2021年喀什地区肺结核患者利福平耐药影响因素分析

doi:10.19983/j.issn.2096-8493.20220094

摘要/Abstract

摘要：

目的: 分析喀什地区肺结核患者利福平耐药主要影响因素,为有效控制本地区耐药结核病疫情蔓延提供科学依据。方法:从“中国疾病预防控制信息系统”子系统“结核病管理信息系统”中选取2021年1月1日至12月31日在喀什地区肺科医院登记治疗并完成调查全程的144例利福平耐药肺结核患者作为耐药组,按照1∶1及年龄±3岁的匹配原则随机选取同期同乡镇登记治疗的144例病原学阳性的非利福平耐药肺结核患者作为非耐药组。现场核对入组患者实验室检查结果和诊治信息,并对患者开展现场问卷调查,收集患者一般人口学资料、接受健康教育情况、患者结核病治疗史及服药管理等信息。以是否利福平耐药为因变量,对各因素进行单因素和多因素logistic回归分析。结果:多因素分析显示,耐利福平患者伴有合并症、自服药、不按剂量服药、出现中断治疗、不知晓肺结核传播途径的比例[分别为70.1%(101/144)、78.5%(113/144)、29.9%(43/144)、87.5%(126/144)、14.6%(21/144)]均明显高于非耐利福平患者[分别为26.4%(38/144)、16.0%(23/144)、15.3%(22/144)、6.9%(10/144)、2.8%(4/144)],均是利福平耐药产生的独立危险因素[OR(95%CI)分别为6.552(3.987~10.768)、19.178(11.109~33.103)、2.361(1.335~4.174)、93.800(48.909~179.894)、5.976(2.228~16.026)]。结论:应加强对喀什地区伴有合并症和结核病防治意识淡薄的肺结核患者采取集中服药管理和健康宣传教育等针对性干预措施,以提高患者治疗依从性和治疗成功率,降低耐药发生风险。

关键词: 结核,肺, 利福平, 抗药性, 因素分析, 统计学, 喀什

Abstract:

Objective: To analyze the influencing factors of rifampicin resistance in pulmonary tuberculosis patients, and to provide scientific basis for effective control of drug-resistant tuberculosis in Kashgar. Methods: From January 1 to December 31, 2021, 144 rifampicin-resistant tuberculosis patients who were registered and received treatment in Kashgar Pulmonary Hospital and completed the survey were enrolled as the drug-resistant group based on the Tuberculosis Management Information System, a subsystem of the Chinese Disease Prevention and Control Information System. One hundred and forty-four bacteriology confirmed rifampicin-susceptible tuberculosis patients registered and treated in the same town during the same period were randomly selected as the non-drug-resistant group according to the principles of 1∶1 matching and age ±3 years. The laboratory test results, clinical diagnosis and treatment information were checked on-site, and an on-site questionnaire survey was carried out to collect the general demographic data of the patients, the status of receiving health education, and the patients’ tuberculosis treatment history and management. Univariate and multivariate logistic regression analysis was performed with rifampicin resistance as the dependent variable. Results: Multivariate analysis showed that the proportion of comorbidities, self-administration, non-metered medication, discontinuation of treatment, and unawareness of the transmission way of pulmonary tuberculosis among rifampicin-resistant patients (70.1% (101/144), 78.5% (113/144), 29.9% (43/144), 87.5% (126/144), 14.6% (21/144)) were significantly higher than those of non-rifampicin-resistant patients (26.4% (38/144), 16.0% (23/144), 15.3% (22/144), 6.9% (10/144), 2.8% (4/144)), which were independent risk factors for rifampicin resistance (OR (95%CI)=6.552 (3.987-10.768), 19.178 (11.109-33.103), 2.361 (1.335-4.174), 93.800 (48.909-179.894), 5.976 (2.228-16.026)). Conclusion: For pulmonary tuberculosis patients with comorbidities and low awareness of tuberculosis knowledge in Kashgar, interventions such as centralized medication management,and health education should be strengthened to improve patients’ treatment adherence and success rate, and to reduce the risk of acquired drug resistance.

