阳江市肺结核患者耐药状况调查及影响因素分析
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摘要
目的研究我院肺结核患者耐药情况,并分析其影响因素。方法选择我院收治的118例耐药肺结核患者作为耐药组,同期收治的非耐药肺结核患者120例作为非耐药组,对两组临床资料(年龄、性别、初复治、治疗过程中断、依从医嘱治疗、用药是否合理、居住地、人口构成及药物不良反应)进行统计分析,再通过Logistic回归分析对肺结核耐药相关因素进行分析。结果药敏试验显示,单耐药45例(38.14%),多耐药73例(61.86%),耐多药56例(47.46%),泛耐药24例(20.33%),原发性耐药61例(51.69%),继发性耐药57例(48.31%)。肺结核原发性耐药患者耐1种药的耐药率为16.39%,耐2种及2种以上药物耐药率为26.23%;继发性耐药患者耐1种药的耐药率为21.05%,耐2种及2种以上药物耐药率为35.09%。两组患者年龄、性别比例方面比较,差异无统计学意义(P>0.05)。耐药组患者在初复治、治疗过程中断、是否依从医嘱治疗、用药是否合理、居住地、人口构成及药物不良反应与非耐药组比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,初复治、治疗中断、居住地(农村)及人口构成(流动人口)是影响肺结核耐药的危险因素(P<0.05),合理用药、依从医嘱治疗是影响肺结核耐药的保护因素(P<0.05),年龄与肺结核耐药无相关性(P>0.05)。结论复治、医嘱依从性差、用药不合理、居住地农村及流动人口患者易发生肺结核耐药。因此,应加强医院合理用药、医患沟通,普及结核知识,加强流动人口管理及提高患者治疗依从性来提高肺结核治愈率,预防耐药发生。
Objective To investigate the drug resistance of tuberculosis patients in our hospital and analyze the influencing factors.Methods Totally 118 patients with drug-resistant pulmonary tuberculosis in our hospital were selected as drug resistance group,and 120 patients with non-drug-resistant pulmonary tuberculosis were selected as non-drug resistant group at the same time.The clinical data(age,sex,first treatment and retreatment,interruption of treatment process,compliance with medical advice,rational use of drug,residence,population composition,and adverse drug reactions) of two groups were statistically analyzed,then Logistic regression analysis was used to analyze the factors which influence the drug resistance of pulmonary tuberculosis.Results Drug sensitivity test showed that there were 45 cases of mono-drug resistance(38.14%),73 cases of poly-drug resistance(61.86%),56 cases of multi-drug resistance(47.46%),24 cases of extensive drug resistance(20.33%),61 cases of primary drug resistance(51.69%),and 57 cases of secondary drug resistance(48.31%).The resistance rate of primary drug-resistant patients resistant to one drug was 16.39%,and the resistance rate of them resistant to two or more kinds of drugs was 26.23%;the drug resistance rate of secondary drug-resistant patients to one drug was 21.05 %,and the resistance rate of them to 2 or more kinds of drugs was 35.09%.There was no significant difference in age or sex ratio between the two groups(P>0.05).There were significant differences in the first treatment and retreatment,interruption of treatment process,compliance with medical advice,rational use of drug,residence,population composition and the adverse drug reactions between drug resistant group and non-drug resistant group(P<0.05).Logistic regression analysis showed that the primary treatment and retreatment,interruption of treatment,residence(rural) and population composition(migrant population) were the risk factors for the drug resistance of pulmonary tuberculosis(P<0.05),rational drug use and compliance with medical advice were protective factors that affect the drug resistance of tuberculosis(P<0.05),and there was no correlation between age and drug resistance of pulmonary tuberculosis(P>0.05).Conclusion Patients with retreatment,poor compliance,irrational drug use,rural resident and floating population are prone to drug resistance;therefore,we should promote the rational use of drugs and communication between doctors and patients,popularize the knowledge of tuberculosis,strengthen the management of floating population and improve the compliance of patients in order to improve the cure rate of tuberculosis and prevent the occurrencing of drug resistance.
