Epidemic and influencing factors of drug-resistant tuberculosis in border and non-border area of Guangxi

doi:10.3969/j.issn.1000-6621.2019.05.017

Abstract

Abstract:

Objective To explore the epidemic and influencing factors of drug-resistant tuberculosis in border and non-border area of Guangxi.Methods From February 2016 to June 2017, five cities including Guilin, Guigang, Chongzuo, Baise and Fangchenggang located on East, West, South, North and Central of Guangxi were selected as the research sites. Among them, three cities including Baise, Chongzuo and Fangchenggang bordering Vietnam were in the border group, and the other two cities, Guilin and Guigang, which are not bordering Vietnam, were in the non-border group. Tuberculosis patients registered at the survey site during the study, positive for sputum smear and isolated Mycobacterium tuberculosis, were included in the study. Proportional method was used to test drug resistance of the clinical isolates in two groups. A total of 1306 patients were enrolled in the study, including 631 in the border group and 675 in the non-border group. Univariate and multivariate logistic regression were used to analyze influencing factors of drug resistance in the two groups.Results The rates of total drug resistance (18.1%, 114/631), single drug resistant (SDR) (9.5%,60/631), poly-drug resistant (PDR) (2.7%,17/631) and multidrug resistant (MDR) (5.9%,37/631) in the border group are higher than those in the non-border group ((11.1%,75/675), (7.7%,52/675), (1.8%,12/675), and (1.6%,11/675), respectively). The differences of the total resistance rate and MDR rate were statistically significant between the two groups ( $χ total 2$ =12.75, $χ MDR 2$ =16.52, Ps<0.05). Results of multivariate logistic regression analysis showed that the influencing factor of tuberculosis resistance in border areas and non-border areas were patient types, and retreatment was a risk factor for drug resistance in tuberculosis patients in two groups. The OR values were 1.86 (95%CI: 1.13-3.05, Wald χ ²=5.97, P=0.015) in the border group and 2.72 (95%CI: 1.39-5.33, Wald χ ²=8.45, P=0.004) in the non-border group. Conclusion The drug resistance rate of tuberculosis patients in border area is higher than that in non-border area in Guangxi, retreatment was the influencing factor of drug resistance in both regions.

Key words: Tuberculosis, pulmonary, Tuberculosis, multidrug-resistant, Small-area analysis, Factor analysis, statistical

Xi LONG,Mei LIN,Ru-shu LAN,Zhe-zhe CUI,Da-bin LIANG,Ding-wen LIN,Dan LUO,Jing YE,Hui-fang QIN,Li-wen HUANG,Min-ying HUANG. Epidemic and influencing factors of drug-resistant tuberculosis in border and non-border area of Guangxi[J]. Chinese Journal of Antituberculosis, 2019, 41(5): 564-568. doi: 10.3969/j.issn.1000-6621.2019.05.017

Figures/Tables 5

References 19

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变量	赋值
是否耐药	敏感=0;耐药=1
性别	女=1;男=2
年龄组	0~岁=1;31~岁=2;61~92岁=3
现住址	城镇=1;农村=2
民族	汉族=1;壮族=2;其他=3
职业	农民=1;其他=2
家庭年收入	≤20000元=1;>20000元=2
文化水平	初中以下=1;初中及以上=2
患者类型	初治=1;复治=2
累及肺野数	≤3个肺野=1;>3个肺野=2
有无空洞	肺部无空洞=1;肺部有空洞=2

耐药类型	合计(1306株)		边境组(631株)		非边境组(675株)		χ²值	P值
耐药类型	菌株数	耐药率(%)	菌株数	耐药率(%)	菌株数	耐药率(%)	χ²值	P值
单耐药	112	8.6	60	9.5	52	7.7	1.36	0.244
多耐药	29	2.2	17	2.7	12	1.8	1.26	0.261
耐多药	48	3.7	37	5.9	11	1.6	16.52	<0.001
总耐药	189	14.5	114	18.1	75	11.1	12.75	<0.001

药敏试验结果	合计(1306株)		边境组(631株)		非边境组(675株)		χ²值	P值
药敏试验结果	菌株数	耐药率(%)	菌株数	耐药率(%)	菌株数	耐药率(%)	χ²值	P值
任一耐H	111	8.5	68	10.8	43	6.4	8.14	0.004
任一耐R	65	5.0	53	8.4	12	1.8	30.24	<0.001
任一耐E	32	2.5	16	2.5	16	2.4	0.04	0.847
任一耐S	72	5.5	41	6.5	31	4.6	2.27	0.132
任一耐Km	6	0.5	4	0.6	2	0.3	0.24	0.623
任一耐Ofx	36	2.8	22	3.5	14	2.1	2.43	0.119

影响因素	边境组					非边境组
影响因素	例数	耐药例数	耐药率 (%)	χ²值	P值	例数	耐药例数	耐药率 (%)	χ²值	P值
性别				1.12	0.290				0.01	0.922
女	122	18	14.8			150	17	11.3
男	509	96	18.9			525	58	11.0
年龄组(岁)				0.95	0.623				2.38	0.304
0~	87	13	14.9			112	12	10.7
31~	365	70	19.2			334	43	12.9
61~	179	31	17.3			229	20	8.7
现住址				0.13	0.720				0.01	0.918
城镇	109	21	19.3			132	15	11.4
农村	522	93	17.8			543	60	11.1
民族				0.55	0.759				1.42	0.491
汉族	118	19	16.1			603	64	10.6
壮族	493	92	18.7			53	8	15.1
其他^a	20	3	15.0			19	3	15.8
职业				0.01	0.932				0.14	0.710
农民	500	90	18.0			538	61	11.3
其他^b	131	24	18.3			137	14	10.2
家庭年收入(元)				3.35	0.067				0.17	0.685
≤20000	278	59	21.2			221	23	10.4
>20000	353	55	15.6			454	52	11.5
文化水平				2.22	0.137				0.69	0.408
初中以下	276	57	20.7			282	28	9.9
初中及以上	355	57	16.1			393	47	12.0
患者类型				6.10	0.014				9.06	0.003
初治	530	87	16.4			619	62	10.0
复治	101	27	26.7			56	13	23.2
累及肺野数(个)				2.52	0.112				2.29	0.130
≤3	297	46	15.5			289	26	9.0
>3	334	68	20.4			386	49	12.7
有无空洞				1.90	0.168				0.67	0.414
无	252	39	15.5			250	31	12.4
有	379	75	19.8			425	44	10.4

地区	因素	β值	s_$\bar{x}$值	Wald χ²值	P值	OR值(95%CI值)
边境组	患者类型	0.62	0.25	5.97	0.015	1.86(1.13~3.05)
	常量	-1.63	0.12	192.65	0.000
非边境组	患者类型	1.00	0.34	8.45	0.004	2.72(1.39~5.33)
	常量	-2.20	0.13	268.90	0.000