242例耐多药结核病患者特征及治疗转归的影响因素分析

摘要

Objective To understand the characters and treatnent outcomes of multidrug-resistant tuberculosis (MDR TB) in Fujian Province,and to explore the influencing factors on treatment outcomes.Methods The information of 242 patients with MDR TB,who had been reported in the National TB Recording and Reporting System in Fujian Province from Jan.1st,2012 to Dec.31th,2014,was exported.The social and clinical characteristics,as well as the treatment outcomes of those MDR-TB patients were descriptively analyzed.The influencing factors on the treatment outcomes of the patients were analyzed by using the univariate and multivariate logistic regression methods.Results Among 242 MDR-TB patients who were involved in this research,their average age was 44.2±13.5;78.9％ (191/242) of them were male and 57.9％ (140/242) of them were farmers.Except for isoniazid (INH) and rifampicin (RFP) resistance,the drug resistant rate to streptomycin (Sm),ethambutol (EMB),ofloxacin (Ofx) and kanamycin (Km) was 60.7％ (142/234),38.3％ (88/230),30.7％ (74/241) and 4.6％ (11/238) respectively.There were only 156 patients (64.5％) received treatment and the treatment success rate was 57.7％ (90/156).Multivariate logistic regression analysis showed that the risk factors on treatment outcomes of 156 MDR-TB patients included:age more than 55 years old (OR=2.55,95％ CI=1.06-6.11),registration category with relapse,return after interruption and retreatment failure (OR=3.49,95 ％ CI=1.51-8.07),farmer (OR=0.45,95％CI=0.26-0.78) and ofloxacin resistance (OR=0.35,95％CI=0.16-0.78).Conclusion Most of MDR TB patients are male,young or middle-aged farmers;the Sm resistant rate is high.In order to increase the successful treatment,it's necessary to strengthen health education and treatment monitoring to the patients with the risk factors,such as age more than 55 years old,farmer,retreatment (relapse,return after interruption and retreatment failure) etc,their treatment regimens should also be adjusted whenever necessary.%目的 了解福建省耐多药结核病(MDR TB)患者特征及治疗转归情况,并探讨其影响因素.方法 通过全国《结核病专报系统》导出2012年1月1日至2014年12月31日在福建省登记的242例MDR-TB患者信息,描述性分析患者的社会学、临床学特征及治疗转归情况;单因素及多因素logistic回归分析影响MDR-TB患者治疗转归的因素.结果 242例MDR-TB患者中男性患者占78.9％(191/242),农民工占57.9％(140/242),平均年龄(44.2±13.5)岁;除同时耐异烟肼和利福平外,对链霉素、乙胺丁醇、氧氟沙星和卡那霉素的耐药率分别为60.7％(142/234)、38.3％(88/230)、30.7％(74/241)和4.6％(11/238).其中进行治疗者156例(64.5％),治疗成功率为57.7％(90/156).多因素logistic回归分析显示年龄≥55岁(OR=2.55,95％CI=1.06～6.11),职业为农民工(OR=0.45,95％ CI=0.26～0.78),登记分类为复治(复发、返回及复治失败)(OR=3.49,95％CI=1.51～8.07),以及对氧氟沙星耐药(OR=0.35,95％CI=0.16～0.78)是156例MDR-TB患者治疗成功的危险因素.结论 MDR-TB患者中以中青年、男性及农民工偏多,且对链霉素耐药率较高;需加大对年龄≥55岁、职业为农民工,以及登记分类为复发、返回和复治失败的MDR TB患者的健康教育、疗效观察,并及时调整方案,以提高患者的治疗成功率.