河南省耐多药和非耐多药结核病对患者社会生活影响的比较

摘要/Abstract

摘要： 目的调查研究并比较河南省耐多药结核病(MDR-TB)和非耐多药结核病(非MDR-TB)对患者社会生活的影响，为制订综合有效的结核病防治策略提供科学依据。方法利用2001年河南省参加世界卫生组织结核病耐药监测调查患者数据库, 采用Excel生成随机数字表方法随机抽取入选患者。使用问卷面对面访谈形式于2010年对MDR-TB患者和非MDR-TB患者的社会经济状况及结核病相关情况进行访谈性调查研究；共调查访谈234例TB患者。按照对异烟肼和利福平的耐药状态分为暴露组（MDR-TB患者组）86例和对照组（非MDR-TB患者组）148例。对收集的数据进行t检验和卡方检验。结果暴露组（70.9%，61/86）对患结核病的态度比对照组（52.4%，77/148）明显悲观，两组间差异有统计学意义（χ²=8.58，P=0.01）。与对照组比较（2.0%, 3/148），更多暴露组患者在患病期间依旧外出打工（9.3%，8/86），两组间差异有统计学意义（χ²=6.43，P=0.01）。结核病治愈后暴露组外出打工的比例（8.8%，7/80）明显低于对照组（24.0%，35/146），两组间差异有统计学意义（χ²=7.92，P<0.01）。与对照组相比（18.9%，28/148），更多暴露组患者患结核病后仍吸烟 (34.9%，30/86)，两组间差异有统计学意义（χ²=7.44，P<0.01）。更高比率的暴露组患者报告其未来生活计划被患结核病所改变（45.8%，33/72），相比之下23.9%(27/113) 的对照组报告其未来生活计划被改变，两组间差异有统计学意义（χ²=11.67，P<0.01）。结论与对照组患者相比，暴露组患者在患病后的社会生活受到明显影响。因此，建议为更加有效的控制结核病尤其是耐多药结核病，应进一步加强对MDR-TB患者的社会支持。

关键词: 结核, 抗药性, 细菌, 生活质量, 河南省

Abstract: Objective To investigate the social impacts of MDR-TB and compare to non-MDR-TB in Henan province in 2010 to provide scientific evidence for developing comprehensive TB control strategies. Methods Participants were randomly selected by using Excel generated random digits table from an anti-TB drug resistance surveillance survey dataset collected by the Institute for Tuberculosis Control and Prevention, Henan Centre for Disease Control and Prevention in 2001, supported by the World Health Organization. Face to face interviews were carried out using a questionnaire to collect information on the social impacts among MDR-TB and non-MDR-TB patients. Bivariate analysis was performed for data analysis. Altogether 234 TB cases were interviewed. Among the interviewed cases, 86 were MDR-TB cases and 148 were non-MDR-TB cases based on their anti-TB drug resistance status. T-test was applied in continuous variables and Chi square test was used for categorical variables for comparison. Results Compared to non-MDR-TB (52.4%, 77/148), a greater proportion of MDR-TB patients (70.9%, 61/86) reported pessimism (χ²=8.58, P=0.01). More MDR-TB patients (9.3%, 8/86) continued working outside when they were ill with TB compared to non MDR-TB patients (2.0%, 3/148) and the difference was statistically significant (χ²=6.43, P=0.01). However, after TB recovery, less MDR-TB patients (8.8%, 7/80) were able to work outside compared to non-MDR-TB patients (24.0%, 35/146), and the difference between the two groups was statistically significant (χ²=7.92, P<0.01). Compared to non-MDR-TB patients (18.9%, 28/148), more MDR-TB patients (34.9%, 30/86) maintained their smoking habit after they became ill with TB (χ²=7.44, P<0.01). A substantially greater proportion of MDR-TB patients reported future plans changed because of the disease compared to non-MDR-TB patients (45.8%,33/72 vs 23.9%,27/113, χ²=11.67, P<0.01). Conclusion The findings from this study suggest that social support to TB patients, especially MDR-TB patients is an important factor to be concerned when designing a comprehensive TB program.

Key words: Tuberculosis, Drug resistance, bacterial, Quality of life, Henan province

孙燕妮王国杰甄新安刘占峰 Harley David Hall Gillian Vally Hassan Sleigh Adrian. 河南省耐多药和非耐多药结核病对患者社会生活影响的比较[J]. 中国防痨杂志, 2013, 35(1): 41-47.

