河南省5县市2007年耐药结核病及危险因素研究

[目的]确定2007年河南省5个县市的结核病耐药率及其危险因素。[方法]5个县市结核病防治中心所有痰涂片阳性病人按顺序入选,痰涂片用萋-尼氏染色法镜检,培养用罗杰氏培养基,对4种一线抗结核药物异烟肼、利福平、链霉素和乙胺丁醇采用比例法进行药敏试验。病人资料由经过培训的医生通过调查问卷获得。[结果]338例肺结核病人中,269例(79.6%)为新病人,69例为(20.4%)复治病人。新病人中任一耐药率和耐多药(MDR)率分别为17.5%和3.0%,复治病人分别为39.1%和21.7%。复治病人首次治疗超过6个月是任一耐药的危险因素(AOR=3.45,95%CI(1.25～9.09),P=0.017),复治病人(AOR=9.06,95%CI(3.62～22.67),P=0.000)以及曾经在其他地方居住1年以上(AOR=2.71,95%CI(1.10～6.69),P=0.030)是MDR的独立危险因素。[结论]河南省5个县市结核病任一耐药率和MDR率仍然很高,是实施DOTS策略和结核病控制面临的一个主要挑战。首次抗结核治疗6个月以上是任一耐药的危险因素,而复治病人以及在其他地方居住超过1年是MDR-TB的两个独立危险因素。全面实施MDR-TB控制以及提高DOTS质量是河南省结核病控制工作的当务之急。

PREVALENCE AND RISK FACTORS OF DRUG RESISTANT TUBERCULOSIS IN 5 COUNTIES(CITIES)IN HENAN OF 2007

[Objective]To determine the prevalence and risk factors of drug resistant tuberculosis in the five counties(cities)in Henan in 2007.[Methods]Intake of patients was succeed in the 5 TB centers.Ziehl-Neelsen staining was used for sputum smear microscopy,and Loewenstein-Jensen medium for culture.Proportion method was used for drug susceptibility tests for the four first line anti-tuberculosis drugs,isoniazid,rifampicin,streptomycin and ethambutol.Data were collected by trained clinicians using a standardized questionnaire.[Results]Of the 338 pulmonary TB cases,269(79.6%)were new cases and 69(20.4%)previously treated cases.The Prevalence of any drug resistance and MDR-TB was 17.5% and 3.0% in new cases,and 39.1% and 21.7% in previously treated cases,respectively.Treatment ﹥6 months in the first episode of treatment was the risk factor of any drug resistance(AOR=3.45,95% CI(1.25-9.09),P = 0.017).Previous treatment(AOR=9.06,95% CI(3.62-22.67),P = 0.000)and once lived in other place more than one year(AOR=2.71,95% CI(1.10-6.69),P = 0.030)were the independent risk factors associated with MDR-TB.[Conclusion]The prevalence of any drug resistance and MDR-TB was still high and a major challenge for DOTS implementation and TB control in the 5 counties(cities)in Henan.Patients with first episode of treatment ﹥6 months was a risk factor for any drug resistance,and previously treated cases and lived in other places for more than one year are independent risk factors for MDR-TB.It is urgent to fully implement MDR-TB project as well as to improve the quality of DOTS in Henan.