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[目的]确定2007年河南省5个县市的结核病耐药率及其危险因素。[方法]5个县市结核病防治中心所有痰涂片阳性病人按顺序入选,痰涂片用萋-尼氏染色法镜检,培养用罗杰氏培养基,对4种一线抗结核药物异烟肼、利福平、链霉素和乙胺丁醇采用比例法进行药敏试验。病人资料由经过培训的医生通过调查问卷获得。[结果]338例肺结核病人中,269例(79.6%)为新病人,69例为(20.4%)复治病人。新病人中任一耐药率和耐多药(MDR)率分别为17.5%和3.0%,复治病人分别为39.1%和21.7%。复治病人首次治疗超过6个月是任一耐药的危险因素(AOR=3.45,95%CI(1.25～9.09),P=0.017),复治病人(AOR=9.06,95%CI(3.62～22.67),P=0.000)以及曾经在其他地方居住1年以上(AOR=2.71,95%CI(1.10～6.69),P=0.030)是MDR的独立危险因素。[结论]河南省5个县市结核病任一耐药率和MDR率仍然很高,是实施DOTS策略和结核病控制面临的一个主要挑战。首次抗结核治疗6个月以上是任一耐药的危险因素,而复治病人以及在其他地方居住超过1年是MDR-TB的两个独立危险因素。全面实施MDR-TB控制以及提高DOTS质量是河南省结核病控制工作的当务之急。
[Objective] To determine the rate of TB drug resistance and its risk factors in five counties and cities in Henan Province in 2007. [Methods] All the sputum smear-positive patients in 5 counties and cities were selected according to the sequence. The sputum smear was examined by 萋-Nisshin staining, and cultured with Roger’s medium. Four kinds of first-line anti-TB drugs Hydrazine, rifampicin, streptomycin and ethambutol use the proportion method for susceptibility testing. Patient information is obtained from a trained doctor through a questionnaire. [Results] Of the 338 pulmonary tuberculosis patients, 269 (79.6%) were new patients and 69 (20.4%) were retreatment patients. The rates of resistance and MDR were 17.5% and 3.0% in new patients and 39.1% and 21.7% in retreatment patients respectively. The first treatment of retreatment patients for more than 6 months was a risk factor for either drug resistance (AOR = 3.45, 95% CI 1.25 to 9.09, P = 0.017), relapsed patients (AOR 9.06, 95% CI 3.62 to 22.67), P = 0.000) and those who had lived more than one year elsewhere (AOR = 2.71, 95% CI 1.10 to 6.69, P = 0.030) were independent risk factors for MDR. [Conclusion] Any one of the five counties and cities in Henan Province, tuberculosis resistance rate and MDR rate is still high, is the implementation of DOTS strategy and control of tuberculosis is a major challenge. The first anti-TB treatment for more than 6 months is a risk factor for any drug resistance, whereas rehospitalization and living in other places for more than 1 year are two independent risk factors for MDR-TB. The full implementation of MDR-TB control and improving the quality of DOTS are top priorities for tuberculosis control in Henan Province.