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目的调查乌鲁木齐市肺结核病患者对8种抗结核药物的耐药情况,分析产生耐药的危险因素。方法以2014年3月1日—2015年3月31日乌鲁木齐市7区1县结核病定点医院确诊并收治的活动性肺结核患者为调查对象。用改良罗氏管进行分枝杆菌分离培养,培养阳性菌株采用比例法对8种抗结核药物进行药物敏感性试验,并对患者做问卷调查,对耐药情况和产生耐药性的危险因素进行统计学分析。结果 319例肺结核病患者中药物全敏感255例,耐药64例,经logistic多因素分析,耐药患者在性别(χ2=3.761)、年龄(χ2=0.121)、族别(χ2=1.346)、户籍(χ2=0.110)、文化程度(χ2=0.518)、婚姻状况(χ2=1.812)、职业(χ2=0.069)、医保类型(χ2=0.692)、人类免疫缺陷病毒(HIV)检测结果(χ2=0.373)、体质指数(BMI,χ2=0.071)、卡介苗接种(χ2=3.646)、吸烟(χ2=1.338)、饮酒(χ2=0.007)、体育锻炼(χ2=0.801)等因素耐药率差异均无统计学意义(均P>0.05);在治疗分类方面差异有统计学意义(χ2=8.782,P=0.003,OR=3.324),即复治产生耐药的危险性是初治的3.324倍(OR 95%CI为1.502~7.355)。结论对初治肺结核病患者要实施有效的治疗管理,确保规律治疗,尽可能减少耐药的产生;对复治患者尽可能做药敏试验,依据药敏结果进行个体化治疗。
Objective To investigate the drug resistance of 8 kinds of anti-tuberculosis drugs in patients with pulmonary tuberculosis in Urumqi and to analyze the risk factors of drug resistance. Methods From March 1, 2014 to March 31, 2015, patients with active tuberculosis diagnosed and admitted to tuberculosis designated hospitals in 7 districts and 1 county in Urumqi were investigated. Mycobacterium was isolated and cultured with modified Roche tube, and the positive strains were cultured to test the drug susceptibility of 8 kinds of anti-tuberculosis drugs by proportional method. The patients were surveyed, and the drug resistance and risk factors of drug resistance were statistically analyzed Analysis. Results Among the 319 pulmonary tuberculosis patients, 255 were sensitive and 64 were drug-resistant. According to logistic multivariate analysis, among the resistant (χ2 = 3.761), age (χ2 = 0.121) (Χ2 = 0.110), education level (χ2 = 0.518), marital status (χ2 = 1.812), occupation (χ2 = 0.069), medical insurance type (χ2 = 0.692) and HIV test results (Χ2 = 0.373), body mass index (χ2 = 0.071), BCG vaccination (χ2 = 3.646), smoking (χ2 = 1.338), alcohol consumption (Χ2 = 8.782, P = 0.003, OR = 3.324). The risk of resistance to retreatment was 3.324 times that of the initial treatment (OR 95% CI 1.502 ~ 7.355). Conclusions For patients with newly diagnosed pulmonary tuberculosis, effective treatment and management should be implemented to ensure regular treatment and reduce the generation of drug resistance as much as possible. Drug susceptibility testing should be conducted in retreatment patients as much as possible and individualized treatment should be based on drug susceptibility results.