The Clinical Features And Prognosis Of Multi-drug Resistant Tuberculosis In Luzhou Region

Objective To investigate the epidemic situation of the multi-drug resistant tuberculosis(MDR-TB)in Luzhou region and to analyze the clinical features and prognosis of multi-drug resistant tuberculosis.Methods 1.The source of cases:1218 sputum smear-positive pulmonary tuberculosis patients were Collected from January 2013 to October 2016.2.Lwenstein-Jensen culture : All the sputum specimens were cultured by Lwenstein-Jensen culture.3.Line probe assay(LPA): The obtained Mycobacterium tuberculosis isolates’ DNA were extracted and amplified by PCR,and the resistance to RFP and INH was rapid detected by the line probe assay(GenoType?MTBDRplus).4.Traditional drug sensitivity test(DST): All the mutant strains and part of the requirements culture specimens were detected by traditional drug sensitivity test.5.Multi-drug resistant pulmonary tuberculosis questionnaire:The basic information,risk factors and treatment outcome of multi-drug resistant tuberculosis patients were screened,and the epidemiological characteristics of multi-drug resistant tuberculosis patients in Luzhou region were analyzed.6.Prognosis analysis:Analyze the clinical features and prognosis of patients with multi-drug resistant tuberculosis,and to analyze the prognostic factors by logistic regression.Results 1.General condition:The total of the samples were 1218 from January 2013 to October 2016,including 1055 Mycobacterium tuberculosis strains,41 cases of NontuberculousMycobacteria(NTM).2.The results of LPA:There were 150 gene mutations from 2014 to 2016,contained 87(9.01%)cases of multi-drug resistant tuberculosis,36(3.73%)cases of isoniazide resistant and 27(2.80%)cases of rifampicin resistant.The results of line probe assay showed that ropB WT8-,MUT3+ were mainly included by rifampicin mutations,and the mutations of isoniazide were inhA WT-,MUT1+ and katG WT-,MUT1+.3.Results of DST:There were 188 cases of drug resistance,of which,94 cases were multi-drug resistant tuberculosis.The total drug resistance rate of Mycobacterium tuberculosis was 17.81%,and the rate of multi-drug resistant pulmonary tuberculosis was 8.91%.4.Comparison of LPA and DST: Compared with the traditional drug sensitivity test,the specificities of GenoType?MTBDRplus assay for detecting INH and RFP were 91.07 % and88.89%,respectively.Their sensitivities were 89.39% and98.13%,respectively.The chi-square test results showed which had no difference.The Kappa test results showed that the κ of isoniazide and rifampicin were0.769 and 0.879,respectively.5.Clinical features of multi-drug resistant tuberculosis: Till the end of 2016,102 MDR-PTB were obtained.Multi-drug resistant tuberculosis were mainly distributed in the male,middle-aged and elderly,peasants,low education,re-treatment and the family income of less than 10 thousands yuan.Eight of them had exposure history;thirteen of them had diabetes mellitus.6.The prognosis of MDR-PTB:At least one years after the treatment,25(28.74%)patients were cured,21(24.14%)died,27(31.03%)were not treated,11(12.64%)were treatment failed and 3(3.45%)lost.The results of Logistic regression analysis showed that the main factors affecting the prognosis of multi-drug resistant tuberculosis were regular treatment(OR =7.787).Conclusions The prevalence of multi-drug resistant tuberculosis in Luzhou region is serious.Multi-drug resistant tuberculosis is mainly distributed in the male,middle-aged and elderly,farmers,low education,low income and re-treatment.Multi-drug resistant tuberculosis patients with high mortality;the proportion of treatment in different places and under treatment rate is high;the patients who go out to work is generally;a large number of them are associated with the other chronic diseases.Compliance of patients is generally poor:The effect of regular treatment on the prognosis of multi-drug resistant tuberculosis is very important.Rapid detection should be applied to improve the early detection,early diagnosis and early treatment of MDR-TB patients.