Flora M S, Amin M N, Karim M R, Afroz S, Islam S, Alam A, Hossain M
National Institute of Preventive and Social Medicine, Dhaka.
Bangladesh Med Res Counc Bull. 2013 Apr;39(1):34-41. doi: 10.3329/bmrcb.v39i1.15808.
Despite success in tuberculosis control, multi-drug resistant tuberculosis in Bangladesh is increasing and currently multi-drug-resistant tuberculosis rate is 3.6% in new cases and 19% in re-treatment cases. This study focused on determination of multi-drug-resistant tuberculosis which is warranted for effective prevention strategy. An unmatched case control study was conducted in 2010. Purposively recruited 136 culture-proved multi-drug-resistant- tuberculosis cases and 152 cured tuberculosis patients were interviewed. Associations between exposure and outcome variables were initially tested by chi2-test, t-test. A result was considered significant at p value < 0.05. Effects of exposure variables were also assessed after adjusting for other variables by binary logistic regression models. Crude and adjusted Odds Ratio with 95% Confidence Interval was computed. Younger age (p = 0.008) and, peri-urban locality (p = 0.002) were associated with multi-drug-resistant tuberculosis. History of contact (p < 0.001) and tuberculosis in the past (p < 0.001) were four and eight times, respectively, more likely to influence multi-drug-resistant tuberculosis. Regularity [Odds Ratio 0.05; 95% Confidence Interval (0.01 to 0.39)] and always observation of treatment [Odds Ratio 0.25; 95% Confidence Interval (0.10 to 0.61)], sputum conversion [Odds Ratio 0.02; 95% Confidence Interval (0.01 to 0.08)] negatively associated with multi-drug-resistant tuberculosis. Gender and socio-economic status did not show any influence. Treatment course and sputum conversion was the best predictors. Like other developing countries adequacy of treatment is the most important exposure variable. Strengthening of control activities might contribute in preventing development of resistance in tuberculosis patients.
尽管在结核病控制方面取得了成功，但孟加拉国的耐多药结核病仍在增加，目前新病例中的耐多药结核病率为3.6%，复治病例中的耐多药结核病率为19%。本研究侧重于确定耐多药结核病，这对于有效的预防策略是必要的。2010年进行了一项非匹配病例对照研究。有目的地招募了136例经培养证实的耐多药结核病病例，并对152例治愈的结核病患者进行了访谈。暴露变量与结局变量之间的关联最初通过卡方检验、t检验进行检验。p值<0.05时结果被认为具有显著性。在通过二元逻辑回归模型对其他变量进行调整后，也评估了暴露变量的影响。计算了粗比值比和调整后的比值比以及95%置信区间。年龄较小（p = 0.008）和城郊地区（p = 0.002）与耐多药结核病相关。接触史（p < 0.001）和过去患结核病（p < 0.001）分别使耐多药结核病的发生可能性增加4倍和8倍。规律服药[比值比0.05；95%置信区间（0.01至0.39）]、始终坚持治疗[比值比0.25；95%置信区间（0.10至0.61）]、痰菌转阴[比值比0.02；95%置信区间（0.01至0.08）]与耐多药结核病呈负相关。性别和社会经济地位未显示出任何影响。治疗疗程和痰菌转阴是最佳预测因素。与其他发展中国家一样，治疗的充分性是最重要 的暴露变量。加强控制活动可能有助于预防结核病患者产生耐药性。
