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目的了解朝阳区当前结核病耐药状况及相关影响因素,为今后结核病防治工作提供参考依据。方法将2006—2007年朝阳区结防所登记的所有初治及复治痰结核分枝杆菌培养阳性的病例作为研究对象,采用绝对浓度间接法对4种抗结核药物异烟肼(H)、利福平(R)、链霉素(S)及乙胺丁醇(E)进行疗前药物敏感试验。结果430株结核分枝杆菌总耐药率为15.6%(67/430),耐多药率3.0%(13/430);初始耐药率为12.3%(47/381),耐多药率1.8%(7/381);获得性耐药率为40.8%(20/49),耐多药率12.2%(6/49)。复治组耐药率及耐多药率均显著高于初治组,差异有统计学意义(P<0.001)。4种抗结核药物的总体耐药率顺位由高到低依次为S(12.6%)、H(8.4%)、R(5.8%)、E(0.9%);初始耐药率顺位为S(10.0%)、H(6.3%)、R(3.7%)、E(0.8%);获得性耐药率顺位为S(32.7%)、H(24.5%)、R(22.4%)、E(2.0%)。初始耐药以耐单药为主,获得性耐药以耐2种药为主。经多因素非条件logistic回归分析,化疗史是影响耐药的主要因素,复治患者耐药率明显高于初治患者(OR=4.9,95%,CI为2.6~9.4,P<0.001),而不同年龄、不同性别、有无空洞、有无糖尿病对耐药率的影响差异无统计学意义(P>0.05)。复治患者既往治疗用药不规律是造成耐药的主要原因(OR=5.8,95%,CI为1.5~23.5,P<0.05)。结论朝阳区肺结核患者的耐药率处在全国较低水平。抓好初治病人的治疗管理,减少不规律用药,是控制耐药的关键。
Objective To understand the status of current TB drug resistance in Chaoyang District and related influencing factors so as to provide reference for future TB control. Methods The positive cases of all newly diagnosed and retreatment sputum Mycobacterium tuberculosis registered in the district of Chaoyang district in 2006-2007 were selected as the research objects. The absolute concentrations of indomethacin were tested against 4 kinds of anti-TB drugs, such as isoniazid (H) Rifampicin (R), streptomycin (S) and ethambutol (E) for pre-treatment drug susceptibility testing. Results The total drug resistance rate of Mycobacterium tuberculosis in 430 strains was 15.6% (67/430) and the multidrug resistance rate was 3.0% (13/430). The initial drug resistance rate was 12.3% (47/381) and the multidrug resistance rate was 1.8 % (7/381). The acquired drug resistance rate was 40.8% (20/49) and the multi-drug resistance rate was 12.2% (6/49). The drug resistance rate and multidrug resistance rate of retreatment group were significantly higher than those of the initial treatment group, the difference was statistically significant (P <0.001). The overall resistance rates of four anti-TB drugs were S (12.6%), H (8.4%), R (5.8%) and E The susceptibility rates of acquired resistance were S (32.7%), H (24.5%), R (22.4%), E (22.4%), E (2.0%). The initial resistance to drug-resistant monotherapy, acquired resistance to resistance-based drugs. According to the multivariate non-conditional logistic regression analysis, the history of chemotherapy was the main factor affecting the drug resistance. The drug resistance rate in retreatment patients was significantly higher than that in the untreated patients (OR = 4.9, 95%, CI = 2.6-9.4, P <0.001) However, there was no significant difference in the resistance rate between different age, gender, presence or absence of diabetes and diabetes mellitus (P> 0.05). Previous treatment of refractory patients with refractory drug resistance is the main reason (OR = 5.8,95%, CI 1.5 ~ 23.5, P <0.05). Conclusions The drug resistance rate of patients with pulmonary tuberculosis in Chaoyang District is at a low level in China. Do a good job in the treatment of patients with initial management, reducing irregular medication, the key to control drug resistance.