武汉市耐药/耐多药结核病影响因素分析

目的 探索武汉市耐药/耐多药结核患者的影响因素，为制定武汉市耐药结核病防控措施提供科学的参考依据。方法 对2006年12月~2014年6月武汉市登记管理的5 524例耐多药可疑者进行筛查（痰培养、菌型鉴定及药敏检测），发现耐药病例。描述不同分类的结核病患者耐药率，采用χ2检验和非条件Logistic回归分析进行耐药影响单因素和多因素分析。结果 武汉市结核分枝杆菌总耐药率为33.4%（1 627/4 870）。近4年来，总耐药率和复治患者耐药率均呈下降趋势（均有P<0.05），初治患者耐药率无上升趋势（χ_趋势2=0.79，P=0.372）；总耐多药率、初治和复治患者耐多药率均呈下降趋势（均有P<0.05）。多因素Logistic回归分析显示，复治患者较初治患者更易产生耐药（OR=2.212，95%CI:1.949~2.491，P<0.001）和耐多药（OR=3.433，95%CI:2.844~4.193，P<0.001）。结论 武汉市耐药和耐多药结核病疫情呈下降趋势，仍需加强对有既往结核病史患者的治疗和管理，以降低耐药/耐多药结核病疫情。

Analysis on the influential factors of drug resistance and multidrug resistant tuberculosis in Wuhan City

Objective To investigate the influential factors of drug resistance or multidrug resistance of tuberculosis patients in Wuhan,and to provide scientific basis for municipal control strategy for drug resistance. Methods From December 2006 to June 2014,a total of 5 524 smear positive tuberculosis(TB) patients were screened for The Globel Fund to Tuberculosis project in Wuhan. Sputum samples were then smear cultured,identified and tested for drug susceptibility test (DST). DST results were statistically analyzed as patterns of drug resistance. The drug resistant rates of tuberculosis patients with different categories were described;χ2 test and an unconditioned logistic regression were employed to carry out univariate as well as multivariate analysis on influential factors of drug resistant TB. Results The total drug resistance rate among these patients was 33.4% (1 627/4 870).There were decrease in total drug resistance and acquired drug resistance (all P<0.05). No upward trend was visible in terms of drug resistant rate of initial TB patients(χ_trend2=0.79,P=0.372). There were decrease in total multidrug-resistance,initial multidrug-resistance,and acquired multidrug-resistance (all P<0.05) in recent four years. The multivariate Logistic analysis results showed that the history of previous treatment for TB were more likely to have drug resistance(OR=2.212,95% CI:1.949-2.491,P<0.001) and multidrug-resistance(OR=3.433,95% CI:2.844-4.193,P<0.001) than primary treatment. Conclusions The epidemic of drug resistant and multidrug resistant Tuberculosis is falling. However to maintain the current downward trend, a strengthened effort must be put into the treatment and management of patients with a history of TB treatment.