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

李静; 张阳奕; 桂晓虹; 袁政安; 潘启超; 梅建; 沈鑫

Abstract

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].Chinese journal of Epidemiology,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

Received:January 31, 2012

DOI：

KeyWord: 耐多药结核病危险因素

English Key Word: Multidrug resistant tuberculosis Risk factors

FundProject: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]

Author Name	Affiliation	E-mail
LI Jing	Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
ZHANG Yangyi	Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
GUI Xiaohong	Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
YUAN Zhengan	Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
PAN Qichao	Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
MEI Jian	Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China	meijiansh@yahoo.com.cn
SHEN Xin	Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China	xshen@scddc.sh.cn

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Abstract:

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。

English Abstract:

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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