SUN Yan-ni, WANG Guo-jie, ZHEN Xin-an, LIU Zhan-feng, Harley David, Hall Gillian, Vally Hassan, Sleigh Adrian. The social impacts of MDR-TB on patients compared to non-MDR-TB in Henan province[J]. Chinese Journal of Antituberculosis, 2013, 35(1): 41-47.

参考文献

［1］World Health Organization. WHO definition of Health.Geneva:WHO,1948 ［2012-11-22］.http://www.who.int/about/definition/en/print.html.

［2］陈灏珠. 内科学. 4版. 北京: 人民卫生出版社, 1998:73.

［3］中华人民共和国卫生部疾病预防控制局，中华人民共和国卫生部医政司，中国疾病预防控制中心. 中国结核病防治规划实施工作指南（2008年版）.北京：中国协和医科大学出版社，2008: 62-64.

［4］中国疾病预防控制中心. 耐多药肺结核防治管理工作方案（2011年版）.北京：中国疾病预防控制中心，2011: 19-24.

［5］World Health Organization. Guidelines for the programmatic management of drug-resistant tuberculosis. Geneva:WHO, 2008 ［2012-11-22］.http://www.who.int/tb/challenges/mdr/programmatic_guidelines_for_mdrtb/en/index.html.

［6］杜长梅，王国斌，徐吉英，等.河南省第二轮结核病耐药监测及耐药趋势研究.中国防痨杂志，2006，28（2）：95-99.

［7］翟玉胜，张礼晓，李若蕊. 肺结核病人的生活质量的调查研究. 社区医学杂志, 2005,3(9): 54-59.

［8］张慧慧，彭立萍，杨水秀，等.难治与初治肺结核病人生活质量调查分析. 中华实用护理杂志, 2004, 20(8)： 50-51.

［9］Rajeswari R, Muniyandi M, Balasubramanian R, et al. Perceptions of tuberculosis patients about their physical, mental and social well-being: a field report from south India. Soc Sci Med, 2005, 60(8):1845-1853.

［10］Liefooghe R, Michiels N, Habib S, et al. Perception and social consequences of tuberculosis: a focus group study of tuberculosis patients in Sialkot, Pakistan. Soc Sci Med, 1995, 41(12): 1685-1692.

［11］Hansel NN, Wu AW, Chang B, et al. Quality of life in tuberculosis: patient and provider perspectives. Qual Life Res, 2004, 13(3): 639-652.

［12］Mata JI. Integrating the client’s perspective in planning a tuberculosis education and treatment program in Honduras. Med Anthropol, 1985, 9(1): 57-64.

［13］Zhang SR, Yan H, Zhang JJ, et al. The experience of college students with pulmonary tuberculosis in Shaanxi, China: a qualitative study. BMC Infect Dis, 2010, 10: 174.

［14］Chamla D. The assessment of patients health-related quality of life during tuberculosis treatment in Wuhan, China. Int J Tuberc Lung Dis, 2004, 8(9): 1100-1106.

［15］Lewis CP, Newell JN. Improving tuberculosis care in low income countries-a qualitative study of patients’ understanding of “patient support” in Nepal. BMC Public Health, 2009, 9: 190.

［16］Jaggarajamma K, Ramachandran R, Charles N, et al. Psycho-social dysfunction: perceived and enacted stigma among tuberculosis patients registered under revised national tuberculosis control programme. Indian J Tuberc，2008, 55(4): 179-187.

［17］Long NH, Johansson E, Diwan VK, et al. Fear and social isolation as consequences of tuberculosis in VietNam: a gender analysis. Health Policy, 2001, 58(1): 69-81.

［18］Connolly M， Nunn P. Women and tuberculosis. World Health Stat Q, 1996, 49(2): 115-119.

［19］Hudelson P. Gender differentials in tuberculosis: the role of socio-economic and cultural factors.Tuber Lung Dis, 1996, 77(5): 391-400.

［20］Sougakoff W. Molecular epidemiology of multidrug-resistant strains of Mycobacterium tuberculosis.Clin Microbiol Infect, 2011, 17(6): 800-805.

［21］Marra CA, Marra F, Cox VC, et al. Factors influencing quality of life in patients with active tuberculosis. Health Qual Life Outcomes, 2004, 2: 58.

［22］Rundi C. Understanding tuberculosis: perspectives and experiences of the people of Sabah, East Malaysia. J Health Popul Nutr, 2010, 28(2): 114-123.

