Analysis on drug resistance characteristics and risk factors for extensively drug resistant tuberculosis patients
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摘要:
目的 分析广泛耐药结核病（extensively drug-resistant tuberculosis，XDR-TB）患者对一、二线抗结核药物耐药情况及危险因素。 方法 收集结核分枝杆菌培阳的住院结核患者，采用分枝杆菌微孔板法药敏检测试可信区间剂盒筛出XDR-TB患者，采用Logistic回归分析XDR-TB患者一、二线抗结核药耐药危险因素。 结果 利福平、异烟肼和利福喷丁耐药率100%，链霉素、利福布汀、乙硫异烟肼、左氧氟沙星和卷曲霉素耐药率90~100%，卡那霉素和对氨基水杨酸耐药率70~80%，阿米卡星耐药率60~70%，丙硫异烟肼耐药率50~60%，乙胺丁醇和莫西沙星耐药率40~50%，克拉霉素耐药率10~20%，氯法齐明耐药率5.2%。XDR-TB中有92.1%的患者对10种以上抗结核药物，耐药种类最少的患者耐6种抗结核药物。Logistic回归分析XDR-TB对一、二线抗结核药物耐药的危险因素包括年龄[20~40岁为（OR=6.318，95%CI：1.204~33.15，P=0.029；40~60岁为（OR=4.772，95%CI：0.973~23.392，P>0.05）；60岁以上为（OR=41.366，95%CI：2.909~588.265，P=0.006）]和抗结核治疗史为复治（OR=28.013，95%CI：3.357~233.766，P=0.002）。 结论 XDR-TB患者耐药情况严重，但有药可治，耐药种类多，其危险因素主要来源于年龄和抗结核治疗史。 Abstract:Objective To analyze the drug resistance profile and risk factors for extensively drug resistant tuberculosis (XDR-TB) patients. Methods XDR-TB cases were identified by sixteen anti-TB drug susceptibility kits among inpatients with a diagnosis of laboratory-confirmed mycobacterium tuberculosis. Single-factor and Logistic analysis were used to analyze the risk factors for drug resistant of the first and second-line anti-TB drugs in XDR-TB patients. Results Resistant rate of rifampin, isoniazid and rifampicin were 100%, Resistant rate of streptomycin, rifampicin and dean, b sulfur isoniazid, levofloxacin and capreomycin were from 90% to 100%, resistant rate of kanamycin and amino salicylic acid were from 70% to 80%, resistant rate of amikacin from 60% to 70%, resistant rate of sulfur isoniazid was from 50% to 60%, resistant rate of ethambutol and moxifloxacin were from 40% to 50%, resistant rate of clarithromycin was from 10% to 20%, resistant rate of clofazimine 5.2%. 92.1% of XDR-TB patients were resistant to more than 10 anti-TB drugs, and the least of the patients were resistant to 6 anti-TB drugs.Logistic regression analysis showed the risk factors for XDR-TB first-and second-line anti-tb drugs included age[20-40 year (OR=6.318, 95% CI: 1.204-33.15, P=0.029;40-60 year (OR=4.772, 95% CI: 0.973-23.392, P=0.054); 60 year (OR=41.366, 95% CI: 2.909-588.265, P=0.006)] and anti-TB treatment history was retreatment(OR=28.013, 95% CI: 3.357-233.766, P=0.002). Conclusions XDR-TB patients have serious drug resistance, but there were some drug treatable drug resistance types, and the risk factors mainly come from age and anti-TB treatment history. -
Key words:
- XDR-TB /
- Drug resistance /
- Risk factors
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图 1 XDR-TB患者对一、二线抗结核药物的耐药情况
Figure 1. Drug resistance of first and second-line anti-TB drugs for XDR-TB patients
表 1 38例XDR-TB患者一、二线抗结核药物耐药率
Table 1. Drug resistance rates of first and second-line anti-TB drugs in 38 XDR-TB patients
药物 耐药病例数(例) 耐药率(%) 药物 耐药病例数(例) 耐药率(%) S 37 97.4 Rfb 35 92.1 R 38 100.0 Km 27 71.7 H 38 100.0 Lfx 36 94.7 E 18 47.4 Cm 35 92.1 Rft 38 100.0 Eto 35 92.1 Am 25 65.8 Pas 29 76.3 Pto 20 52.6 Clx 7 18.4 Mfx 17 44.7 Cfz 4 5.2 
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表 2 单因素分析XDR-TB对一、二线抗结核药物耐药的危险因素
Table 2. The risk factors of XDR-TB resistance to first and second-line anti-TB drugs by single factor analysis
变量 XDR 非XDR χ2值 P值 性别 0.076 0.783 男 30 29 女 8 9 年龄(岁) 0.683 0.711 0~ 2 4 20~ 14 13 40~ 15 14 60~77 7 7 涂片 0.157 0.692 阴性 3 4 阳性 35 34 空洞 25.544 <0.001 无 9 31 有 29 7 病程(年) 16.152 0.012 0~ 0 10 1~ 18 11 5~ 3 7 10~ 8 4 15~50 9 6 抗结核史 30.389 <0.001 初治 2 25 复治 36 13 吸烟情况 0.054 0.817 不吸烟 16 17 吸烟 22 21 接触史 1.134 0.287 无 3 6 有 35 32 并发症 1.362 0.243 无 18 13 有 20 25
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表 3 Logistic多因素分析XDR-TB对一、二线抗结核药物耐药的危险因素
Table 3. Risk factors for XDR-TB resistance to first and second-line anti-TB drugs by Logistic multivariate analysis
变量 β值 sx Wald值 自由度 P值 OR(95% CI)值 年龄(岁，X1) - - - 3 0.032 - 20~X1(1) 1.843 0.846 4.751 1 0.029 6.318(1.204~33.15) 40~X1(2) 1.563 0.811 3.712 1 0.054 4.772(0.973~23.392) 60~X1(3) 3.722 1.354 7.553 1 0.006 41.366(2.909~588.265) 初复治X6 0.093 0.607 0.024 1 0.002 28.013(3.357~233.766)
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