首次复治涂阳肺结核病例耐药及影响因素，以便有针对性地采取措施减少复治肺结核耐药率。方法：采用整群抽样方法，抽取武汉市2011年7月一2012年3月登记的首次复治涂阳、有明确首次治疗史、培养阳性并有药敏结果的病例共188例进行问卷调查，采用X2检验及Logistic回归分析耐药之影响因素。结果：首次复治涂阳肺结核病例总耐药率为33．7%，耐多药率为12．9％。单因素分析结果显示，影响武汉市首次复治涂阳病例耐药的因素为：职业、初次治疗用药时间、初次治疗服药规律性。多因素Logistic回归分析显示，初次治疗用药时间大于4个月是耐药的危险因素，差异有统计学意义。结论：武汉市首次复治涂阳肺结核病例耐药和耐多药率较高，初次治疗用药时间是影响复治涂阳肺结核耐药的主要因素。

Analysis on Factors Influencing Drug Resistance of the First - time Retreated Smear -positive Pulmonary Tuberculosis Patients in Wuhan

Objective： To investigate drug resistance pattern and influencing factors of the first - time retreated smear - positive pulmonary tuberculosis （TB） patients and to reduce the rate of drug resistance. Methods： A cluster sampling was carried out to select the first - time retrea- ted pulmonary TB patients which had drug susceptibility result registered in Wnhan TB center from July 2011 to March 2012,which had a total of 188 subjects, as well as an interview with questionnaire being conducted. Thex2 test and logistic regression were used to analyze the influence fac- tors of drug resistance. Results： The total drug resistance rate was 33.7% ,and the multi - drug resistance rate was 12.9%. Univariate analysis revealed that the influence factors of drug resistance were occupation （X2 = 11. 768, P = 0. 038） , duration of the first - time chemotherapy （X2 = 10. 278, P = 0,010 ）, the regularity of the first - time chemotherapy （X2 = 10. 230, P = 0.006 ）. A logistic regression analysis revealed that dura- tion of the first - time chemotherapy longer than 4 months（ OR = 3. 091, 95% CI： 1. 542 - 6. 196） was the risk factor of drug resistance, thus the difference was significant （ P 〈 0.05 ）. Conclusion： The drug resistance rate of the first - time retreated smear - positive pulmonary TB patients was relatively high in Wuhan. Duration of the first - time chemotherapy was the main influencing factor upon drug resistance of first - time retrea- ted smear - positive pulmonary TB.