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目的 了解西北地区结核分枝杆菌耐药状况及其影响因素,为预防和控制耐药结核病提供基础科学依据.方法 选取中国西北4省、自治区(甘肃、西藏、新疆、内蒙古)2005-2011年从结核病患者痰标本中分离培养的757株结核分枝杆菌(MTB),采用比例法检测MTB对4种一线抗结核药物链霉素(SM)、利福平(RFP)、异烟肼(INH)和乙胺丁醇(EMB)的敏感性,结合病例背景资料分析相关影响因素.结果 共检测了757株结核分枝杆菌,对SM、RFP、INH和EMB的耐药率分别为28.14％、26.68％、26.02％和7.53％,总的耐药率和耐多药率分别为40.55％和18.63％.西藏、新疆、甘肃和内蒙古的总耐药率和MDR率分别为64.42％和42.94％、40.48％和23.81％、41.61％和3.36％、27.90％和11.29％.x2检验结果显示,各省份间菌株对INH、RFP和SM 3种药物的耐药率以及耐多药率差异有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,影响结核病耐药产生的主要原因是病例类型.复治病例发生耐药的危险性是新发病例的2.582倍(95％CI1.869-3.566).结论 中国西北地区耐多药情况较为严重,特别是西藏和新疆.加强对结核病耐药性监测,规范化和针对性的全程治疗,防止疾病复发,是预防和控制耐药结核病的关键.“,”In this study,we investigated the status of the first-line drugs resistance (DR) of Mycobacterium tuberculosis (MTB) and its influencing factors in the four provinces of northwestern China to provide basic scientific evidence for the prevention and control of drug-resistant tuberculosis (TB).A total of 757 clinical MTB isolates from the sputum specimens of the patients with TB in 2005-2011 from four provinces and the autonomous regions (Gansu,Tibet,Xinjiang,Inner Mongolia) of Northwest China were collected.The drug susceptibility of these clinical isolates to the four first-line drugs streptomycin (SM),rifampicin (RFP),isoniazid (INH) and ethambutol (EMB) was determined by means of the drug susceptibility test (DST) of proportion method,The related influencing factors of DR-TB were analyzed by x2 analysis with case background data.Of 757 clinical MTB isolates tested with DST,the percentages of drug resistance to SM,RFP,INH and EMB were 28.14％,26.68％,26.02％ and 7.53％,and the total drug resistance rate and multi-drug resistance (MDR) rate were 40.55％ and 18.63％,respectively.The total drug resistance rate and MDR rate of Tibet,Xinjiang,Gansu and Inner Mongolia were 64.42％ and 42.94％,40.48％ and 23.81％,41.61％ and 3.36％,27.90％ and 11.29％,respectively.The statistical x2 analysis results showed that there were significant differences in drug resistance rate to RFP,INH and SM and MDR rate in these provinces (P＜0.05).Logistic regression analysis results showed that the influence factors were the case types.The risk of drug resistance in retreatment cases was 2.582 times (95％CI:1.882-3.737) than that in the initial treatment cases.The status of MDR is serious in the northwestern China,especially in Tibet and Xinjiang.Strengthening surveillance of drug resistance and standardized and whole course treatment of TB to prevent the disease recurrence are the key measures for the better prevention and control of drug resistant TB.