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[目的]了解并掌握上海市流动人口肺结核耐药流行状况及其影响因素,为制定和实施针对流动人口肺结核的防治措施和提高管理水平提供依据。[方法]将2006年1—12月在上海市肺结核定点医院诊治的流动人口中痰培养阳性肺结核患者作为研究对象,收集其相关基本情况、流行病学和管理信息,进行菌型鉴定及利福平(R)、异烟肼(H)、链霉素(S)和乙胺丁醇(E)敏感性测试,分析本市流动人口肺结核耐药流行状况及其影响因素。[结果]共入选585例痰培养阳性肺结核患者。这些患者多为新发初治、青壮年、医疗保障不足,普遍存在就诊延误,部分患者因返乡治疗而流失,直接面视下短程督导化疗(DOTS)管理率、痰菌阴转率和治愈率都较低。总耐药率为20.00%,耐多药率为4.10%;初始耐药率为17.14%,初始耐多药率为3.43%;获得性耐药率为45.00%,获得性耐多药率为10.00%。4种药物中,S和H的耐药率最高(分别为14.87%和10.94%)。30～49岁组总耐药率最高,为8.72%;15～29岁组初始耐药率最高,为8.57%。经单因素和多因素分析,复治患者是流动人口耐药肺结核的相关因素。[结论]上海市流动人口肺结核耐药现象较为严重,今后要根据流动人口肺结核耐药流行病学特点加强防治措施。
[Objective] To understand and grasp the prevalence and influencing factors of pulmonary tuberculosis (TB) in floating population in Shanghai and provide the basis for developing and implementing prevention and treatment measures and improving the management level of tuberculosis for floating population. [Methods] The sputum culture positive pulmonary tuberculosis patients who were diagnosed and treated in Shanghai TB Hospital from January to December 2006 were selected as the research object, and their basic information, epidemiology and management information were collected, (R), isoniazid (H), streptomycin (S) and ethambutol (E) sensitivity test to analyze the floating population of tuberculosis drug-resistant prevalence and its influencing factors. [Results] A total of 585 sputum culture positive pulmonary tuberculosis patients were enrolled. Most of these patients were newly diagnosed, young and middle-aged, lack of medical insurance, prevalent treatment delays, loss of some patients due to return home treatment, management of short-distance supervising and directing chemotherapy (DOTS), sputum negative conversion rate and cure Rate is lower. The total drug resistance rate was 20.00%, the multi-drug resistance rate was 4.10%, the initial drug resistance rate was 17.14%, the initial multi-drug resistance rate was 3.43%, the acquired drug resistance rate was 45.00% and the acquired multidrug resistance rate was 10.00 %. Of the four drugs, S and H had the highest rates of resistance (14.87% and 10.94%, respectively). The total drug resistance rate was highest in 30-49 years old group, accounting for 8.72%. The highest initial drug resistance rate was 8.57% in 15-29 years old group. After univariate and multivariate analysis, relapsed patients were the related factors of drug-resistant pulmonary tuberculosis in floating population. [Conclusion] The pulmonary TB resistance in Shanghai floating population is more serious. In the future, the prevention and treatment measures should be strengthened according to the epidemiological characteristics of TB resistance in floating population.