甘肃省初治肺结核患者耐药现状及耐多药影响因素分析

马玲; 辜吉秀; 李晴; 李银花; 王冬冬; 何健; 司红艳

Abstract

马玲,辜吉秀,李晴,李银花,王冬冬,何健,司红艳.甘肃省初治肺结核患者耐药现状及耐多药影响因素分析[J].Chinese journal of Epidemiology,2022,43(7):1093-1098

甘肃省初治肺结核患者耐药现状及耐多药影响因素分析

Current situation on drug resistance and influencing factors of multidrug-resistance in newly treated pulmonary tuberculosis patients in Gansu province

Received:November 17, 2021

DOI：10.3760/cma.j.cn112338-20211117-00896

KeyWord: 肺结核耐多药影响因素

English Key Word: Pulmonary tuberculosis Multidrug-resistance Influencing factors

FundProject:甘肃省自然科学基金(145RJZA148,21JR11RA184);甘肃省卫生行业科研计划(GSWSKY-2014-24)

Author Name	Affiliation	E-mail
Ma Ling	Institute of Tuberculosis Prevention and Control, Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730020, China
Gu Jixiu	Institute of Tuberculosis Prevention and Control, Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730020, China
Li Qing	Institute of Tuberculosis Prevention and Control, Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730020, China
Li Yinhua	Institute of Tuberculosis Prevention and Control, Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730020, China
Wang Dongdong	Institute of Tuberculosis Prevention and Control, Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730020, China
He Jian	Office of Gansu Provincial Red Cross Blood Center, Lanzhou 730000, China
Si Hongyan	Institute of Tuberculosis Prevention and Control, Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730020, China	1134864781@qq.com

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Abstract:

目的分析甘肃省初治肺结核患者耐药现状及其影响因素，为精准防控提供参考依据。方法纳入2014年9月至2017年8月甘肃省30家结核病定点医疗机构（耐药监测点）初治肺结核患者，并进行问卷调查。临床分离的结核分枝杆菌进行异烟肼、利福平、乙胺丁醇、链霉素、卡那霉素、阿米卡星、氧氟沙星、卷曲霉素、丙硫异烟胺和对氨基水杨酸钠10种抗结核药物表型药敏（比例法）鉴定。采用logistic回归模型分析耐多药结核病产生的危险因素。结果 1 815例初治患者中，1例患者对应1株结核分枝杆菌，其中总耐药率、单耐药、多耐药、耐多药和广泛耐药率及其95%CI分别为25.45%（23.45%~27.46%）、11.40%（9.94%~12.87%）、6.23%（5.11%~7.34%）、7.82%（6.59%~9.06%）、0.28%（0.03%~0.52%）；142例耐多药患者中，农民、20~59岁青壮年及低收入者分别占90.85%、62.68%、31.69%。单因素及多因素分析结果显示，男性、少数民族、治疗<1个月且停药<2个月为耐多药结核病的危险因素。结论与全国平均水平相比，甘肃省初治患者总耐药率低，但耐多药率高。对农村低收入结核病患者提供救助是甘肃省遏制耐多药传播的重要策略，重点关注并解决患者治疗不规范及依从性差等问题

English Abstract:

Objective In order to provide the precise prevention and control strategy of drug resistance TB in Gansu province, we analyzed the status and risk factors of new drug resistance pulmonary tuberculosis patients. Methods New pulmonary tuberculosis patients were enrolled from 30 tuberculosis-specialized medical institutions (drug resistance monitoring stations) in Gansu province between first September 2014 to 31^th August 2017, and filled in the survey questionnaire. The isolated Mycobacterium tuberculosis (MTB) strains were implemented 10 drugs drug- susceptibility tes, including isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (Sm), kanamycin (Km), amikacin (Am), ofloxacin (Ofx), capreomycin (Cm), propithio-iso-nicotinamide (Pto).The risk factors were analyzed by logistic regression model. Results One patient was corresponding one clinical isolates among 1 815 patients. The rate (95%CI) of total drug-resistance, single drugresistance, multiple drug- resistance, multidrug-resistance and extensively drug-resistant were 25.45% (23.45%-27.46%), 11.40% (9.94%-12.87%),6.23% (5.11%-7.34%), 7.82% (6.59%-9.06%) and 0.28% (0.03%-0.52%) respectively. Among 142 multidrug-resistant TB patients, the farmers, young adults aged 20-59 and low-income group were 90.85%, 62.68% and 31.69%, respectively. The results of univariate and multivariate analysis showed that the male, non-Han, treatment less than 1 month group and treatment less than 1 month and withdrawal less than 2 month group were risk factors of new multidrug-resistant pulmonary TB. Conclusions Compared with the Chinese national baseline level of TB resistance, the total drug resistance rate of new TB patients in Gansu province was low, but the multidrug-resistance rate was high. The health assistance for rural low-income TB patients was still an important strategy to prevent and control multidrug-resistant in Gansu province. And measures must implement to stop irregular treatment and poor compliance, as the risk factors of multidrug-resistance in new PTB patients.

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