苏北农村耐药结核病现状及影响因素的研究

目的 探讨农村耐药结核病的流行现状与可能的危险因素及保护因素。方法 对实施直接面视下短程化疗(DOTS)的苏北某项目县2002年全部结核病患者和某非项目县同期患者的一个样本进行问卷调查和痰菌培养,对新分离株进行比例法药敏试验,以单因素及多因素非条件logistic回归方法分析资料。结果 共有152例患者的药敏结果可以分析。其中32.9％的病例耐至少1种一线药,26.3％耐异胭肼(INH),18.4％耐利福平(RIF),17.1％同时耐INH和RIF。INH耐药和RIF耐药共同的独立危险因素是结核病治疗史和来自非项目县,而不重视自身健康和就医延误1个月以上的患者更可能耐RIF。耐多药(MDR)的独立预告因素包括:就医延误1个月以上(OR=4.66,95％CI:1.26～17.24)、来自非项目县(OR=3.01,95％CI:1.10～8.22)、不重视健康(OR=5.13,95％CI:1.06～24.90)和患有慢性病(OR=0.22,95％CI:0.05～0.87)。结论 当地农村耐药结核病疫情严重,耐药性主要与人为因素有关,但可能存在一定的传播。

Study on the epidemiology and determ inants of drug-resistant tuberculosis in northern rural area of Jiangsu province

Objective To understand the determinants and epidemiology of drug-resistanttuberculosis (TB) in rural area. Methods All the diagnosed TB patients in a county with directly observedtreatment (DOTS) short-course program in 2002 and a sample of patients in another county without DOTSprogram located in northern Jiangsu province were surveyed with questionnaires. Drug susceptibility testing(DST) for positive cultures were performed by standardized proportion method. Univariable analysis andmultivariate nonconditional logistic regression modeling were applied for data analysis. Results Among the152 patients with DST results, 32. 9% of the cases showed resistance to at least one of the first-line anti-tuberculosis drugs with 26. 3% to isoniazid, 18. 4% to rifampin and 17. 1% to both isoniazid and rifampinrespectively. Previous treatments for TB and residence in the county without DOTS program wereindependent risk factors for isoniazid and rifampin resistance TB patients showing indifferent to theirhealth and delayed health seeking for more than 1 month were more likely to have rifampin resistance.Independent predictors of multidrug-resistant TB would include delayed health seeking for more than 1month (OR=4.66, 95% CI: 1. 26-17.24), residing in the county without a DOTS program (OR=3.01,95 % CI: 1. 10-8.22), indifference to their health condition (OR=5.13, 95% CI: 1. 06-24. 90) andsuffering from chronic diseases (OR=0.22, 95% CI: 0. 05-0. 87). Conclusion Drug-resistant TB wasquite serious in this rural areas, mainly associated with man-made factors but partly due to the availability ofthe transmission.