2016—2020年济南市肺结核患者耐药情况分析

doi:10.19983/j.issn.2096-8493.20210138

摘要/Abstract

摘要：

目的: 分析济南市肺结核患者的耐药情况,为耐药肺结核的防控提供依据。方法: 采用回顾性的调查方法,对2016—2020年济南市1104例痰培养阳性肺结核患者的耐药检测结果进行分析。结果: 2016—2020年济南市肺结核患者总耐药率为24.82%(274/1104),其中初治患者耐药率为21.47%(204/950),复治患者耐药率为45.45%(70/154);单耐药率为10.14%(112/1104),耐多药率为7.70%(85/1104),准广泛耐药率为1.54%(17/1104),其他耐药率为5.43%(60/1104)。2016—2020年肺结核患者总耐药率[2016年耐药率为50.00%(46/92),2017年耐药率为50.00%(32/64),2018年耐药率为24.44%(33/135),2019年耐药率为16.16%(58/359),2020年耐药率为23.13%(105/454)]呈下降趋势,差异有统计学意义(χ_趋势²=38.100,P<0.001)。多因素logistic 回归分析结果显示,以14~20岁年龄组为参照,21~40岁肺结核患者耐药率较高(OR=4.394,95%CI:1.325~14.570);以初治患者为参照,复治肺结核患者耐药率较高(OR=3.276,95%CI:2.264~4.740)。结论: 济南市耐药肺结核疫情较为严重,应重点关注21~40岁与复治肺结核患者。

关键词: 结核, 抗药性, 因素分析,统计学, 小地区分析

Abstract:

Objective: To analyze the drug resistance situation of pulmonary tuberculosis patients in Ji’nan, in order to provide basis for the prevention and control of drug-resistant pulmonary tuberculosis. Methods: The drug resistance results of 1104 patients with sputum culture positive pulmonary tuberculosis in Ji’nan from 2016 to 2020 were analyzed by retrospective research method. The factors affecting drug resistance of pulmonary tuberculosis patients were analyzed by univariate and multivariate logistic regression model. Results: From 2016 to 2020, the total drug resistance rate of pulmonary tuberculosis patients in Ji’nan was 24.82% (274/1104), of which the drug resistance rate of newly treated patients was 21.47% (204/950), and the drug resistance rate of retreated patients was 45.45% (70/154); The single drug resistance rate was 10.14% (112/1104), the multidrug-resistance rate was 7.70% (85/1104), the pre-extensively drug-resistant tuberculosis rate was 1.54% (17/1104), and the other drug resistance rate was 5.43% (60/1104). From 2016 to 2020, the total drug resistance rate of tuberculosis patients (the drug resistance rate was 50.00% (46/92) in 2016, and 50.00% (32/64) in 2017, 24.44% (33/135) in 2018, 16.16% (58/359) in 2019, and 23.13% (105/454) in 2020) showed a downward trend, and the difference was statistically significant (χ_trend²=38.100, P<0.001). Multivariate logistic regression analysis showed that the drug resistance rate of pulmonary tuberculosis patients aged 21-40 was higher (OR=4.394, 95%CI: 1.325-14.570); The drug resistance rate of retreated pulmonary tuberculosis patients was higher (OR=3.276, 95%CI: 2.264-4.740). Conclusion: The epidemic situation of drug-resistant pulmonary tuberculosis in Ji’nan is serious. We should focus on patients aged 21-40 and retreated pulmonary tuberculosis patients.

Key words: Tuberculosis, Drug resistance, Factor analysi,statistical, Small-area analysis

中图分类号:

R521

蔡俊丽, 景睿, 张文茜, 武鸿燕, 刘晓华. 2016—2020年济南市肺结核患者耐药情况分析[J]. 结核与肺部疾病杂志, 2022, 3(1): 27-32. doi: 10.19983/j.issn.2096-8493.20210138

CAI Jun-li, JING Rui, ZHANG Wen-qian, WU Hong-yan, LIU Xiao-hua. Drug-resistant tuberculosis among patients in Ji’nan from 2016 to 2020[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(1): 27-32. doi: 10.19983/j.issn.2096-8493.20210138

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年份	培养阳性例数	总耐药[例 (耐药率,%)]	单耐药[例 (耐药率,%)]	耐多药[例 (耐药率,%)]	准广泛耐药[例 (耐药率,%)]	其他耐药[例 (耐药率,%)]
2016	92	46(50.00)	13(14.13)	28(30.43)	5(5.43)	0(0.00)
2017	64	32(50.00)	10(15.62)	16(25.00)	6(9.38)	0(0.00)
2018	135	33(24.44)	12(8.89)	11(8.15)	2(1.48)	8(5.93)
2019	359	58(16.16)	33(9.19)	11(3.06)	3(0.84)	11(3.06)
2020	454	105(23.13)	44(9.69)	19(4.19)	1(0.22)	41(9.03)
合计	1104	274(24.82)	112(10.14)	85(7.70)	17(1.54)	60(5.43)

人口学特征	例数(1104例)	耐药例数(274例)	耐药率(%)	χ²值	P值
性别				0.120	0.729
男性	805	202	25.09
女性	299	72	24.08
年龄组(岁)				10.177	0.017
14~20	48	3	6.25
21~40	359	98	27.30
41~60	290	70	24.14
61~95	407	103	25.31
职业				10.714	0.057
农民和民工	582	138	23.71
工人	119	29	24.37
行政事业单位人员	102	32	31.37
离退休人员	77	21	27.27
学生	72	9	12.50
其他	152	45	29.61
居住地				21.625	0.001
主城区	400	113	28.25
长清区	107	29	27.10
章丘区	158	51	32.28
莱芜区	199	31	15.58
济阳区	81	18	22.22
钢城区	51	6	11.76
郊区两县	108	26	24.07
患者分类				40.843	<0.001
初治患者	950	204	21.47
复治患者	154	70	45.45

变量	赋值	变量	赋值
因变量		居住地	主城区=1;长清区=2;章丘区=3;莱芜区=4;济阳区=5;钢城区=6;郊区两县=7
耐药	是=1 否=2
自变量
自变量		患者分类	初治患者=1;复治患者=2
年龄组	0~20岁=1;21~40岁=2;41~60岁=3;61~95岁=4	患者分类	初治患者=1;复治患者=2

变量	β值	$\bar{x}±s$值	Wald χ²值	P值	OR值	95%CI值
变量	β值	$\bar{x}±s$值	Wald χ²值	P值	OR值	上限	下限
年龄组(岁)
14~20					1.000
21~40	1.480	0.612	5.857	0.016	4.394	1.325	14.570
41~60	0.011	0.173	0.008	0.959	0.985	0.669	1.527
61~95	0.199	0.186	1.080	0.316	1.213	0.827	1.800
地区分布
主城区					1.000
长清区	-0.349	0.264	1.742	0.187	0.706	0.420	1.184
章丘区	-0.221	0.326	0.460	0.498	0.802	0.424	1.518
莱芜区	-0.433	0.293	2.180	0.140	0.648	0.365	1.152
济阳区	0.529	0.308	2.948	0.086	1.697	0.928	3.103
钢城区	0.177	0.363	0.239	0.625	1.194	0.586	2.432
郊区两县	0.863	0.501	2.969	0.085	2.371	0.888	6.329
患者分类
初治患者					1.000
复治患者	1.187	0.189	39.615	<0.001	3.276	2.264	4.740