文章摘要
李静,张阳奕,桂晓虹,袁政安,潘启超,梅建,沈鑫.上海市耐多药结核病患者二线药物耐药情况及危险因素分析[J].中华流行病学杂志,2012,33(8):795-798
上海市耐多药结核病患者二线药物耐药情况及危险因素分析
Prevalence and risk factors an the reststane related to second-line drugs among multi—drug resistant tuberculosis Csses In Shanghm.China
收稿日期:2012-01-31  出版日期:2014-09-03
DOI:
中文关键词: 耐多药结核病  危险因素
英文关键词: Multidrug resistant tuberculosis  Risk factors
基金项目:上海市科学技术委员会基金(1IZRl430900.IOJCl413700);上海市卫生系统优秀青年人才培养计捌(XYQ2011051);“十一五”国家科技重大专项(2009Z.X10003-017]
作者单位E-mail
李静 上海市疾病预防控制中心 200336  
张阳奕 上海市疾病预防控制中心 200336  
桂晓虹 上海市疾病预防控制中心 200336  
袁政安 上海市疾病预防控制中心 200336  
潘启超 上海市疾病预防控制中心 200336  
梅建 上海市疾病预防控制中心 200336 meijiansh@yahoo.com.cn 
沈鑫 上海市疾病预防控制中心 200336 xshen@scddc.sh.cn 
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中文摘要:
      目的 分析上海市耐多药结核病(MDR-TB)患者二线药物耐药分布情况及危险因素。方法 收集2009年上海市各区(县)结核病定点医院痰培养阳性菌株,进行菌型鉴定和一线抗结核药物(异烟肼、利福平、链霉素及乙胺丁醇)敏感性检测,对耐多药菌株进行二线抗结核药物(卡那霉素、阿米卡星、卷曲霉素、氧氟沙星、对氨基水杨酸及丙硫异烟胺)敏感性检测,结合患者特征及实验室信息,采用多因素分析上海市MDR-TB患者二线药物耐药的危险因素。结果 2009年上海市确诊的1867例结核病病例中,112例(6.0%)为MDR-TB患者,其中58例(51,8%)至少耐1种二线抗结核药物,10例为广泛耐药结核病。多因素分析显示,MDR-TB患者中,45~59岁年龄组(aOR=4.76,P=0.001)及痰涂片阳性(aOR=6.51,P=0.026)与二线药物耐药相关。结论 上海市MDR-TB患者二线抗结核药物耐药情况严重,45~59岁年龄组和痰涂片阳性是MDR-TB患者二线药物耐药相关的危险因素。
英文摘要:
      Objective To determine the prevalence and risk factors on second-line drug resistance in patients with multidrug resistant tuberculosis(MDR-TB) in Shanghai,China.Methods All pulmonary TB patients with sputum culture positivity detected in Shanghai during January to December,2009,were enrolled.All of the pretreatment sputum-positive cultures samples were tested for routine specimen identification and routine drug susceptibility testing for first-line drugs(Isoniazid,Rrifampin,Ethambutol and Streptomycin).Drug susceptibility testing on second-line anti-TB drugs(Ofloxcin,Amikacin,Kanamycin,Capreomycin,P-aminosalicylic acid and Prothionamide) was routinely performed on isolates of Mycobacterium(M.) TB with MDR.Logistic regression analysis was conducted to determine the risk factors regarding second-line drug resistance.Results A total of 1867 patients infected with M.TB isolates were diagnosed at the TB hospitals/clinics in Shanghai during the study period,of whom 112(6.0%) were MDR-TB,in which 58 cases(51.8%) showed resistant to at least one of the second-line drugs tested and 10 cases belonged to extensively drug-resistant.In the multivariate analyses,MDR-TB patients who were aged 45-59 years(aOR=4.76,P=0.001),with sputum smear positivity(aOR=6.51,P=0.026) were significantly more likely to show resistance to second-line drugs.Conclusion The prevalence of second-line drug resistance among MDR-TB patients was high in Shanghai.MDR-TB patients who were under age of 45-59 years and with sputum smear positivity would represent important common risk factors for the resistance to second-line drugs.
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