Prevalence and influencing factors of multi-drug resistance among 1 536 tuberculosis patients in Lanzhou City
ZHANG Yuqi and WANG Zhiyong contributed equally to this article
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摘要:
目的 探索1 536例肺结核患者的耐多药状况及其影响因素。 方法 数据资料来自2018―2020年结核病管理信息系统中登记管理的兰州市1 536例确诊肺结核患者。利用χ2检验和多因素logistic回归分析模型分析探索肺结核患者耐多药的影响因素。 结果 1 536例肺结核患者中，耐药患者445例(29.0%)，耐多药患者327例(21.3%)。单因素分析结果显示，不同性别、年龄、民族、职业、户籍类型和登记分类间患者耐多药情况的差异均有统计学意义(均P＜0.05)。多因素logistic回归分析模型分析结果显示，职业为农牧民及工人(OR=2.95, 95% CI: 1.32~6.59, P=0.008)、其他职业(OR=3.12, 95% CI: 1.41~6.88, P=0.005)、登记分类为复发(OR=6.16, 95% CI: 3.66~10.39, P < 0.001)、复治失败(OR=11.93, 95% CI: 4.61~30.88, P < 0.001)和初治失败(OR=14.10, 95% CI: 7.74~25.69, P < 0.001)的患者出现耐多药可能性较高；而兰州市户籍患者发生耐多药的可能性较低(OR=0.11, 95% CI: 0.08~0.16, P < 0.001)。 结论 兰州市肺结核患者耐多药率较高。农牧民及工人、其他职业、非兰州市户籍、复发、初治失败和复治失败是发生耐多药的主要危险因素。 -
关键词:
- 肺结核 /
- 耐多药肺结核 /
- logistic回归分析模型 /
- 影响因素
Abstract:Objective The goal of this research was to investigate the prevalence of multi-drug resistance and its influencing factors in 1 536 tuberculosis patients. Methods A total of 1 536 confirmed tuberculosis patients were recruited in Lanzhou from 2018 to 2020, using the Tuberculosis Management Information System. Chi-square test and multivariate logistic regression analysis were used to explore the influencing factors of multi-drug resistance. Results Among the 1 536 tuberculosis patients, there were 445 (29.0%) cases presented with drug-resistant tuberculosis and 327 (21.3%) cases with multidrug-resistant tuberculosis. The results of univariate analysis showed that there were significant differences in multidrug-resistant status among patients with different genders, ages, nationalities, occupations, household registration types, and registered classifications. Multivariate logistic regression analysis showed that those working as farmers, herdsmen, workers (OR=2.95, 95% CI: 1.32-6.59, P=0.008) and other occupations (OR=3.12, 95% CI: 1.41-6.88, P=0.005), as well as patients classified as relapse (OR=6.16, 95% CI: 3.66-10.39, P < 0.001), retreatment failure (OR=11.93, 95% CI: 4.61-30.88, P < 0.001) and initial treatment failure (OR=14.10, 95% CI: 7.74-25.69, P < 0.001) were more likely to develop multi-drug resistance. Converserly, patients registered as residing in Lanzhou were less likely to develop multi-drug resistance (OR=0.11, 95% CI: 0.08-0.16, P < 0.001). Conclusions The prevalence of MDR in tuberculosis patients in Lanzhou was found to be high. Occupations such as farmers, herdsmen, and workers, along with other occupations, non-Lanzhou household registration, and classifications of relapse, initial treatment failure, and retreatment failure were identified as major risk factors for developing MDR. -
表 1 兰州市1 536例肺结核患者的基本信息及耐多药肺结核情况的单因素分析
Table 1. Basic information and univariate analysis results of MDR-TB in 1 536 tuberculosis patients in Lanzhou City
变量Variable 肺结核病例数(占比/%)
Nubmer of TB cases (proportion /%)耐多药肺结核人数(耐多药率/%)
Nubmer of MDR-TB cases (Rate of MDR-TB/%)χ2值
χ2 valueP值
