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耐多药结核病发生耐药的危险因素分析
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Abstract:
目的：探讨耐多药结核病患者发生耐药的危险因素，为针对性预防和控制耐多药结核病提供思路。方法：基于云南省传染病医院开展了一项非匹配病例对照研究。将54例耐多药结核病患者作为病例组，52例非耐多药结核病患者作为对照组，收集两组患者的人口学资料(性别、年龄、职业、户籍地)、临床资料(合并糖尿病和既往结核病治疗史)和影像学检查资料(胸部CT有无空洞)，并对其进行单因素χ2检验和多因素logistic回归分析，研究结核病患者产生耐药性的危险因素。结果：单因素分析结果表明，既往结核病治疗史与耐多药结核病的发生有关(χ2 = 20.56, P < 0.05)，而性别、年龄、职业、户籍地、糖尿病以及胸部CT空洞有无与耐多药结核病的发生无显著相关性(χ2 = 0.31, 1.41, 0.43, 0.05, 3.73, 1.33, P > 0.05)；多因素二元Logistic回归分析显示，既往结核病治疗史(OR = 9.173, 95%CI = 3.632~22.985)和合并糖尿病(OR = 9.484, 95%CI = 1.742~51.618)是耐多药结核病发生的独立危险因素。结论：应规范结核病的诊疗，重视结核病合并糖尿病患者结核耐药筛查，早期发现耐药，减少耐药的发生。
Objective: To explore the risk factors of resistance in MDR-TB patients, and to provide ideas for tar-geted prevention and control of MDR-TB. Methods: An unmatched case-control study was conducted in Yunnan Provincial Infectious Disease Hospital. 54 multidrug-resistant tuberculosis patients were taken as the case group and 52 non-multidrug-resistant tuberculosis patients as the control group. The demographic data (sex, age, occupation, place of residence), clinical data (diabetes and previous tuberculosis treatment history)and imaging data (whether there are cavities in chest CT) were col-lected from the two groups of patients, and univariate χ2 test and multivariate logistic regression analysis were performed to study the risk factors for drug resistance in tuberculosis patients. Re-sults: The results of univariate analysis showed that previous TB treatment history was associated with the occurrence of MDR-TB (χ2 = 20.56, P < 0.05), while gender, age, occupation, place of resi-dence, diabetes mellitus and chest CT cavities were not significantly associated with the occurrence of MDR-TB (χ2 = 0.31, 1.41, 0.43, 0.05, 3.73, 1.33, P > 0.05), while multivariate binary logistic re-gression analysis showed that previous TB treatment history (OR = 9.173, 95%CI = 3.632~22.985) and diabetes mellitus (OR = 9.484, 95%CI = 1.742~51.618) were independent risk factors for the development of MDR-TB. Conclusion: The diagnosis and treatment of tuberculosis should be stand-ardized, and attention should be paid to the screening of tuberculosis drug resistance in patients with tuberculosis and diabetes, so as to detect drug resistance early and reduce the occurrence of drug resistance.
| [1] | World Health Organization (2021) Global Tuberculosis Report 2020. World Health Organization Document. |
| [2] | World Health Organization (2022) Global Tuberculosis Report 2021. World Health Organization Document. |
| [3] | Chan, E.D. and Iseman, M.D. (2008) Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis: A Review. Current Opin-ion in Infectious Diseases, 21, 587-595. https://doi.org/10.1097/QCO.0b013e328319bce6 |
| [4] | Xing, W., Zhang, R., Jiang, W., et al. (2021) Adherence to Multidrug Resistant Tuberculosis Treatment and Case Management in Chong-qing, China—A Mixed Method Research Study. Infection and Drug Resistance, 14, 999-1012.
https://doi.org/10.2147/IDR.S293583 |
| [5] | Dillard, L.K., Martinez, R.X., Perez, L.L., et al. (2021) Prevalence of Aminoglycoside-Induced Hearing Loss in Drug-Resistant Tuberculosis Patients: A Systematic Review. Journal of Infec-tion, 83, 27-36.
https://doi.org/10.1016/j.jinf.2021.05.010 |
| [6] | Bogale, L., Tsegaye, T., Abdulkadir, M., et al. (2021) Unfavorable Treatment Outcome and Its Predictors among Patients with Multidrug-Resistance Tuberculosis in Southern Ethiopia in 2014 to 2019: A Multi-Center Retrospective Follow-Up Study. Infection and Drug Resistance, 14, 1343-1355. https://doi.org/10.2147/IDR.S300814 |
| [7] | Chaves-Torres, N.M., Fadul, S., Pati？o, J., et al. (2021) Factors Asso-ciated with Unfavorable Treatment Outcomes in Patients with Rifampicin-Resistant Tuberculosis in Colombia 2013-2015: A Retrospective Cohort Study. PLOS ONE, 16, e0249565. https://doi.org/10.1371/journal.pone.0249565 |
| [8] | 林志浩, 丘小燕, 马晓慧, 等. 佛山市193例耐多药肺结核患者的治疗转归及影响因素分析[J]. 实用预防医学, 2022, 29(11): 1290-1294. |
| [9] | 潘辰慧, 张顺先, 张少言, 等. 耐多药肺结核治疗转归的影响因素分析[J]. 解放军医学杂志, 2023, 48(9): 1040-1047. |
| [10] | 李德富, 俞玉琪, 卢曲琴, 等. 江西省耐药结核病治疗现状与抗结核药治疗费用分析[J]. 现代预防医学, 2021, 48(18): 3425-3429. |
| [11] | Pan, Y., Yu, Y,, Lu, J., et al. (2022) Drug Resistance Pat-terns and Trends in Patients with Suspected Drug-Resistant Tuberculosis in Dalian, China: A Retrospective Study. Infec-tion and Drug Resistance, 15, 4137-4147.
