Ma L, Gu J X, Li Q, Li Y H, Wang D D, He J, Si H Y
Institute of Tuberculosis Prevention and Control, Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730020, China.
Office of Gansu Provincial Red Cross Blood Center, Lanzhou 730000, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2022 Jul 10;43(7):1093-1098. doi: 10.3760/cma.j.cn112338-20211117-00896.
In order to provide the precise prevention and control strategy of drug resistance TB in Gansu province, we analyzed the status and risk factors of new drug resistance pulmonary tuberculosis patients. New pulmonary tuberculosis patients were enrolled from 30 tuberculosis-specialized medical institutions (drug resistance monitoring stations) in Gansu province between first September 2014 to 31 August 2017, and filled in the survey questionnaire. The isolated (MTB) strains were implemented 10 drugs drug- susceptibility tes, including isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (Sm), kanamycin (Km), amikacin (Am), ofloxacin (Ofx), capreomycin (Cm), propithio-iso-nicotinamide (Pto).The risk factors were analyzed by logistic regression model. One patient was corresponding one clinical isolates among 1 815 patients. The rate (95%) of total drug-resistance, single drugresistance, multiple drug- resistance, multidrug-resistance and extensively drug-resistant were 25.45% (23.45%-27.46%), 11.40% (9.94%-12.87%),6.23% (5.11%-7.34%), 7.82% (6.59%-9.06%) and 0.28% (0.03%-0.52%) respectively. Among 142 multidrug-resistant TB patients, the farmers, young adults aged 20-59 and low-income group were 90.85%, 62.68% and 31.69%, respectively. The results of univariate and multivariate analysis showed that the male, non-Han, treatment less than 1 month group and treatment less than 1 month and withdrawal less than 2 month group were risk factors of new multidrug-resistant pulmonary TB. Compared with the Chinese national baseline level of TB resistance, the total drug resistance rate of new TB patients in Gansu province was low, but the multidrug-resistance rate was high. The health assistance for rural low-income TB patients was still an important strategy to prevent and control multidrug-resistant in Gansu province. And measures must implement to stop irregular treatment and poor compliance, as the risk factors of multidrug-resistance in new PTB patients.
为制定甘肃省耐多药结核病精准防控策略，我们分析了新发耐多药肺结核患者的现状及危险因素。选取2014年9月1日至2017年8月31日期间甘肃省30家结核病专科医院（耐药监测点）的新发肺结核患者，填写调查问卷。对分离出的结核分枝杆菌（MTB）菌株进行10种药物的药敏试验，包括异烟肼（INH）、利福平（RFP）、乙胺丁醇（EMB）、链霉素（Sm）、卡那霉素（Km）、阿米卡星（Am）、氧氟沙星（Ofx）、卷曲霉素（Cm）、丙硫异烟胺（Pto）。采用logistic回归模型分析危险因素。1815例患者中1例患者对应1株临床分离株。总耐药率、单耐药率、多耐药率、耐多药率和广泛耐药率（95%）分别为25.45%（23.45%-27.46%）、11.40%（9.94%-12.87%）、6.23%（5.11%-7.34%）、7.82%（6.59%-9.06%）和0.28%（0.03%-0.52%）。142例耐多药结核病患者中，农民、20-59岁青壮年和低收入人群分别占90.85%、62.68%和31.69%。单因素和多因素分析结果显示，男性、非汉族、治疗时间小于1个月组以及治疗时间小于1个月且停药时间小于2个月组是新发耐多药肺结核的危险因素。与全国结核病耐药基线水平相比，甘肃省新发肺结核患者的总耐药率较低，但耐多药率较高。对农村低收入肺结核患者的健康援助仍是甘肃省预防和控制耐多药结核病的重要策略。必须采取措施杜绝不规则治疗和依从性差的情况，因为这是新发肺结核患者耐多药的危险因素。