P value性别Sex 3.03 0.082 男Male 865(56.3) 198(22.9) 女Female 671(43.7) 129(19.2) 年龄组/岁Age group/years 41.78 ＜0.001 ＜30 347(22.6) 83(23.9) 30~＜60 646(42.1) 177(27.4) ≥60 543(35.4) 67(12.3) 民族Nationality 30.09 ＜0.001 汉族Han 1 436(93.5) 284(19.8) 非汉族Non-Han 100(6.5) 43(43.0) 职业Occupation 175.07 ＜0.001 学生Students 108(7.0) 17(15.7) 家政、家务及待业人员Domestic, housework and unemployed staff 435(28.3) 71(16.3) 农牧民及工人Farmers/herdsmen/workers 330(21.5) 136(41.2) 事业编制及公务员Institution establishment workers and civil servants 121(7.9) 15(12.4) 离退休人员Retirees 371(24.2) 22(5.9) 其他Other occupations 171(11.1) 66(38.6) 户籍类型Household registration type 470.74 ＜0.001 兰州市Lanzhou City 1 014(66.0) 51(5.0) 非兰州市Non-Lanzhou City 522(34.0) 276(52.9) 登记分类Registered classification 561.11 ＜0.001 新患者New patients 1 262(82.2) 130(10.3) 初治失败Initial treatment failure 125(8.1) 109(87.2) 复发Relapse 111(7.2) 56(50.5) 复治失败Retreatment failure 38(2.5) 32(84.2) 
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表 2 兰州市1 536例肺结核患者中出现耐多药肺结核情况的多因素logistic回归分析模型
Table 2. Multivariate logistic regression analysis model of MDR-TB among 1 536 tuberculosis patients in Lanzhou City
变量Variable β sx OR值(95% CI))
OR value (95% CI))Wald值
Wald valueP值
P value性别Sex 男Male -0.19 0.18 0.83(0.58~1.18) 1.06 0.303 女Female 年龄组/岁Age group /years ＜30 30~＜60 -0.13 0.25 0.88(0.54~1.43) 0.28 0.599 ≥60 -0.44 0.31 0.65(0.36~1.18) 2.05 0.153 民族Nationality 汉族Han -0.35 0.31 0.71(0.39~1.29) 1.30 0.254 非汉族Non-Han 职业Occupation 学生Students 家政、家务及待业人员Domestic, housework and unemployed staff 0.70 0.38 2.00(0.95~4.24) 3.29 0.070 农牧民及工人Farmers/herdsmen/workers 1.08 0.41 2.95(1.32~6.59) 6.95 0.008 事业编制及公务员Institution establishment workers and civil servants 0.40 0.47 1.49(0.59~3.75) 0.71 0.399 离退休人员Retirees 0.19 0.48 1.21(0.47~3.12) 0.15 0.695 其他Other occupations 1.14 0.40 3.12(1.41~6.88) 7.90 0.005 户籍类型Household registration type 兰州市Lanzhou City -2.21 0.20 0.11(0.08~0.16) 128.88 ＜0.001 非兰州市Non-Lanzhou City 登记分类Registered classification 新患者New patient 初治失败Initial treatment failure 2.65 0.31 14.10(7.74~25.69) 74.78 ＜0.001 复发Relapse 1.82 0.27 6.16(3.66~10.39) 46.66 ＜0.001 复治失败Retreatment failure 2.48 0.49 11.93(4.61~30.88) 26.11 ＜0.001
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[1] World Health Organization. Global tuberculosis report 2021[R]. Geneva: WHO, 2021. [2] 周银发, 张山鹰, 戴志松, 等. 福建省耐药肺结核高危人群利福平耐药情况及其影响因素分析[J]. 中国防痨杂志, 2020, 42(4): 339-344. DOI: 10.3969/j.issn.1000-6621.2020.04.008.Zhou YF, Zhang SY, Dai ZS, et al. Analysis of rifampicin resistance and its influencing factors in drug-resistant pulmonary tuberculosis population in Fujian Province[J]. Chin Antituberculosis Association, 2020, 42(4): 339-344. DOI: 10.3969/j.issn.1000-6621.2020.04.008. [3] 王宇. 耐多药肺结核防治管理工作方案[M]. 北京: 军事医学科学出版社, 2012: 8-9.Wang Y. Management plan for the prevention and treatment of multidrug-resistant tuberculosis[M]. Beijing: Military Medical Science Press, 2012: 8-9. [4] 胡彦, 杨春, 卢楠, 等. 重庆市耐多药肺结核可疑患者药敏结果分析[J]. 重庆医科大学学报, 2018, 43(7): 923-926. DOI: 10.13406/j.cnki.cyxb.001210.Hu Y, Yang C, Lu N, et al. Analysis of susceptibility results of suspected patients with multi-drug resistant pulmonary tuberculosis in Chongqing[J]. J Chongqing Med Univ, 2018, 43(7): 923-926. DOI: 10.13406/j.cnki.cyxb.001210. [5] 肖东楼. 全国结核病耐药性基线调查报告(2007-2008)[M]. 北京: 人民卫生出版社, 2010: 30-32.Xiao DL. National TB drug resistance baseline survey report (2007-2008)[M]. Beijing: People's Medical Publishing House, 2010: 30-32. [6] Yang X, Yuan Y, Pang Y, et al. The burden of MDR/XDR tuberculosis in coastal plains population of China[J]. PLoS One, 2015, 10(2): e0117361. DOI: 10.1371/journal.pone.0117361. [7] Law WS, Yew WW, Chiu LC, et al. Risk factors for multidrug-resistant tuberculosis in Hong Kong[J]. Int J Tuberc Lung Dis, 2008, 12(9): 1065-1070. DOI: 10.3126/ijasbt.v5i4.18771. -
