目的：探讨导致耐多药肺结核病的危险因素,从而为预防和控制耐多药结核病提供依据。方法采用非匹配病例对照研究的方法,以青海省第四人民医院2013年1月-2014年6月的住院肺结核患者为样本框,痰罗氏培养结果为结核分枝杆菌复合群,药敏试验证实异烟肼和利福平同时耐药的患者为病例组；异烟肼和利福平均敏感的患者为对照组。对患者的姓名、年龄、性别、民族、婚姻状况、职业、住房、吸烟史、饮酒、既往治疗是否规律、病例分类(为初治或复治患者)、病变累及肺野数、肺内空洞数、病程、住房通风情况等相关因素做统计分析。结果采取logistic回归方法进行分析,最终耐多药肺结核发生的主要危险因素为复治病人患耐药的风险是初治的5．24倍,95%CI(2.005-14.648)；病变范围>3个肺野数的患者患耐药的风险是≤3个肺野的0.177倍,95% CI(0.062-0.506)；空洞数每上升一个等级,患耐药的风险是原来的7.686倍,95%CI(4.524-13.058)。结论加强对肺结核病例的管理,良好的治疗策略,做好基础DOTS工作,积极发现和治愈初复治结核病人,并针对其他危险因素采取措施对降低耐多药结核病疫情有重要意义。%Objective To explore the risk factors of multi-drug resistant tuberculosis ( MDR-TB) , in order to provide the basis for the prevention and control of MDR-TB. Methods Non-matching case-control study was car-ried out in Qinghai. This study took patients in the Fourth People′s Hospital of Qinghai from January, 2013 to June, 2014 as match box. The results of sputum culture were mycobacterium tuberculosis complex. Those patients showing resistance to isoniazid and rifampicin were taken as the case group, and those showing sensitivity to isoniazid and rifampicin as the control group. The related factors were analyzed, including name, age, gender, nation, marital status, occupation, housing, history of smoking and drinking, regularity of treatment, case classification (initial or recurrent patients), existence of cavities of lung, scale of lesion on lung field, course of disease and housing ventilation. Results All of the factors were analyzed by logistic regression, and the risk factors causing multi-drug resistance included 5. 24 times 95%CI (2. 005-14. 648), extent of disease more than 3 lung fields, and more cavities. Conclusion The situation of MDR-TB can be controlled by strengthening the management of tuberculosis cases, taking sound treatment strategy, doing a good job in basic DOTS, early detection and treatment of the disease, and taking appropriate preventive measures to control other risk factors.
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