北京市朝阳区肺结核患者耐药状况及相关因素分析

目的了解朝阳区当前结核病耐药状况及相关影响因素，为今后结核病防治工作提供参考依据。方法将2006—2007年朝阳区结防所登记的所有初治及复治痰结核分枝杆菌培养阳性的病例作为研究对象，采用绝对浓度间接法对4种抗结核药物异烟肼(H)、利福平(R)、链霉素(S)及乙胺丁醇(E)进行疗前药物敏感试验。结果430株结核分枝杆菌总耐药率为15.6%（67/430），耐多药率3.0%（13/430）；初始耐药率为12.3%（47/381），耐多药率1.8%（7/381）；获得性耐药率为40.8%（20/49），耐多药率12.2%（6/49）。复治组耐药率及耐多药率均显著高于初治组，差异有统计学意义（P<0.001）。4种抗结核药物的总体耐药率顺位由高到低依次为S（12.6%）、H（8.4%）、R（5.8%）、E（0.9%）；初始耐药率顺位为S（10.0%）、H(6.3%)、R(3.7%)、E(0.8%)；获得性耐药率顺位为S（32.7%）、H(24.5%)、R(22.4%)、E(2.0%)。初始耐药以耐单药为主，获得性耐药以耐2种药为主。经多因素非条件logistic回归分析，化疗史是影响耐药的主要因素，复治患者耐药率明显高于初治患者（OR=4.9，95%， CI为2.6～9.4，P<0.001），而不同年龄、不同性别、有无空洞、有无糖尿病对耐药率的影响差异无统计学意义（P>0.05）。复治患者既往治疗用药不规律是造成耐药的主要原因（OR=5.8，95%， CI为1.5～23.5，P<0.05）。结论朝阳区肺结核患者的耐药率处在全国较低水平。抓好初治病人的治疗管理，减少不规律用药，是控制耐药的关键。

Analysis of the status and risk factors of drug resistant tuberculosis in Chaoyang district in Beijing

Objective To find out the status and risk factors of drug-resistant tuberculosis in Chaoyang district, and to provide evidence for tuberculosis control in future. Methods All new and previously treated cases with positive sputum culture registered at Chaoyang TB control institute from 2006 to 2007 were enrolled as study population. Drug susceptibility of Mycobacterium tuber- culosis to isoniazid （H）, rifampicin （R）, streptomycin （S） and ethambutol （E） was tested by the absolute concentration method before treatment. Results The overall drug resistance of 430 strains was 15.6% （67/430）, the multi-drug resistance （MDR） was 3.0% （13/430）; the primary drug resistance and multi-drug resistance were 12.3% （47/381） and 1.8% （7/381）; the acquired drug resistance and multi-drug resistance were 40. 8% （20/49） and 12.2% （6/49）. The drug resistance and multi-drug resistance were higher in previously treated cases than in new cases, which was significant difference （P〈0. 001）. The overall drug resistance to four anti-tuberculosis drugs which sorted in descending order were S （12.6%）, H（8. 4%）, R（5.8%）and E（0.9%） ; the primary drug resistance were S （10.0%）, H（6.3%）, R（3.7%）and E（0.8%） ; the acquired drug resistance were S （32.7%）, H（24.5%）, R（22.4%）andE（2.0%）. Resistance to a single drug was main in new cases, while to 2 drugs was main in previously treated cases. Multivariate non-conditional logistic regression analysis showed that the with drug resistance, drug resista that among new cases （OR=4.9, history of previous treatment was the most significantly factor nce among previously treated cases was significantly higher than 95%CI 2.6-9.4, P〈0. 001）. The differences of age, gender, cavity and diabetes were not significantly correlated with drug resistance（P〉0.05）. The main reason of drug resistance for the previously treated cases was the irregular treatment （OR=5.8, 95% CI 1.5-23.5, P%0.05）. Conclusions The d