Analysis of drug resistance characteristics and influencing factors in 159 patients with re-treated pulmonary tuberculosis

doi:10.19983/j.issn.2096-8493.20210063

Abstract

Abstract:

Objective To analyze independent factors associated with drug resistance in re-treated pulmonary tuberculosis (PTB) patients and evaluate their predictive values. Methods Between January 2019 and December 2020, a total of 159 re-treated PTB patients were divided into drug resistant group (71 cases) and sensitive group (88 cases) according to drug susceptibility test. Demographic data, clinical characteristics, chest computed tomography (CT) characteristics and laboratory test results were collected. Multivariate analysis was performed using binomial logistic regression model to identify independent risk factors associated with drug resistance of re-treated PTB, and their predictive values were evaluated with receiver operating characteristics (ROC) curves. Results The total drug resistance rate was 44.7% (71/159). According to univariate analysis results, average duration of disease in the drug resistant group was longer than that in the sensitive group (0.82±0.27 vs 0.29±0.13, t=15.181, P<0.001), proportion of cavitary PTB in the drug-resistant group was greater than that in the sensitive group (71.8% (51/71) vs 54.5% (48/88), χ²=4.997, P=0.025), average cavity count of the drug resistant group was greater than that of the sensitive group (4 (2, 4) vs 2 (1, 4), Z=2.703, P=0.007), average chest CT score for tuberculosis of the drug resistant group was greater than that of the sensitive group (12.61±2.84 vs 11.22±2.79, t=3.098, P=0.002), average C-reactive protein (CRP) level of the drug-resistant group was higher than that of the sensitive group (52.60 (24.67, 80.30) mg/L vs 34.04 (17.43, 58.37) mg/L, Z=2.604, P=0.009), and average white blood cell count of the drug resistant group was higher than that of the sensitive group (8.90 (7.42, 11.18)×10 ⁹/L vs 7.76 (5.71, 10.75)×10 ⁹/L, Z=-2.165, P=0.030). Binary logistic regression analysis showed that CRP was independently associated with drug resistance in re-treated PTB patients after adjusting for duration of disease, proportion of cavitary PTB, cavity count, chest CT score for PTB, white blood cells, age, previous medication irregularity and counts of blood platelets, and its odds ratio (OR) was 1.019 (95% confidence interval (CI): 1.006-1.032, P=0.011). The area under curve (AUC) of CRP in predicting drug-resistance was 0.631 (standard error: 0.048, P=0.009), and the best cutoff was 49.01mg/L with the sensitivity of 57.6% and specificity of 69.3%. Conclusion CRP was independently associated with drug-resistance in re-treated PTB patients, which had the potential for predicting drug-resistance of re-treated PTB.

Key words: Tuberculosis,multidrug-resistant, C-reactive protein, Factor analysis, statistical

LI Yuan-yuan, SU Dong-dong, Aertai . Analysis of drug resistance characteristics and influencing factors in 159 patients with re-treated pulmonary tuberculosis[J]. Journal of Tuberculosis and Lung Disease , 2021, 2(4): 347-351. doi: 10.19983/j.issn.2096-8493.20210063

Figures/Tables 3

因素	合计(159例)	耐药组(71例)	敏感组(88例)	统计检验值	P值
年龄[岁,M(Q₁,Q₃)]	50(32,64)	47(33,57)	57(31,68)	Z=-1.799	0.072
性别[例,构成比(%)]				χ²=0.198	0.657
男性	100(62.9)	46(64.8)	54(61.4)
女性	59(37.1)	25(35.2)	34(38.6)
体质量指数( $x -$ ±s)	19.14±1.67	19.06±1.63	19.20±1.70	t=-0.528	0.603
临床特点
病程(年, $x -$ ±s)	0.53±0.19	0.82±0.27	0.29±0.13	t=15.181	<0.001
既往服药不规律[例,百分率(%)]	90(56.6)	35(49.3)	55(62.5)	χ²=2.789	0.095
既往治疗中断[例,百分率(%)]	99(62.3)	42(59.2)	57(64.8)	χ²=0.528	0.468
胸部CT检查结果
空洞型肺结核[例,百分率(%)]	99(62.3)	51(71.8)	48(54.5)	χ²=4.997	0.025
病灶累及肺野数(个, $x -$ ±s)	3.19±1.04	3.34±0.94	3.07±1.10	t=1.638	0.103
空洞数[个,M(Q₁,Q₃)]	3(1,4)	4(2,4)	2(1,4)	Z=2.703	0.007
肺结核胸部CT评分(分, $x -$ ±s)	11.84±2.89	12.61±2.84	11.22±2.79	t=3.098	0.002
实验室检查
结核感染T细胞斑点试验阳性[例,百分率(%)]	124(78.0)	52(73.2)	72(81.8)	χ²=1.685	0.194
C反应蛋白[mg/L,M(Q₁,Q₃)]	40.44 (22.00,69.58)	52.60 (24.67,80.30)	34.04 (17.43,58.37)	Z=2.604	0.009
白细胞计数[×10⁹/L,M(Q₁,Q₃)]	8.49 (6.34,10.83)	8.90 (7.42,11.18)	7.76 (5.71,10.75)	Z=-2.165	0.030
红细胞计数[×10¹²/L,M(Q₁,Q₃)]	4.67 (4.29,5.06)	4.70 (4.31,5.13)	4.65 (4.24,5.05)	Z=-1.210	0.226
中性粒细胞百分比[M(Q₁,Q₃)]	0.707 (0.658,0.778)	0.717 (0.662,0.785)	0.703 (0.649,0.771)	Z=0.943	0.346
淋巴细胞百分比[M(Q₁,Q₃)]	0.159 (0.114,0.218)	0.157 (0.104,0.201)	0.169 (0.122,0.222)	Z=-1.452	0.147
血小板计数(×10⁹/L, $x -$ ±s)	326.62±134.72	349.96±127.53	307.66±138.14	t=1.955	0.052
血红细胞沉降率[mm/1h,M(Q₁,Q₃)]	34.00 (11.24,73.74)	35.50 (12.96,91.71)	32.00 (10.04,49.54)	Z=-1.091	0.275

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因素	β值	$s_{\bar{x}}$值	Wald χ²值	OR值	95%CI值	P值
年龄	-0.013	0.011	1.348	0.991	0.972~1.010	0.245
病程	0.897	0.581	2.394	2.448	0.788~7.063	0.119
既往服药不规律	-0.432	0.354	1.465	0.647	0.320~1.305	0.227
空洞数	0.091	0.129	0.501	1.094	0.847~1.412	0.480
肺结核胸部CT评分	0.130	0.068	3.509	1.139	0.995~1.306	0.060
空洞型肺结核	0.397	0.385	1.059	1.486	0.671~3.152	0.303
白细胞计数	0.051	0.047	1.016	1.052	0.956~1.158	0.313
C反应蛋白	0.017	0.006	6.579	1.019	1.006~1.032	0.011
血小板计数	0.014	0.009	2.660	1.003	0.996~1.057	0.107

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