［23］Wen CP, Chan TC, Chan HT, et al. The reduction of tuberculosis risks by smoking cessation. BMC Infect Dis, 2010, 10: 156.

［24］Zhao M, Li X, Xu P, et al. Transmission of MDR and XDR tuberculosis in Shanghai, China. PLoS One, 2009,4(2):e4370.

［25］Gilpin CM, Simpson G, Vincent S, et al. Evidence of primary transmission of multidrug-resistant tuberculosis in the Western Province of Papua New Guinea. Med J Aust, 2008, 188(3):148-152.

[1]	刘晓莉, 雷丽梅, 郭周莉, 黄殷, 徐静, 赵霞, 王燕, 付莉. 结核病患者产生病耻感与领悟社会支持的相关性研究[J]. 中国防痨杂志, 2020, 42(9): 1002-1008.
[2]	中国防痨协会学术工作委员会《中国防痨杂志》编辑委员会. 抗结核药品固定剂量复合制剂的临床使用专家共识[J]. 中国防痨杂志, 2020, 42(9): 885-893.
[3]	靳鸿建. 我国县级结核病防治服务体系建设及防治工作亟需加强——一位老防痨工作者的意见和建议[J]. 中国防痨杂志, 2020, 42(9): 896-902.
[4]	张灿有, 夏辉, 成君. Ⅱ级生物安全柜在结核病实验室中的检测及报告要求[J]. 中国防痨杂志, 2020, 42(9): 903-909.
[5]	周林, 刘二勇, 孟庆琳, 陈明亭, 周新华, 高微微, 林明贵, 谢汝明. 《WS 288—2017 肺结核诊断》标准实施后肺结核诊断质量评估分析[J]. 中国防痨杂志, 2020, 42(9): 910-915.
[6]	刘二勇, 王前, 周林, 张国钦, 张修磊, 马永成, 杨枢敏, 王毳, 孟庆琳, 陈明亭, 林明贵, 屠德华. 我国部分地区病原学检测阴性肺结核诊断质量现状分析[J]. 中国防痨杂志, 2020, 42(9): 916-920.
[7]	孟庆琳, 李进岚, 林定文, 马永成, 侯双翼, 刘年强, 周林. 结核病防治从业人员对新的结核病标准相关知识知晓情况调查分析[J]. 中国防痨杂志, 2020, 42(9): 921-925.
[8]	王前, 周林, 刘二勇, 赵雁林, 李涛, 陈明亭, 杨丽佳, 王嘉. 我国县级结核病定点医疗机构结核病诊断能力现况调查研究[J]. 中国防痨杂志, 2020, 42(9): 926-930.
[9]	李婷, 何金戈, 苏茜, 李京, 李运葵, 高文凤, 高媛, 杨文. 结核菌素试验在四川省布拖县HIV感染/AIDS患者中筛查结核感染的价值[J]. 中国防痨杂志, 2020, 42(9): 931-936.
[10]	李运葵, 何金戈, 苏茜, 李婷, 李京, 高文凤, 杨文, 毛光玉. 结核病症状筛查在四川省布拖县HIV感染/AIDS患者中发现结核病患者的价值[J]. 中国防痨杂志, 2020, 42(9): 937-941.
[11]	苏茜, 夏勇, 逯嘉, 王丹霞, 何金戈. 2009—2018年四川省0~14 岁儿童肺结核流行特征分析[J]. 中国防痨杂志, 2020, 42(9): 942-947.
[12]	邓亚丽, 张天华, 刘卫平, 张宏伟, 马煜, 李鹏. 2014—2018年陕西省肺结核发病的时空聚集性分析[J]. 中国防痨杂志, 2020, 42(9): 948-955.
[13]	董晓, 赵珍, 刘年强, 王森路, 崔燕. 2009—2017年新疆维吾尔自治区老年肺结核发现特征分析[J]. 中国防痨杂志, 2020, 42(9): 956-961.
[14]	马廷龙, 韩毅, 程序, 刘志东. 超声抗结核药品电导入联合化疗对胸壁结核的疗效观察[J]. 中国防痨杂志, 2020, 42(9): 968-972.
[15]	南海, 张芸, 杨新婷, 段鸿飞. GeneXpert MTB/RIF对骨关节结核诊断价值的Meta分析[J]. 中国防痨杂志, 2020, 42(9): 973-980.