深圳市肺结核患者产生耐多药的危险因素

目的分析深圳市肺结核患者产生耐多药的主要危险因素,为进一步完善深圳市耐多药肺结核(MDR-TB)防控策略提供科学依据。方法采用1∶2配对病例对照研究方法,对2014年1月—2015年12月深圳市慢性病防治中心确诊的178例MDR-TB患者和356例敏感性结核(DS-TB)患者的相关情况进行调查,获取可能导致MDR-TB的主要危险因素,并对其危险因素进行logistic回归分析。结果多因素logistic回归分析结果显示:30~45岁年龄组(OR=2.704,95%CI=1.239~5.899,P=0.012)、既往有抗结核治疗史(OR=19.815,95%CI=10.411~37.716,P0.01)、结核空洞(OR=1.701,95%CI=1.101~2.628,P=0.017)和不规律服药(OR=2.063、95%CI=1.035~4.115、P=0.040)发生MDR-TB的风险较高;已婚(OR=0.187、95%CI=0.089~0.392、P0.01)发生MDR-TB的风险较低。结论 MDR-TB发生的危险因素较为复杂,建议进一步加强早期发现、快速诊断、规范诊疗,强化健康管理、提供心理支持,确保患者接受全程规范治疗,从而降低MDR-TB发生的风险。

Risk factors of multi-drug resistance in pulmonary tuberculosis patients in Shenzhen

Objective To analyze the risk factors associated with multi-drug resistance ot pulmonary tuberculosis (MDR-TB) patients in Shenzhen City,so as to provide the evidence for MDR-TB control.Methods A 1 ∶ 2 matched casecontrol study using questionnaire investigation was implemented in 178 MDR-TB patients (a patient group) and 356 DS-TB patients (a control group) diagnosed in Shenzhen Center for Chronic Disease Control from January 2014 to December 2015.The logistic regression analysis was used to investigate the risk factors associated with MDR-TB.Results The multivariate analysis showed that the 30-45 age group (OR=2.704,95％CI=1.239-5.899,P=0.012),history of anti-tuberculosis treatment (OR=19.815,95％CI=10.411-37.716,P ＜ 0.01),tuberculosis cavity (OR=1.701,95％CI=1.101-2.628,P=0.017),and irregular treatment (OR=2.063,95％CI=1.035-4.115,P=0.040) were significantly associated with MDR-TB,while the married patients (OR=0.187,95％CI=0.089-0.392,P＜0.01) was significantly less associated with MDR-TB.Conclusion The risk factors associated with MDR-TB are complex;we should reinforce early detection and rapid diagnosis,standardize the diagnosis and therapy,strengthen health management and provide psychosocial support,in order to make sure that the patients take the full course of the treatment to reduce the risk of MDR-TB.