Key words: Tuberculosis,pulmonary, Rifampicin, Drug resistance, Factor analysis, statistical, Kashgar

中图分类号:

R521

古力米娜·阿布力米提, 麦维兰江·阿不力米提, 地尔木拉提·吐逊, 刘振江, 何懿, 苏伟, 欧喜超. 2021年喀什地区肺结核患者利福平耐药影响因素分析[J]. 结核与肺部疾病杂志, 2022, 3(4): 269-273. doi: 10.19983/j.issn.2096-8493.20220094

Gulimina·Abulimiti , Maiweilanjiang·Abulimiti , Diermulati·Tusun , Liu Zhenjiang, He Yi, Su Wei, Ou Xichao. Analysis of influencing factors of rifampicin resistance in pulmonary tuberculosis patients in Kashgar in 2021[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(4): 269-273. doi: 10.19983/j.issn.2096-8493.20220094

图/表 3

表1

表2

表3

肺结核患者发生利福平耐药影响因素的多因素logistic回归分析

变量	β值	s $x ¯$ 值	Wald χ²值	P值	OR(95%CI)值
有合并症	2.339	0.814	54.999	0.004	6.552(3.987~10.768)
自服药	4.402	1.377	112.457	0.000	19.178(11.109~33.103)
不按剂量服药	1.865	0.998	8.732	0.003	2.361(1.335~4.174)
中断治疗	3.650	0.842	186.817	0.000	93.800(48.909~179.894)
不知晓肺结核传播途径	5.230	1.152	12.615	0.000	5.976(2.228~16.026)

表3

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特征	利福平耐药组(144例)	非利福平耐药组(144例)	χ²值	P值
性别			1.384	0.239
男性	76(52.8)	66(45.8)
女性	68(47.2)	78(54.2)
年龄组(岁)			0.347	0.841
15~35	26(18.1)	29(20.1)
36~59	26(18.1)	23(16.0)
60~88	92(63.8)	92(63.9)
民族			1.313	0.252
汉族	2(1.4)	5(3.5)
维吾尔族	142(98.6)	139(96.5)
职业			10.413	0.001
农牧民	126(87.5)	104(72.2)
其他	18(12.5)	40(27.8)
经济状况			7.070	0.029
差	110(76.4)	90(62.5)
中等	21(14.6)	29(20.1)
较好	13(9.0)	25(17.4)
文化程度			0.016	0.901
初中以下	96(66.7)	95(66.0)
初中及以上	48(33.3)	49(34.0)
医疗保险类型			2.578	0.108
三保合一	126(87.5)	116(80.6)
其他	18(12.5)	28(19.4)
合并症			55.000	<0.001
有	101(70.1)	38(26.4)
无	43(29.9)	106(73.6)
抗结核治疗次数			37.749	<0.001
1	31(21.5)	82(56.9)
≥2	113(78.5)	62(43.1)
特征	利福平耐药组(144例)	非利福平耐药组(144例)	χ²值	P值
服药督导方式			112.457	<0.001
自服药	113(78.5)	23(16.0)
乡村医生面视下服药	31(21.5)	121(84.1)
按剂量服药			8.732	0.003
否	43(29.9)	22(15.3)
是	101(70.1)	122(84.7)
中断治疗			186.817	<0.001
是	126(87.5)	10(6.9)
否	18(12.5)	134(93.1)
接受过肺结核宣传教育			3.708	0.054
否	20(13.9)	10(6.9)
是	124(86.1)	134(93.1)
知晓肺结核的传播途径			12.615	<0.001
否	21(14.6)	4(2.8)
是	123(85.4)	140(97.2)
知晓肺结核的治疗疗程			100.120	<0.001
否	117(81.3)	32(22.2)
是	27(18.7)	112(77.8)

变量	赋值	变量	赋值
职业	农牧民=1;其他=2	按剂量服药	否=1;是=2
经济状况	差=1;中等=2;较好=3	中断治疗	是=1;否=2
合并症	有=1;无=2	知晓肺结核的传播途径	是=1;否=0
抗结核治疗次数	≥2次=1;1次=2	知晓肺结核的治疗疗程	是=1;否=0
服药督导方式	自服药=1;乡村医生面试下服药=2