2型糖尿病合并初治肺结核患者耐药情况及影响因素分析

目的回顾性分析了2型糖尿病合并初治耐药肺结核患者结核分枝杆菌的耐药情况和影响因素,从而为此类患者的早期发现提供一定的依据。方法收集首都医科大学附属北京胸科医院2012年1月至2014年12月收治的行结核分枝杆菌培养及药敏试验的2型糖尿病合并肺结核患者356例,其中初治耐药患者93例,复治耐药患者56例,初治敏感患者182例。对患者的耐药率、耐药种类、任一耐药率、耐药谱、耐药危险因素等情况进行分析。采用SPSS16.0统计学软件进行统计学分析,P0.05为差异有显著性意义。结果 356例2型糖尿病合并肺结核患者,总耐药率41.9%,耐多药率达12.9%。2型糖尿病合并初治耐药肺结核患者中,以单耐药和多耐药患者为主,耐单药前三位为耐SM、INH和利福类,喹诺酮类药物的耐药率为11.8%,耐多药患者组合耐药谱以耐HRSEPto+二线注射剂为最多(38.1%)。与初治敏感患者相比,2型糖尿病合并初治耐药肺结核患者体重下降者占多数(P0.05)。结论 2型糖尿病合并初治肺结核的耐药率较高,以单耐药和多耐药为主,体重下降是2型糖尿病合并初治耐药肺结核患者的影响因素。

Analysis on drug resistance and risk factors associated with drug-resistant in patients with type 2 diabetes mellitus and initial pulmonary tuberculosis

Objective To analyze the situation and risk factors of drug resistance of Mycobacterium tubercu-losis among patients with type 2 diabetes mellitus and drug-resistant pulmonary tuberculosis. Methods 356 patients with type 2 diabetes and pulmonary tuberculosis were admitted in Beijing Chest Hospital affiliated to Capital Medical University from January 2012 to December 2014. Based on the results of drug susceptibility test in Lowenstein-Jensen media,93 patients with drug-resistant pulmonary tuberculosis were as the initial drug-resistant group,56 patients with drug-resistant tuberculosis as the previously treated drug-resistant group,and 182 patients with drug-sensitive tuber-culosis as the initial drug-sensitive group. We analyzed the drug susceptibility situation of patients’sputum. Statisti-cal analysis was performed with SPSS 16. 0 statistical software. Differences among groups were compared with χ2test. P < 0. 05 was considered statistically significant. Results Among the 356 sputum culture positive patients,the total drug resistant rate was 41. 9% . In terms of resistance pattern,the majority were mono resistant and poly resistant tu-berculosis. In single-drug resistance pattern,the majority of drug resistance were SM,INH and RFP. The drug re-sistant rate of fluroquinolones was 11. 8% . The most combined pattern of drug resistance in the initial drug-resistant group was resistant for HRSEP to and second line injection. Compared with the initial drug-sensitive group,the weights of the initial drug-resistant group with type 2 diabetes and pulmonary tuberculosis decreased significantly(P< 0. 05). Conclusion The Mycobacterium tuberculosis drug resistant rate is higher than the baseline leve1 in pa-tients with type 2 diabetes and initial pulmonary tuberculosis patients,especially for mono resistant and poly resistant patients. The decreased weight may be the risk factors contributing to the development of patients with type 2 diabetes and initial drug resistant pulmonary tuberculosis patients.