海南省结核分枝杆菌耐药影响因素分析

目的探讨海南省结核菌耐药影响因素,为制定耐药结核病防控措施提供科学依据。方法将全省18个市县均纳入调查点,通过调查问卷获取患者相关信息,采用比例法进行药敏试验,检测药物包括异烟肼(H)、利福平(R)、链霉素(S)、乙胺丁醇(E)、卡那霉素(Km)和氧氟沙星(Ofx);采用多因素非条件Logistic回归分析耐药的影响因素。结果纳入耐药分析的患者1 155例,其中初治880例,复治275例。总体耐药率和耐多药率分别为20.87%、7.53%。影响因素分析表明,对于初治患者,女性(χ2=4.35,P=0.04,OR=0.51,95%CI=0.27~0.96)和年龄的增长(χ2=4.03,P=0.04,OR=1.02,95%CI=1.00~1.04)是发生耐药、耐多药结核病的危险因素;对于复治患者,接受过2次以上抗结核药物治疗(χ2=4.07,P=0.04,OR=0.61,95%CI=0.38~0.99)、首次在综合医院治疗(χ2=5.28,P=0.02,OR=3.06,95%CI=1.18~7.96)、无人监督服药(χ2=4.99,P=0.03,OR=0.43,95%CI=0.21~0.90)、有药物副反应(χ2=5.71,P=0.02,OR=2.42,95%CI=1.17~4.98)发生耐药的风险较高,而产生耐多药的危险因素主要是有药物副反应发生(χ2=10.14,P=0.00,OR=3.40,95%CI=1.60~7.23)。结论女性及年老的初治患者发生耐药、耐多药结核病的风险较高;患者初次治疗在综合医院、有药物副反应发生、无人监督服药且多次治疗是复治患者产生耐药的危险因素。

Risk factor analysis of drug-resistant tuberculosis in Hainan Province

Objective To identify risk factors associated with drug resistant tuberculosis and multidrug-resistant tuberculosis in new and retreatment cases in Hainan Province, and provide scientific basis for the efficient control and prevention of drug-resistant tuberculosis. Methods Eighteen counties in Hainan Province were selected as samples. Clinical information of patients was collected through questionnaires, and proportion methods were employed for drug susceptibility test ( DST ) including:rifampicin, isoniazid, streptomycin, ethambutol, ofloxacin and kanamycin. The risk factors toward drug-resistant patients were assessed by multivariate non-conditional logistic regression model. Results Of the 1 155 TB cases, 880 were initial treated cases, and 275, repeated treatment cases. The total drug-resistance rate and multi-drug resistance rate were 20. 9%, 7. 5% respectively. The multivariate analysis results showed that female gender (χ2 =4. 35,P=0. 04,OR=0. 51, 95%CI=0. 27 ~0. 96 ) and older cases (χ2 =4. 03,P=0. 04,OR=1. 02, 95%CI =1. 00 ~1. 04) were independent risk factors for the presence of drug resistant TB and MDR-TB in initial treatment cases. Retreatment patients who had previously been treated for TB for more than 2 times (χ2 =4. 07,P=0. 04,OR=0. 61, 95%CI=0. 38~0. 99),the initial treated patients by medical facility (χ2 =5. 28,P=0. 02,OR=3. 06,95%CI =1. 18~7. 96 ), the non-supervised treated patients (χ2 =4. 99,P=0. 03,OR=0. 43, 95%CI=0. 21~0. 90) and those with adverse drug reactions (χ2 =5. 71,P=0. 02, OR=2. 42, 95%CI=1. 17 ~4. 98 ) were significantly more likely to have drug resistance. While adverse drug reactions (χ2 =10. 14,P=0. 00,OR=3. 40,95%CI=1. 60~7. 23) were independent risk factors for the presence of MDR-TB in retreated patients. Conclusion Initial treated cases who were female and elderly were at high risk for developing drug resistant to TB and MDR-TB;while the initial treated patients by medical facility, those with adverse drug reactions, non-supervised, and repeated TB treatment for more than 2 times were independent risk factors for the development of drug resistant to TB.