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383例耐药肺结核患者的相关危险因素分析

Analysis on the risk factors of 383 patients with drug-resistant pulmonary tuberculosis

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【作者】 马艳尹韶华杜建谢仕恒王红红谭守勇傅衍勇马丽萍张联英刘飞鹰胡代玉张艳玲刘宇红李亮

【Author】 MA Yan;YIN Shao-hua;DU Jian;XIE Shi-heng;WANG Hong-hong;TAN Shou-yong;FU Yan-yong;MA Li-ping;ZHANG Lian-ying;LIU Fei-ying;HU Dai-yu;ZHANG Yan-ling;LIU YU-hong;LI Liang;Central Office of Beijing Tuberculosis and Thoracic Tumor Research Institute;

【通讯作者】 刘宇红;李亮;

【机构】 北京结核病胸部肿瘤研究所中国疾病预防控制中心结核病临床中心内蒙古医科大学公共卫生学院广州市胸科医院天津市结核病控制中心河南省疾病预防控制中心结核病防治所河北省疾病预防控制中心结核病防治科广西壮族自治区疾病预防控制中心结核病防治所重庆市结核病防治所云南省疾病预防控制中心结核病防治所首都医科大学附属北京胸科医院

【摘要】 目的 探索肺结核患者的耐药状况及相关影响因素,为今后结核病防治工作提供参考依据。方法 采用统一设计的调查问卷对2008年10月至2010年12月期间在上海市、广东省、天津市、河北省、河南省、重庆市、广西壮族自治区及云南省等8个省(直辖市、自治区)共49个实施单位的1992例痰培养阳性肺结核病患者进行调查,运用卡方检验比较敏感和耐药患者在人口学特征、痰结核分枝杆菌检验结果、治疗转归等方面的差异,检验水准为0.05;运用多因素logistic回归分析筛选耐药肺结核发生的影响因素。结果 痰培养阳性的肺结核患者耐药率为19.2%(383/1992)。在对耐药肺结核患者进行单因素分析的基础上进行多因素非条件logistic分析,结果 表明复治及治疗2个月末培养阳性结核病患者是发生耐药结核病的危险因素,β值分别为0.593、0.786,sx值分别为0.172、0.191,Wald χ~2值分别为11.323、17.102,OR值(95%CI值)分别为1.789(1.312~2.398)和2.098(1.372~3.065),P值均<0.001。结论 复治及治疗2个月末培养阳性是痰培养阳性肺结核患者产生耐药的危险因素。

【Abstract】 Objective To explore the status of drug resistant tuberculosis(TB)and risk factors associated with drug-resistant pulmonary tuberculosis(PTB),and provide evidence for tuberculosis control. Methods With unified questionnaire to investigate 1992 cases with culture-positive pulmonary tuberculosis from 49 organizations of Shanghai,Guangdong,Tianjin,Hebei,He’nan,Chongqing,Guangxi Zhuang Autonomous Region,Yunnan and other eight provinces from October 2008 to December 2010.Demographic characteristics,lab test,treatment outcome were analyzed using Chi-square test.Significance tests with P<0.05 were considered statistically significant.Multivariate logistic regression was used to explore risk factors of drug-resistance. Results Drug-resistant rate was 19.2%(383/1992)of culture-positive pulmonary tuberculosis.Univariate analysis showed that age(χ2=16.09,P<0.001),education level(χ2=11.05,P=0.011),occupation(χ2=13.79,P<0.001),medical expenses expenditure type(χ2=8.511,P=0.037),history of TB exposure(χ2=7.13,P=0.028),type of treatment(χ2=20.97,P<0.001),treatment outcome(χ2=24.37,P<0.001),culture results at the end of the 1st month(χ2=21.62,P<0.001)and culture results at the end of the 2nd months(χ2=25.64,P<0.001)were statistically significant difference.The multivariate logistic analysis showed that retreatment and culture-positive at the end of 2nd months were risk factors for the presence of drug-resistant tuberculosis.Theβvalues were 0.593 and 0.786,the sxvalues were 0.172 and 0.191,the Wald χ2 values were 11.323 and 17.102,the ORvalues(95%CI)were 1.422(1.066-1.896)and 2.130(1.48-3.049),respectively. Conclusion Retreatment and culture-positive at the end of the 2nd month are the risk factors of drug-resistant occurrence with culture-positive originally.

【基金】 “十一五”国家科技重大专项项目(2008ZX10003-008-02)
  • 【文献出处】 结核病与肺部健康杂志 ,Journal of Tuberculosis and Lung Health , 编辑部邮箱 ,2016年02期
  • 【分类号】R521
  • 【下载频次】36
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