| BackgroundAs one of the major public health problems which endanger human health,the fight against tuberculosis has never been stopped.According to the latest statistics from the World Health Organization(WHO)in 2016,there were 10.4 million new cases of tuberculosis in 2015 and 1.4 million deaths from tuberculosis.China ranks fourth in the list of the top 30 global tuberculosis burden countries made by the World Health Organization(WHO).As the prevalence of drug-resistant tuberculosis in China,we faced a very serious form in tuberculosis prevention and control work.Therefore,the understanding of the epidemic situation of the drug-resistant tuberculosis and the grasping of its trend can provide some reference value for the modification and improvement of our existing tuberculosis prevention and control strategy.Analysis and identification of the relevant risk factors for drug-resistant tuberculosis can provide a useful reference for early detection and diagnosis of drug-resistant tuberculosis and the rational use of anti-tuberculosis drugs by clinicians and other related persons engaged in first-line tuberculosis prevention and treatment.MethodsWe collected data from patients with pulmonary tuberculosis who were positive for sputum culture and were treated in Shandong Provincial X Hospital from January 1,2011 to December 31,2014.SPSS 19.0 statistical analysis software was used to analyze the trend of total drug resistance rate and the single drug resistance rate of four kinds of first-line anti-TB drugs.The differences of clinical features between the drug-resistant group and the sensitive group were analyzed.We use the method of chi-square test to compare the different types of data in this study.When the frequency of the theory of a group of data<5,we use Fisher exact test to analysis it.Logistic regression analysis was used to explore the risk factors of drug resistant patients.For the different samples with unclear overall distribution characteristics,we use the rank sum test to analysis the data.In this study,all of the statistical tests and P values of<0.05 were consider significant.ResultsWe collected a total of 1815qualified cases,including 1240(68.32%)drug-sensitive strains,575 drug-resistant strains(31.68%);1257(69.26%)male,558(30.74%)female;There were 1467(80.83%)cases of newly diagnosed cases and 348(19.07%)cases of retreatment.The minimum age of the patients was 10 years old and the maximum age was 90 years old(mean 53.2 years).In the past four years,there was no significant change in the overall resistance trend,and single drug resistance trend analysis showed that the resistance rate of ethambutol was decreasing year by year,while the resistance rate of isoniazid,rifampicin and streptomycin maintained at a higher level.The logistic regression analysis showed that the risk factors of drug resistance in tuberculosis patients were:rural residents(OR=1.380,95%CI 1.287-1.481),closely contact history of tuberculosis(OR=1.429,95%CI 1.342-1.520),chest CT showed empty formation(OR=1.465,95%CI 1.409-1.522)and bilateral lung lobes affected(OR=1.044,95%CI 1.001-1.089),COPD(OR=13.640,95%CI12.976-14.337)and long-term use of glucocorticoids(OR=1.185,95%CI 1.025-1.371)and diabetes is a protective factor(OR=0.759,95%CI 0.726-0.793).We divided all selected tuberculosis patients into drug-resistant group and drug-sensitive group,then we use rank sum test to analyze the differences of misdiagnosis time and length of hospitalization between two groups,and use the mean and median to describe their respective data characteristics.The mean time of misdiagnosis was 5.94 months in the drug-resistant group,and the mean time of misdiagnosis in the sensitive group was 4.39 months(P = 0.013).The average hospitalization time was 47.62 days in the drug-resistant group,which was higher than the 42.01 days in the drug-sensitive group(P = 0.003)..ConclusionIn recent years,the prevention and control of tuberculosis has made a great achievement in Shandong Province.The overall and single drug resistance rate of four first-line anti-TB drug were significantly lower than the national level.According to the trend of nearly four years of resistance,the resistance level of isoniazid,rifampicin and streptomycin is high,while the resistance level of ethambutol is significantly decreased.However,there was no significant decrease in the level of multidrug-resistant tuberculosis.Much attention should be paid to the risk factors for patients with tuberculosis:rural residents;closely contact history of tuberculosis;chest CT showed chest CT showed empty formation and bilateral lung lobes affected;combined with COPD and long-term use of glucocoticoids.Therefore,we need to strengthen the screening of tuberculosis in rural residents,and vigilance should not be reduced in the patients with atypical imaging performance More effort is needed to put into the prevention and treatment of COPD.The improvement of compliance in tuberculosis patients and the protection of surrounding should not be relaxed at all.Because drug-resistant tuberculosis patients are more likely to be misdiagnosed,clinicians should be aware of these patients and increase the diagnostic rate.Longer hospitalization not only brings greater economic burden to drug-resistant tuberculosis patients,but also brings greater difficulties to clinical treatment. |
PDF Full Text Request