【摘要】 目的 分析青岛市耐药肺结核高危人群的耐药筛查情况及耐药影响因素，了解利福平患者耐药纳入治疗情况，为耐药结核病防治工作开展提供参考依据。方法 从中国疾病预防控制中心“全民健康保障信息系统”中获得青岛市2018—2022年期间登记的726例耐药肺结核高危人群病案信息，分析耐药肺结核高危人群5种抗结核药品异烟肼（isoniazid, INH）、利福平（rifampicin, RFP）、乙胺丁醇（ethambutol, EMB）、左氧氟沙星（levofloxacin, Lfx）和丁胺卡那霉素（amikacin, Am）耐药情况，采用单因素和多因素logistic回归分析利福平耐药患者的影响因素，评价利福平耐药患者检出及纳入治疗情况。结果 726例研究对象中耐药278例，总耐药率达38.29%。5种抗结核药物的耐药顺位依次为：INH 25.90%(188/726)、RFP 22.87%(166/726)、Lfx 14.19%(103/726)、EMB 11.29%(82/726)、Am 2.48%(18/726)。耐药谱分析显示，耐1种药中，RFP最多，占13.67%(38/278)；耐2种药中，以INH+RFP最多，占15.83%(44/278)；耐3种药中，以INH+RFP+Lfx最多，占7.19%(22/278)；耐4种药中，以INH+RFP+EMB+Lfx最多，占6.12%(17/278)。利福平耐药多因素logistic回归分析显示，与<25岁组患者相比，45～<65岁组、≥65岁组患者发生利福平耐药的风险较低（OR=0.356,95%CI:0.181～0.700;OR=0.352,95%CI:0.170～0.729）。与其它省流动患者相比，本县区患者发生利福平耐药风险较低（OR=0.599,95%CI:0.373～0.962）。与初治2月末痰涂片阳性患者相比，复发/返回、复治失败/慢性患者、其他患者发生利福平耐药风险较高（OR=9.380,95%CI:3.717～23.671;OR=25.749,95%CI:8.037～82.490;OR=36.651,95%CI:8.438～159.201）。结论 青岛市耐药肺结核形势不容忽视，<25岁、其它省流动患者以及复发/返回、复治失败/慢性患者、其他患者为耐药肺结核高危人群发生利福平耐药的危险因素。更多还原

【Abstract】 Objective To analyze the drug resistance screening status and drug resistance influencing factors of highrisk groups of drug-resistant pulmonary tuberculosis in Qingdao, and to understand the inclusion of rifampicin patients in treatment, so as to provide a reference for the prevention and treatment of drug-resistant pulmonary tuberculosis.Methods The medical records of 726 cases of drug-resistant pulmonary tuberculosis among high-risk populations registered in Qingdao from 2018 to 2022 were obtained from the National Health Insurance Information System of the China Center for Disease Control and Prevention. The drug resistance to five anti-tuberculosis drugs, namely isoniazid(INH), rifampicin(RFP),ethambutol(EMB), levofloxacin(Lfx), and amikacin(Am), in the high-risk populations of drug-resistant pulmonary tuberculosis was analyzed. Univariate and multivariate logistic regression were used toidentify factors influencing rifampicin resistance, and the detection and inclusion of treatment for rifampicin-resistant patients were evaluated.ResultsOf the 726subjects, 278 were drug-resistant, with a total drug resistance rate of 38.29%. The drug resistance for the five anti-tuberculosis drugs in descending order was: INH 25.90%(188/726), RFP 22.87%(166/726), Lfx 14.19%(103/726), EMB 11.29%(82/726),Am 2.48%(18/726). Analysis of the drug resistance spectrum showed that among those resistant to one drug, RFP was most common, accounting for 13.67%(38/278); among those resistant to two drugs, INH+RFP was predominant, accounting for 15.83%(44/278); among those resistant to three drugs, INH+RFP+Lfx was most frequent, at 7.19%(22/278); and among those resistant to four drugs, INH+RFP+EMB+Lfx was highest, at 6.12%(17/278). Multivariate logistic regression analysis of rifampicin resistance showed that compared with patients under 25 years of age, the risk of developing rifampicin resistance was lower in the groups aged 45 to under 65 and those aged 65 and above(OR=0.356, 95%CI: 0.181-0.700; OR=0.352,95%CI: 0.170-0.729). Compared with migrant patients in other provinces, local patients from within the same county or district had a lower risk of developing rifampicin resistance(OR=0.599, 95%CI: 0.383-0.962). Compared with patients who were smear-positive at the end of the second month of initial treatment, the risk of developing rifampicin resistance was higher in patients with relapse/return, failure of retreatment/chronic, and other categories of patients(OR=9.380, 95%CI:3.717-23.671;OR=25.749, 95%CI: 8.037-82.490; OR=36.651, 95%CI: 8.438-159.201).Conclusions The situation of drug-resistant pulmonary tuberculosis in Qingdao cannot be ignored. Individuals under 25 years old, migrants from other provinces, and patients with relapse/return, failure of retreatment/chronic, and other categories are significant risk factors for developing rifampicin resistance in the high-risk groups of drug-resistant pulmonary tuberculosis.更多还原