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目的探讨异烟肼耐药结核病与耐多药结核病的影响因素,为其临床研究提供依据。方法选择160例确诊为肺结核的患者作为研究对象,其中耐多药组33例(20.62%),耐异烟肼组40例(25.00%),全敏感组87例(54.38%)。采用回顾性方法记录相关信息,筛选出影响耐药发生的相关因素,采用logistic回归分析进行多因素分析,并随访观察耐多药结核病发生情况。结果耐多药组与全敏感组在年龄、性别、治疗史及痰涂片比较差异有统计学意义(χ2=5.281、11.018、2.211、4.013,P=0.022、0.001、0.027、0.045);耐异烟肼组与全敏感组在年龄、性别、治疗史、痰涂片及肺部空洞比较差异有统计学意义(χ2=5.970、15.044、2.486、4.770、5.970,P=0.015、0.000、0.013、0.029、0.015)。多因素分析显示复治2次、复治≥3次、痰涂片阳性、肺部空洞是耐异烟肼结核病发生的危险因素[OR=2.611,95%CI(1.323~5.152);OR=3.522,95%CI(1.220~10.168);OR=2.014,95%CI(1.104~3.674);OR=1.784,95%CI(1.193~2.655),P<0.05];复治≥3次、痰涂片阳性是耐多药结核病发生的危险因素[OR=3.012,95%CI(1.203~7.541);OR=2.945,95%CI(1.131~7.824),P<0.05]。耐异烟肼结核病患者更容易发展为耐多药结核病,差异有统计学意义(χ2=10.093,P=0.001)。结论复治及痰涂片阳性是耐异烟肼结核病与耐多药结核病发生的危险因素,耐异烟肼结核分枝杆菌有向耐多药结核病演变的风险。
Objective To investigate the influencing factors of isoniazid-resistant tuberculosis and multidrug-resistant tuberculosis and provide basis for its clinical study. Methods Totally 160 patients diagnosed as pulmonary tuberculosis were enrolled in this study. Among them, 33 (20.62%) were resistant to MDR, 40 (25.00%) were resistant to isoniazid and 87 (54.38%) were sensitive to TB. Retrospective methods were used to record the relevant information, screening out the factors that influence the occurrence of drug resistance, using multivariate analysis with logistic regression analysis and follow-up observation of the occurrence of MDR-TB. Results There was significant difference in age, sex, history of treatment and sputum smear between multidrug-resistant group and full-sensitive group (χ2 = 5.281,11.018,2.211,4.013, P = 0.022,0.001,0.027,0.045) There were significant differences in age, sex, history of treatment, sputum smear and lung cavity among the group of hydrazide and the full sensitive group (χ2 = 5.970,15.044,2.486,4.770,5.970, P = 0.015,0.000,0.013,0.029 , 0.015). Multivariate analysis showed that retreatment was repeated twice, retreatment more than 3 times, sputum smear positive, and pulmonary voids were risk factors for the development of isoniazid-resistant tuberculosis (OR = 2.611, 95% CI 1.323-5.152); OR = 3.522 , OR = 2.014, 95% CI (1.104 ~ 3.674); OR = 1.784, 95% CI (1.193 ~ 2.655), P <0.05] Positive was the risk factor of MDR-TB [OR = 3.012,95% CI (1.203 ~ 7.541); OR = 2.945,95% CI 1.131 ~ 7.824, P <0.05]. Patients resistant to isoniazid are more likely to develop MDR-TB, the difference was statistically significant (χ2 = 10.093, P = 0.001). Conclusions Both retreatment and sputum smear positive are the risk factors for the occurrence of isoniazid-resistant tuberculosis and multidrug-resistant tuberculosis, and the risk of the development of MDR-TB of isoniazid-resistant Mycobacterium tuberculosis.