儿童结核病耐药特点及耐多药相关因素分析

doi:10.3969/j.issn.1000-6621.2020.10.005

摘要/Abstract

摘要：

目的了解儿童结核病的耐药现况,发现儿童耐多药相关的危险因素。方法收集沈阳市第十人民医院2017年1月31日至2019年12月31日收治的≤18岁的结核病患者314例,男178例,女136例,年龄1~18岁,中位年龄(四分位数)[M(Q₁,Q₃)]为17(15,18)岁,初治253例,复治61例。分析314例患者培养阳性且菌种鉴定为结核分枝杆菌(MTB)的临床分离株的药物敏感性试验结果。采用多因素非条件logistic回归分析儿童耐药结核病的危险因素。结果 314例患者的MTB临床分离株总耐药率、初治耐药率和复治耐药率分别为27.1%(85/314)、20.9%(53/253)和52.5%(32/61),复治耐药率明显高于初治耐药率(χ²=24.771,P=0.000);总耐多药率、初治耐多药率和复治耐多药率分别为10.8%(34/314)、6.3%(16/253)和29.5%(18/61),复治耐多药率明显高于初治耐多药率(χ²=27.360,P=0.000)。logistic多因素回归分析表明,复治(OR=5.671,95%CI=2.228~14.435,P=0.000)、14~18岁年龄组(OR=2.235,95%CI=1.568~3.562,P=0.032)、并发营养不良(OR=1.908,95%CI=1.337~2.447, P=0.034)、吸烟(OR=1.225,95%CI=1.013~2.740,P=0.046)是儿童患者发生耐多药结核病的危险因素。结论儿童结核病耐药现状严峻,复治、14~18岁年龄组、并发营养不良、有吸烟史是儿童患者发生耐多药的危险因素。

关键词: 分枝杆菌, 结核, 儿童, 结核, 抗多种药物性, 因素分析, 统计学

Abstract:

Objective To understand the status of drug resistance in children with tuberculosis and to identify risk factors associated with drug resistance. Methods Information of 314 tuberculosis patients under 18 years old admitted to Shenyang Tenth People’s Hospital from January 31, 2017 to December 31, 2019 were collected. 178 cases were male, and 136 cases were female. The age ranged from 1 to 18 years old, median age (M(Q₁,Q₃)) was 17 (15,18). There were 253 primary treated cases and 61 retreated cases. Drug susceptibility test results of positive culture isolates from those 314 patients were analyzed. Risk factors for multidrug-resistant tuberculosis (MDR-TB) in children were analyzed using multivariate logistic regression. Results The overall drug resistance rate, primary treated drug resistance rate and retreatment drug resistance rate of 314 clinical isolates of Mycobacterium tuberculosis (MTB) were 27.1% (85/314), 20.9% (53/253) and 52.5% (32/61) respectively, and the retreatment drug resistance rate was significantly higher than the primary treated drug resistance rate (χ²=24.771,P=0.000). The overall,primary treated and retreatment multidrug-resistance rate were 10.8% (34/314), 6.3% (16/253) and 29.5% (18/61) respectively. The retreatment multidrug-resistance rate was significantly higher than that of primary treated multidrug-resistance rate (χ²=27.360, P=0.000). Logistic multivariate regression analysis showed that retreatment (OR=5.671, 95%CI=2.228-14.435, P=0.000), 14-18 years old (OR=2.235, 95%CI=1.568-3.562, P=0.032), complicated with malnutrition (OR=1.908, 95%CI=1.337-2.447, P=0.034), smoking (OR=1.225, 95%CI=1.013-2.740, P=0.046) were risk factors related to MDR-TB in children. Conclusion The current situation of tuberculosis drug resistance in children is severe. Retreatment, 14-18 years old, malnutrition and smoking history are risk factors of MDR-TB in children.

Key words: Mycobacterium tuberculosis, Child, Tuberculosis, multidrug-resistant, Factor analysis, statistical

樊丽超, 吴浩宇, 程漠鑫, 杨一帆, 王晓虹, 于艳红, 陈禹. 儿童结核病耐药特点及耐多药相关因素分析[J]. 中国防痨杂志, 2020, 42(10): 1029-1035. doi: 10.3969/j.issn.1000-6621.2020.10.005

FAN Li-chao, WU Hao-yu, CHENG Mo-xin, YANG Yi-fan, WANG Xiao-hong, YU Yan-hong, CHEN Yu. Analysis of characteristics and related factors of tuberculosis resistance in children[J]. Chinese Journal of Antituberculosis, 2020, 42(10): 1029-1035. doi: 10.3969/j.issn.1000-6621.2020.10.005

图/表 5

表1

表2

表3

表4

表5

患者耐多药影响因素的非条件 logistic回归多因素分析

影响因素	β值	$s x ˉ$ 值	Wald χ²值	P值	OR值	95%CI值
年龄(以<14岁组为参照)
14~18岁	1.449	1.032	2.398	0.032	2.235	1.568~3.562
有吸烟史	0.203	0.106	2.530	0.046	1.225	1.013~2.740
治疗史(以初治组为参照)
复治	1.735	0.477	13.256	0.000	5.671	2.228~14.435
营养不良	-0.097	0.506	10.370	0.034	1.908	1.337~2.447
居住地(以农村组为参照)
城镇	0.774	0.399	3.758	0.053	2.168	0.991~4.740
规律用药	-0.349	0.561	0.387	0.534	0.705	0.235~2.118
有结核病患者接触史	-6.495	1.250	26.998	0.000	0.002	0.000~0.018

表5

参考文献 22

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耐药顺位	总体(314例)耐药			初治(253例)耐药			复治(61例)耐药
耐药顺位	药品	例数	耐药率(%)	药品	例数	耐药率(%)	药品	例数	耐药率(%)
1	Sm	60	19.1	Sm	38	15.0	INH	25	41.0
2	INH	58	18.5	INH	33	13.0	RFP	22	36.1
3	RFP	45	14.3	RFP	23	9.1	Sm	22	36.1
4	Lfx	12	3.8	Lfx	7	2.8	EMB	6	9.8
5	EMB	10	3.2	EMB	4	1.6	Lfx	5	8.2
6	Am	3	1.0	Am	1	0.4	Am	2	3.3
7	Mfx	1	0.3	Mfx	1	0.4	Mfx	0	0.0
8	Lzd	1	0.3	Lzd	1	0.4	Lzd	0	0.0
9	Pto	1	0.3	Pto	1	0.4	Pto	0	0.0

因素	赋值方式	因素	赋值方式
性别	男=0;女=1	治疗史	初治=0;复治=1
年龄	<14岁=0; 14~18岁=1	居住地	城镇=0;农村=1
吸烟史	否=0;是=1	规律用药	是=0;否=1
营养不良	否=0;是=1	结核病患者接触史	否=1;是=0