深圳市流动人口肺结核耐药情况及相关因素分析

目的 了解深圳市流动人口肺结核耐药情况及主要影响因素，为完善流动人口结核病防控策略提供科学依据。 方法 将深圳市2010年确诊登记的682例流动人口痰培养阳性肺结核患者（初治595例，复治87例）作为研究对象，进行菌种鉴定和4种一线抗结核药物敏感性试验；并通过现场问卷调查收集相关信息，采取logistic回归分析获得流动人口肺结核患者耐药的主要影响因素。 结果682例结核分枝杆菌感染的流动人口涂阳肺结核患者中，总耐药率为17.74%（121/682），其中初治耐药率15.29%（91/595），复治耐药率34.48%（30/87）；耐多药率为5.87%（40/682），其中初治耐多药率4.20%（25/595），复治耐多药率17.24%（15/87）；单耐药率为9.24%（63/682）；多耐药率为2.64%（18/682）。4种药物的耐药率顺位依次是链霉素、异烟肼、利福平和乙胺丁醇。复治患者的耐药率显著高于初治患者（χ²=19.15，P＜0.01）。多因素logistic回归分析显示，女性（OR=1.623，95%CI=1.023～2.598，P＜0.05）、复治患者（OR=3.648，95%CI=2.133～6.237，P＜0.01）和有中断治疗史的患者（OR=2.847，95%CI=1.718～4.718，P＜0.01）与耐药性之间存在相关性，差异有统计学意义。 结论 深圳市流动人口肺结核总体耐药率和耐多药率相对较高，女性、复治化疗史和初治中断治疗是流动人口耐药肺结核的主要影响因素。

Prevalence and risk factors of drug-resistant tuberculosis among floating population in Shenzhen

Objective To understand the prevalence and risk factors of drug resistant tuberculosis among floating population in Shenzhen,and provide scientific evidence for TB control.Methods Six hundred and eighty two cases of the sputum culture positive tuberculosis registered in 2010 among floating population were enrolled,the number of the initial patients and retreatment patients was 595 and 87 respectively.Species identification and drug sensitivity tests were performed,basic information were collected by questionnaire survey,multivariable logistic regression analysis was performed to determine the relevance between risk factors and drug resistance.Results Among the 682 patients enrolled in the study,the overall drug resistance rate was 17.74%（121/682）,the rates of initial and acquired drug resistance were 15.29%（91/595）and 34.48%（30/87） respectively;the overall multidrug-resistance rates were 5.87%（40/682）,4.20%（25/595） and 17.24%（15/87） for initial and acquired multidrug-resistance respectively;the rate of the resistance to any single drug was 9.24%（63/682）;and the rate of resistance to one or more anti-tuberculosis drugs was 2.64%（18/682）.The highest drug resistance rate was from S,followed with H,R and E.The drug resistance rate of retreatment patients was significantly higher than that of the initial patients（χ^219.15,P0.01）.Multivariate analysis showed that women（OR=1.623,95%CI=1.023-2.598,P0.05）,retreatment pulmonary tuberculosis（OR=3.648,95%CI=2.133-6.237,P0.01） and treatment interruption（OR=2.847,95%CI=1.718-4.718,P0.01）were significantly correlated to the drug resistance.Conclusion The prevalence of drug resistance tuberculosis among floating population in Shenzhen was relatively high.Women,retreatment pulmonary tuberculosis and treatment interruption were the main influencing factors associated with drug resistance.