Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, People's Republic of China.
Thorax. 2012 Jul;67(7):632-8. doi: 10.1136/thoraxjnl-2011-200018. Epub 2012 Mar 8.
The rapid spread of multidrug-resistant tuberculosis (MDR-TB) has attracted global concerns. This study aimed to identify factors contributing to the high prevalence of MDR-TB in China's Heilongjiang province.
A cross-sectional survey following the WHO/International Union Against Tuberculosis and Lung Disease guidelines was conducted with consecutive recruitment of patients with TB in 30 counties selected at random in Heilongjiang in 2004. A total of 1995 patients were tested for MDR-TB. Factors associated with MDR-TB were identified through multilevel models and traditional logistic regression analysis, along with in-depth interviews with nine patients, five healthcare managers and four doctors.
241 patients (12%) were identified with MDR-TB. The retreatment patients were 5.48 times (95% CI 4.04 to 7.44) more likely to have MDR-TB than newly diagnosed patients. The patients who were treated with isoniazid and rifampin for >180 days were 4.82 times (95% CI 2.97 to 7.81) more likely to develop MDR-TB than those treated <180 days. Age and delay in initiating TB treatment were associated with MDR-TB. Financial burden, poor knowledge and side effects of TB treatment were perceived by the interviewees as influencing factors. Lack of coordination of services, unsatisfactory supervision of treatment and infection control jeopardised the control of MDR-TB.
Inappropriate treatment is the most important influencing factor of MDR-TB. Increasing people's awareness of TB, early detection and appropriate treatment of patients with TB should become a priority, which requires strong commitment and collaboration among health organisations and greater compliance with TB treatment guidelines by service providers and patients.
耐多药结核病（MDR-TB）的迅速传播引起了全球关注。本研究旨在确定导致中国黑龙江省 MDR-TB 高发的因素。
2004 年，按照世界卫生组织/国际防痨和肺病联合会的指南，采用横断面调查方法，连续招募黑龙江省 30 个随机县的结核病患者。共对 1995 例患者进行 MDR-TB 检测。采用多水平模型和传统逻辑回归分析，以及对 9 名患者、5 名卫生保健管理人员和 4 名医生进行深入访谈，确定与 MDR-TB 相关的因素。
241 例（12%）患者被诊断为 MDR-TB。复治患者发生 MDR-TB 的可能性是初治患者的 5.48 倍（95%可信区间 4.04 至 7.44）。使用异烟肼和利福平治疗>180 天的患者发生 MDR-TB 的可能性是治疗<180 天的患者的 4.82 倍（95%可信区间 2.97 至 7.81）。年龄和结核病治疗开始延迟与 MDR-TB 相关。受访者认为经济负担、对结核病治疗知识的缺乏和不良反应是影响因素。服务协调不足、治疗监督不力和感染控制不善危及 MDR-TB 的控制。
不适当的治疗是 MDR-TB 的最重要影响因素。提高人们对结核病的认识、早期发现和对结核病患者的适当治疗应成为优先事项，这需要卫生组织的坚定承诺和协作，以及服务提供者和患者对结核病治疗指南的更大遵守。
