2008年深圳市肺结核患者耐药监测分析

目的 掌握深圳市结核分枝杆菌的耐药水平及其影响因素,为有效控制耐药结核病提供依据.方法 依据WHO/IUALD结核病耐药指南,将深圳市2008年度新登记的初治涂阳和复治涂阳肺结核患者纳入研究对象,用比例法进行药物敏感试验获得耐药情况,通过问卷调查方式收集患者信息,经过单因素及多变量Logistic逐步回归分析,了解结核分枝杆菌产生耐药的主要影响因素.结果 （1）769例分离有效菌株中,759例为结核分枝杆菌,其总耐药率为20.2%（153/759）,耐多药率为5.1%（39/759）.结核分枝杆菌耐药患者中,流动人口占87.6%（134/153）,初治患者占79.1%（121/153）;（2）经卡方检验,初、复治肺结核患者的耐药情况差异有统计学意义（x2=15.632,P〈0.001）.趋势检验显示体重指数（BMI）与耐药危险性有线性趋势（x2=4.403,P〈0.05）;（3）登记分类、BMI、家庭肺结核接触史最终进入Logistic逐步回归模型.结论 2008年深圳市结核病耐药水平仍较高,复治患者发生耐药的危险性较高,深圳耐药控制工作需以流动人口和初治肺结核患者的治疗和管理为基础.

Analysis on the monitoring results of drug resistance of the tuberculosis in Shenzhen City in 2008

Objective To study the present status of drug resistance in tuberculosis （DR-TB） and find factors contribute to drug resistance and to control DR-TB effectively.Methods According to the guideline for Surveillance of Drug Resistance in Tuberculosis （WHO/IUALD）,all new smear positive cases and new registered retreatment smear positive cases in 2008 were studied.Drug susceptibility was tested by the proportion method.The information was collected through questionnaires.Univariate analysis and multivariable logistic regression analysis were used to find the risk factors on developing anti-TB drugs.Results （1） Among 769 clinical isolated strains,759 cases were Mycobacterium tuberculosis.The total rate of DR-TB in 759 cases was 20.2% and the multi-drug resistance rate was 5.1%.87.6%（134/153） of DR-TB patients were floating population,and 79.1%（121/153） of them were the initially treated cases.（2） By Chi-square test,there was a significant difference between new and re-treatment patients on drug resistance （χ2=15.632,P0.001）.The linear trend test showed that there was a linear relationship between Body Mass Index （BMI） and Drug resistance （χ2=4.403,P0.05）.（3） The binary logistic stepwise regression analysis demonstrated that the treatment class,BMI and family contacting integrate into the regression equation.Conclusions The drug resistance rate of pulmonary tuberculosis of Shenzhen was high in 2008.The re-treatment patients had higher risk to develop anti-TB drug resistance,and DR-TB control in Shenzhen should be on the basis of the floating population cases and the previously untreated cases.