Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
BMJ Open. 2021 Jun 16;11(6):e044349. doi: 10.1136/bmjopen-2020-044349.
This study was designed to identify the risk factors for drug-resistant tuberculosis (DR-TB) and the association between comorbidity and drug resistance among retreated pulmonary tuberculosis (PTB).
A retrospective study was conducted among all the 36 monitoring sites in Shandong, China, over a 16-year period. Baseline characteristics were collected from the TB Surveillance System. Categorical variables were compared by Fisher's exact or Pearson's χ test. The risk factors for drug resistance were identified using univariable analysis and multivariable logistic models. The influence of comorbidity on different types of drug resistance was evaluated by performing multivariable logistic models with the covariates adjusted by age, sex, body mass index, drinking/smoking history and cavity.
A total of 10 975 patients with PTB were recorded during 2004-2019, and of these 1924 retreated PTB were finally included. Among retreated PTB, 26.2% were DR-TB and 12.5% had comorbidity. Smoking (adjusted OR (aOR): 1.69, 95% CI 1.19 to 2.39), cavity (aOR: 1.55, 95% CI 1.22 to 1.97) and comorbidity (aOR: 1.44, 95% CI 1.02 to 2.02) were risk factors for DR-TB. Of 504 DR-TB, 9.5% had diabetes mellitus, followed by hypertension (2.0%) and chronic obstructive pulmonary disease (1.8%). Patients with retreated PTB with comorbidity were more likely to be older, have more bad habits (smoking, alcohol abuse) and have clinical symptoms (expectoration, haemoptysis, weight loss). Comorbidity was significantly associated with DR-TB (aOR: 1.44, 95% CI 1.02 to 2.02), overall rifampin resistance (aOR: 2.17, 95% CI 1.41 to 3.36), overall streptomycin resistance (aOR: 1.51, 95% CI 1.00 to 2.27) and multidrug resistance (aOR: 1.96, 95% CI 1.17 to 3.27) compared with pan-susceptible patients (p<0.05).
Smoking, cavity and comorbidity lead to an increased risk of drug resistance among retreated PTB. Strategies to improve the host's health, including smoking cessation, screening and treatment of comorbidity, might contribute to the control of tuberculosis, especially DR-TB, in China.
本研究旨在确定耐多药结核病（DR-TB）的危险因素，以及复发性肺结核（PTB）中合并症与耐药性之间的关系。
对中国山东省的所有 36 个监测点进行了为期 16 年的回顾性研究。从结核病监测系统中收集基线特征。通过 Fisher 精确检验或 Pearson χ检验比较分类变量。使用单变量分析和多变量逻辑模型确定耐药的危险因素。通过多变量逻辑模型，在调整年龄、性别、体重指数、饮酒/吸烟史和空洞的情况下，评估合并症对不同类型耐药性的影响。
2004 年至 2019 年期间共记录了 10975 例 PTB 患者，其中最终纳入 1924 例复发性 PTB。在复发性 PTB 中，26.2%为 DR-TB，12.5%有合并症。吸烟（调整后的比值比[aOR]：1.69，95%置信区间[CI] 1.19 至 2.39）、空洞（aOR：1.55，95%CI 1.22 至 1.97）和合并症（aOR：1.44，95%CI 1.02 至 2.02）是 DR-TB 的危险因素。在 504 例 DR-TB 中，糖尿病（9.5%）的患病率最高，其次是高血压（2.0%）和慢性阻塞性肺疾病（1.8%）。有合并症的复发性 PTB 患者更可能年龄较大、有更多不良习惯（吸烟、酗酒）且有临床症状（咳痰、咯血、体重减轻）。合并症与 DR-TB（aOR：1.44，95%CI 1.02 至 2.02）、总利福平耐药（aOR：2.17，95%CI 1.41 至 3.36）、总链霉素耐药（aOR：1.51，95%CI 1.00 至 2.27）和耐多药（aOR：1.96，95%CI 1.17 至 3.27）显著相关，与全敏感患者相比（p<0.05）。
吸烟、空洞和合并症导致复发性 PTB 的耐药风险增加。改善宿主健康的策略，包括戒烟、筛查和治疗合并症，可能有助于控制中国的结核病，尤其是 DR-TB。
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