https://doi.org/10.2147/IDR.S373125 |
| [12] | Hirama, T., Sabur, N., Derkach, P., et al. (2020) Respiratory Syncytial Virus: Risk Factors for Drug-Resistant Tuberculosis at a Referral Centre in Toronto, Ontario, Canada: 2010-2016. Can-ada Communicable Disease Report, 46, 84-92.
https://doi.org/10.14745/ccdr.v46i04a05 |
| [13] | de Dieu Longo, J., Woromogo, S.H., Tekpa, G., et al. (2023) Risk Factors for Multidrug-Resistant Tuberculosis in the Central African Republic: A Case-Control Study. Journal of Infection and Public Health, 16, 1341-1345.
https://doi.org/10.1016/j.jiph.2023.06.007 |
| [14] | Tenzin, C., Chansatitporn, N., Dendup, T., et al. (2020) Factors Associated with Multidrug-Resistant Tuberculosis (MDR-TB) in Bhutan: A Nationwide Case-Control Study. PLOS ONE, 15, e0236250.
https://doi.org/10.1371/journal.pone.0236250 |
| [15] | 符婷, 黄丽菊, 杨进军, 等. 海南省三亚市158例耐多药肺结核患者危险因素的Logistic回归分析[J]. 中国热带医学, 2020, 20(8): 789-793. |
| [16] | Tembo, B.P. and Malangu, N.G. (2019) Prevalence and Factors Associated with Multidrug/Rifampicin Resistant Tuberculosis among Suspected Drug Resistant Tuberculosis Patients in Botswana. BMC Infectious Diseases, 19, Article No. 779. https://doi.org/10.1186/s12879-019-4375-7 |
| [17] | Loddenkemper, R., Sagebiel, D. and Brendel, A. (2002) Strategies against Multidrug-Resistant Tuberculosis. European Respiratory Journal, 20, 66s-77s. https://doi.org/10.1183/09031936.02.00401302 |
| [18] | Antonio-Arques, V., Franch-Nadal, J., Moreno-Martinez, A., et al. (2022) Subjects with Diabetes Mellitus Are at Increased Risk for Developing Tuberculosis: A Cohort Study in an Inner-City District of Barcelona (Spain). Frontiers in Public Health, 10, Article ID: 789952. https://doi.org/10.3389/fpubh.2022.789952 |
| [19] | Adegbite, B.R., Edoa, J.R., Abdul, J., et al. (2022) Non-Communicable Disease Co-Morbidity and Associated Factors in Tuberculosis Patients: A Cross-Sectional Study in Gabon. Eclinicalmedicine, 45, Article ID: 101316.
https://doi.org/10.1016/j.eclinm.2022.101316 |
| [20] | Noubiap, J.J., Nansseu, J.R., Nyaga, U.F., et al. (2019) Global Prevalence of Diabetes in Active Tuberculosis: A Systematic Review and Meta-Analysis of Data from 2.3 Million Pa-tients with Tuberculosis. The Lancet Global Health, 7, e448-e460. https://doi.org/10.1016/S2214-109X(18)30487-X |
| [21] | Adane, H.T., Howe, R.C., Wassie, L., et al. (2023) Diabe-tes Mellitus Is Associated with an Increased Risk of Unsuccessful Treatment Outcomes among Drug-Susceptible Tuber-culosis Patients in Ethiopia: A Prospective Health Facility-Based Study. Journal of Clinical Tuberculosis and Other My-cobacterial Diseases, 31, Article ID: 100368.
https://doi.org/10.1016/j.jctube.2023.100368 |
| [22] | Montes, K., Atluri, H., Tuch, H.S., et al. (2021) Risk Factors for Mortality and Multidrug Resistance in Pulmonary Tuberculosis in Guatemala: A Retrospective Analysis of Mandatory Reporting. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 25, Article ID: 100287. https://doi.org/10.1016/j.jctube.2021.100287 |
| [23] | Habibi, M.R., Bakhtiar, A., Indiastuti, D.N., et al. (2022) Diabe-tes Mellitus and History of Tuberculosis Treatment as Risk Factors of Developing Multidrug-Resistant Tuberculosis at TB Polyclinic Dr. Soetomo General Hospital 2019-2020. Jurnal Ilmiah Universitas Batanghari Jambi, 22, 537-543. https://doi.org/10.33087/jiubj.v22i1.1908 |
| [24] | Iradukunda, A., Ndayishimiye, G.P., Sinarinzi, D., et al. (2021) Key Factors Influencing Multidrug-Resistant Tuberculosis in Patients under Anti-Tuberculosis Treatment in Two Centres in Burundi: A Mixed Effect Modelling Study. BMC Public Health, 21, Article No. 2142. https://doi.org/10.1186/s12889-021-12233-2 |
| [25] | Agustin, H., Massi, M.N., Djaharuddin, I., et al. (2021) Analy-sis of CD4 and CD8 Expression in Multidrug-Resistant Tuberculosis Infection with Diabetes Mellitus: An Experimental Study in Mice. Annals of Medicine and Surgery, 68, Article ID: 102596. https://doi.org/10.1016/j.amsu.2021.102596 |
| [26] | Kumar, A.K.H., Chandrasekaran, V., Kannan, T., et al. (2017) Anti-Tuberculosis Drug Concentrations in Tuberculosis Patients with and without Diabetes Mellitus. European Journal of Clinical Pharmacology, 73, 65-70.
https://doi.org/10.1007/s00228-016-2132-z |
