目的 分析江西省会昌县2019—2022年结核杆菌痰涂片镜检阳性(简称涂阳)肺结核患者耐药情况及相关危险因素,为临床结核病治疗提供依据。方法 收集和分析江西省会昌县2019—2022年耐药涂阳肺结核患者和非耐药涂阳肺结核患者的相关数据,对涂阳肺结核患者的痰标本进行结核菌培养和药敏试验,采用SPSS 22.0分析肺结核患者发生耐药的相关危险因素。结果 1 041例涂阳肺结核患者中,耐药肺结核416例(39.96%)、非耐药肺结核625例(60.04%);耐药率较高的抗肺结核药物分别为异烟肼(26.71%)、利福平(19.60%)、链霉素 (17.20%)。多因素非条件logistic回归分析显示,复治(OR = 3.780,95%CI:2.870～4.988)、不规范服药(OR=3.420,95%CI:2.567～4.549)、合并糖尿病(OR=1.850,95%CI:1.420～2.412)、肺部有结核灶(OR =3.830,95%CI:2.863～5.120)是涂阳肺结核患者发生耐药的危险因素。结论 复治、不规范服药、合并糖尿病及肺部有结核灶是涂阳肺结核患者耐药的危险因素,应规范用药,提高肺结核治愈率,积极治疗肺结核的合并症,减少抗肺结核药物耐药的发生。
Abstract
Objective To analyze the situation and related risk factors of anti-tuberculosis drug resistance in patients with smear positive pulmonary tuberculosis in Huichang County,Jiangxi Province from 2019 to 2022,so as to provide basis for clinical tuberculosis treatment. Methods The related data of drug-resistant pulmonary tuberculosis and non-drug-resistant pulmonary tuberculosis in Huichang County,Jiangxi Province from 2019 to 2022 were collected and analyzed.The sputum samples of smear positive patients were tested for mycobacterium tuberculosis culture and drug sensitivity test.The risk factors of drug resistance of pulmonary tuberculosis were analyzed by SPSS 22.0. Results Among the 1 041 patients with smear positive pulmonary tuberculosis,416 (39.96%) were drug-resistant pulmonary tuberculosis and 625 (60.04%) were non-drug-resistant pulmonary tuberculosis.The high drug resistance rates of anti-tuberculosis drugs were isoniazid (26.71%),rifampicin (19.60%) and streptomycin (17.20%).Multivariate unconditional logistic regression analysis showed that retreatment (OR=3.780,95%CI:2.870-4.988),irregular medication (OR=3.420,95%CI:2.567-4.549),combined diabetes mellitus (OR=1.850,95%CI:1.420-2.412) and tuberculosis foci in the lungs (OR=3.830,95%CI:2.863-5.120) were risk factors for drug resistance of pulmonary tuberculosis. Conclusion Retreatment,non-standard medication,comorbid diabetes mellitus and tuberculosis foci in the lungs are the risk factors for drug resistance of pulmonary tuberculosis patients.Standardized medication should be used to improve the cure rate of pulmonary tuberculosis.Comorbidities of tuberculosis should be treated aggressively to reduce the incidence of anti-tuberculosis drug resistance.
关键词
肺结核 /
耐药 /
危险因素 /
防控措施
Key words
Pulmonary tuberculosis /
Drug resistance /
Risk factors /
Prevention and control measures
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