Objective To investigate the drug resistance of tuberculosis patients in our hospital and analyze the influencing factors.Methods Totally 118 patients with drug-resistant pulmonary tuberculosis in our hospital were selected as drug resistance group,and 120 patients with non-drug-resistant pulmonary tuberculosis were selected as non-drug resistant group at the same time.The clinical data(age,sex,first treatment and retreatment,interruption of treatment process,compliance with medical advice,rational use of drug,residence,population composition,and adverse drug reactions) of two groups were statistically analyzed,then Logistic regression analysis was used to analyze the factors which influence the drug resistance of pulmonary tuberculosis.Results Drug sensitivity test showed that there were 45 cases of mono-drug resistance(38.14%),73 cases of poly-drug resistance(61.86%),56 cases of multi-drug resistance(47.46%),24 cases of extensive drug resistance(20.33%),61 cases of primary drug resistance(51.69%),and 57 cases of secondary drug resistance(48.31%).The resistance rate of primary drug-resistant patients resistant to one drug was 16.39%,and the resistance rate of them resistant to two or more kinds of drugs was 26.23%;the drug resistance rate of secondary drug-resistant patients to one drug was 21.05 %,and the resistance rate of them to 2 or more kinds of drugs was 35.09%.There was no significant difference in age or sex ratio between the two groups(P>0.05).There were significant differences in the first treatment and retreatment,interruption of treatment process,compliance with medical advice,rational use of drug,residence,population composition and the adverse drug reactions between drug resistant group and non-drug resistant group(P<0.05).Logistic regression analysis showed that the primary treatment and retreatment,interruption of treatment,residence(rural) and population composition(migrant population) were the risk factors for the drug resistance of pulmonary tuberculosis(P<0.05),rational drug use and compliance with medical advice were protective factors that affect the drug resistance of tuberculosis(P<0.05),and there was no correlation between age and drug resistance of pulmonary tuberculosis(P>0.05).Conclusion Patients with retreatment,poor compliance,irrational drug use,rural resident and floating population are prone to drug resistance;therefore,we should promote the rational use of drugs and communication between doctors and patients,popularize the knowledge of tuberculosis,strengthen the management of floating population and improve the compliance of patients in order to improve the cure rate of tuberculosis and prevent the occurrencing of drug resistance.
引文
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[11]黄静静,陈亚玲,熊昌富,等.海南省92例肺结核耐药的危险因素分析[J].中国热带医学,2018,18(2):125-127.
[12]马艳,尹韶华,杜建,等.383例耐药肺结核患者的相关危险因素分析[J].结核病与肺部健康杂志,2016,5(2):128-134.
[13]杨文婷,廖江荣,张先明,等.贵州省119例肺结核耐药的危险因素分析[J].贵阳医学院学报,2016,41(3):326-329.
[14]王玉红,董雅坤,王智慧,等.首次复治涂阳肺结核患者耐药情况分析[J].中国防痨杂志,2017,39(2):179-183.
[15]Merza MA,Farnia P,Tabarsi P,et al.Anti-tuberculosis drug resistance and associated risk factors in a tertiary level TB center in Iran:a retrospective analysis[J].J Infect Dev Ctries,2011,5(7):511-519.
[16]Ullah I,Javaid A,Tahir Z,et al.Pattern of drug resistance and risk factors associated w ith development of drug resistant mycobacterium tuberculosis in Pakistan[J].PLoS One,2016,11(1):e0147529.
[17]高会霞,侯军良,张志,等.346例肺结核患者结核分枝杆菌耐药性调查及耐多药结核病影响因素分析[J].中国防痨杂志,2015,37(11):1130-1135.
[2]World Health Organization.Global tuberculosis report 2015[M].World Health Organization,2015.
[3]王巧智,龚德华.结核病疫情现状和控制策略[J].实用预防医学,2017,24(3):257-259,351.
[4]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[5]中国防痨协会基础专业委员会.结核病诊断实验室检验规程[M].北京:中国教育文化出版社,2006:46-65.
[6]张斯钰,白丽琼,谭红专,等.Morisky服药依从性量表在肺结核患者中的应用[J].中国防痨杂志,2010,32(9):527-530.
[7]李哲明,谭守勇,邝浩斌,等.早期广泛耐药肺结核近期临床疗效分析[J].实用医学杂志,2016,32(11):1764-1766.
[8]李志强,刘凤新,何玉霞.中西医结合治疗耐多药肺结核的疗效及对患者免疫功能的影响[J].世界中医药,2018,13(7):1605-1608.
[9]El-Din MAT,Halim AE,El-Tantawy AM.Adverse reactions among patients being treated for multi-drug resistant tuberculosis in Egypt from July 2006 to January 2009[J].Egypt J Chest Dis Tuberculosis,2015,64(3):657-664.
[10]周建文.耐药结核病现状及影响因素研究新进展[J].世界最新医学信息文摘,2016,16(42):23-26.
[11]黄静静,陈亚玲,熊昌富,等.海南省92例肺结核耐药的危险因素分析[J].中国热带医学,2018,18(2):125-127.
[12]马艳,尹韶华,杜建,等.383例耐药肺结核患者的相关危险因素分析[J].结核病与肺部健康杂志,2016,5(2):128-134.
[13]杨文婷,廖江荣,张先明,等.贵州省119例肺结核耐药的危险因素分析[J].贵阳医学院学报,2016,41(3):326-329.
[14]王玉红,董雅坤,王智慧,等.首次复治涂阳肺结核患者耐药情况分析[J].中国防痨杂志,2017,39(2):179-183.
[15]Merza MA,Farnia P,Tabarsi P,et al.Anti-tuberculosis drug resistance and associated risk factors in a tertiary level TB center in Iran:a retrospective analysis[J].J Infect Dev Ctries,2011,5(7):511-519.
[16]Ullah I,Javaid A,Tahir Z,et al.Pattern of drug resistance and risk factors associated w ith development of drug resistant mycobacterium tuberculosis in Pakistan[J].PLoS One,2016,11(1):e0147529.
[17]高会霞,侯军良,张志,等.346例肺结核患者结核分枝杆菌耐药性调查及耐多药结核病影响因素分析[J].中国防痨杂志,2015,37(11):1130-1135.