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目的了解福建省复治涂阳肺结核患者耐药现状,探讨其耐药的影响因素。方法采用统一的患者信息表收集30个监测点复治涂阳患者的社会经济和既往临床诊疗信息。培养阳性菌株采用比例法进行异烟肼(H)、利福平(R)、乙胺丁醇(E)、链霉素(S)、卡那霉素(Km)、氧氟沙星(Ofx)的耐药性测定。对硝基苯甲酸(PNB)培养法鉴定结核分枝杆菌复合群。采用比值比(OR)评估耐药结核病患者和耐多药(MDR)患者的危险因素。结果复治患者男性居多(占84.15%),总耐药率为37.32%,MDR率为15.89%,广泛耐药(XDR)率为0.35%;任一耐药顺位依次为:R(25.00%),H(21.48%),S(16.55%),E(15.49%),Ofx(7.75%)和Km(4.23%);耐多药结核病(MDR-TB)耐药谱有10种,其中同时对S、H、R和E耐药占46.67%;多耐药谱有14种,以耐二联药物为主(占68.00%);治疗2次以上的患者耐药率和MDR率均明显高于治疗1次的患者OR分别为2.43,3.38;P值分别为0.005,0.001。结论福建省复治结核病患者的耐药及MDR-TB问题仍然严重,反复多次治疗是复治患者耐药及MDR-TB的主要危险因素。
Objective To investigate the drug resistance status of patients with relapsed and smear positive pulmonary tuberculosis in Fujian Province and to explore the influencing factors of drug resistance. Methods A unified patient information form was used to collect the socioeconomic and past clinical diagnosis and treatment information of retreatment and smear-positive patients in 30 monitoring sites. The positive strains were cultured using the proportional method for the determination of isoniazid (H), rifampin (R), ethambutol (E), streptomycin (S), kanamycin (Km), ofloxacin ) Drug resistance assay. Identification of Mycobacterium tuberculosis complex by p-nitrobenzoic acid (PNB) culture. Odds ratios (ORs) were used to assess the risk factors for patients with drug-resistant TB and MDR. Results The majority of retreatment patients were male (84.15%), with a total resistance rate of 37.32%, an MDR rate of 15.89% and a rate of extensive drug resistance (XDR) of 0.35% , H (21.48%), S (16.55%), E (15.49%), Ofx (7.75%) and Km (4.23%). There were 10 drug resistance spectrum of MDR- Resistant to S, H, R and E accounted for 46.67%; multidrug resistance spectrum 14, resistant to two drugs (68.00%); treatment more than twice in patients with drug resistance and MDR rates were significantly higher The ORs of patients who were treated once were 2.43 and 3.38, respectively; P values were 0.005 and 0.001 respectively. Conclusion The drug resistance and MDR-TB in patients with retreatment tuberculosis in Fujian Province are still serious. Repeated multiple treatments are the major risk factors for drug resistance and MDR-TB in retreatment patients.