海南省复治肺结核患者耐多药现况与影响因素分析

Analysis on the current situation of retreatment of multidrug－resistant tuberculosis and influential factors in Hainan province

摘要:

目的：探索海南省复治涂阳肺结核患者耐多药发病率以及影响因素，为本地区耐多药结核病防治规划提供可靠的科学依据。方法：对2014年1月至2016年12月期间海南省18个市县的复治涂阳肺结核患者694例进行结核分枝杆菌培养、菌种鉴定以及比例法药敏试验，发现耐多药结核病患者，描述耐多药率，采用卡方检验和多因素非条件logistic回归分析耐多药影响因素。结果：3年间海南省复治涂阳耐多药率为18.4%（128/694），2014至2016年分别为20.9%（49/234）、16.2%（39/241）、18.3%（40/219），近3年耐多药率无明显变化（?字2=1.793，P>0.05）。多因素logistic回归分析显示，农业（OR=1.692，CI=1.047～2.734，P<0.05）、居住在西部地区（OR=1.588，CI=1.266～1.992，P<0.05）、低收入家庭（OR=2.153，CI=1.300～3.567，P<0.05）、接受过2次及以上治疗（OR=1.860，CI=1.222～2.831，P<0.05）、首次诊疗机构在私人医院或个体诊所（OR=1.668，CI=1.128～2.467，P<0.05）更易产生耐多药。结论：海南省复治涂阳耐多药疫情接近全国平均水平。农业、居住在西部地区、低收入、反复多次治疗、不到定点结防机构诊治可能是海南地区耐多药发生的危险因素。

Abstract:

Objective：To investigate the incidence and influential factors of retreatment smear of positive multidrug resistant tubercu－losis patients in Hainan province，and to provide reliable scientific basis for the prevention and control of multidrug-resistant tuber－culosis（MDR-TB）. Methods：From January 2014 to December 2016 ，a total of 694 cases of retreatment smear of positive tuberculosis patients were found in 18 cities and counties of Hainan province. Sputum samples were tested for drug susceptibility test to find the multidrug－resistant tuberculosis patients，and the multidrug－resistance rate was described. Chi-square test and an unconditioned lo－gistic regression were employed to analyze the influential factors of MDR-TB. Results：The retreatment smear positive MDR-TB rate was 18.4%（128/694）. The MDR-TB rates from 2014 to 2016 were 20.9%（49/234），16.2% （39/241） and 18.3%（40/219），and there was no significant difference of MDR-TB rate in the past 3 years in Hainan province（ ?字2=1.793，P>0.05）. The multivariate logistic analysis results showed that the agriculture（OR=1.692，CI=1.047 to 2.734，P<0.05），living in the western region（OR=1.588，CI=1.266 to 1.992，P<0.05），low family income（OR=2.153，CI=1.300 to 3.567，P<0.05），more than once prior anti-TB treatment（OR=1.860，CI=1.222 to 2.831，P<0.05），selecting private hospitals or individual clinics for first health care seeking（OR=1.668，CI=1.128 to 2.467，P<0.05） were found to contribute to higher trend of MDR-TB. Conclusion：The epidemic situation of MDR-TB in Hainan province is close to the national average level. The results indicate that agriculture，living in the western region，low family income，selecting private hospitals or individual clinics for first health care seeking and repeated treatment maybe the risk factors of multidrug resistance.