耐多药结核病发生耐药的危险因素分析

Analysis of Risk Factors of Drug Resistance in Multidrug-Resistant Tuberculosis

摘要: 目的：探讨耐多药结核病患者发生耐药的危险因素，为针对性预防和控制耐多药结核病提供思路。方法：基于云南省传染病医院开展了一项非匹配病例对照研究。将54例耐多药结核病患者作为病例组，52例非耐多药结核病患者作为对照组，收集两组患者的人口学资料(性别、年龄、职业、户籍地)、临床资料(合并糖尿病和既往结核病治疗史)和影像学检查资料(胸部CT有无空洞)，并对其进行单因素χ2检验和多因素logistic回归分析，研究结核病患者产生耐药性的危险因素。结果：单因素分析结果表明，既往结核病治疗史与耐多药结核病的发生有关(χ² = 20.56, P < 0.05)，而性别、年龄、职业、户籍地、糖尿病以及胸部CT空洞有无与耐多药结核病的发生无显著相关性(^χ2 = 0.31, 1.41, 0.43, 0.05, 3.73, 1.33, P > 0.05)；多因素二元Logistic回归分析显示，既往结核病治疗史(OR = 9.173, 95%CI = 3.632~22.985)和合并糖尿病(OR = 9.484, 95%CI = 1.742~51.618)是耐多药结核病发生的独立危险因素。结论：应规范结核病的诊疗，重视结核病合并糖尿病患者结核耐药筛查，早期发现耐药，减少耐药的发生。

Abstract: Objective: To explore the risk factors of resistance in MDR-TB patients, and to provide ideas for tar-geted prevention and control of MDR-TB. Methods: An unmatched case-control study was conducted in Yunnan Provincial Infectious Disease Hospital. 54 multidrug-resistant tuberculosis patients were taken as the case group and 52 non-multidrug-resistant tuberculosis patients as the control group. The demographic data (sex, age, occupation, place of residence), clinical data (diabetes and previous tuberculosis treatment history)and imaging data (whether there are cavities in chest CT) were col-lected from the two groups of patients, and univariate χ2 test and multivariate logistic regression analysis were performed to study the risk factors for drug resistance in tuberculosis patients. Re-sults: The results of univariate analysis showed that previous TB treatment history was associated with the occurrence of MDR-TB (χ² = 20.56, P < 0.05), while gender, age, occupation, place of resi-dence, diabetes mellitus and chest CT cavities were not significantly associated with the occurrence of MDR-TB (χ² = 0.31, 1.41, 0.43, 0.05, 3.73, 1.33, P > 0.05), while multivariate binary logistic re-gression analysis showed that previous TB treatment history (OR = 9.173, 95%CI = 3.632~22.985) and diabetes mellitus (OR = 9.484, 95%CI = 1.742~51.618) were independent risk factors for the development of MDR-TB. Conclusion: The diagnosis and treatment of tuberculosis should be stand-ardized, and attention should be paid to the screening of tuberculosis drug resistance in patients with tuberculosis and diabetes, so as to detect drug resistance early and reduce the occurrence of drug resistance.