| BackgroundTuberculosis is one of the main infectious diseases that are harmful to the health of people all over the world.China is one of the 22 high-burden countries and ranked the second in the list in terms of the number of tuberculosis(TB) patients.China started DOTS since 1990s to control tuberculosis and gained a significant achievement.However,drug-resistance is one of the most problems that it limits and effects our tuberculosis control strategy from now on.According to the results of the fourth national epidemiological sampling survey on TB conducted in 2000,China was one of the highest TB epidemic countries in the world characterized by the secondary resistance rate was 46.5%,and 27.8%for the total drug-resistance.The multi-drug resistance(MDR) rate was 17.1%,and the total rate 10.7%for the secondary resistance.The drug-resistance was the world problem in 2003,that the WHO/IUATLD drug resistance surveillance project had proved by half of the 109 countries and regions.The median of the drug-resistance rate was 23.3%(0-82.1%) and 7.7%(0-58.3%) for MDR-TB among the secondary resistance cases.Compared the retreated cases,the 4 times resistance rate with those never re-treatments,and 10 times for the MDR-TB.The resistance of the re-treatment patients is concerned the results of the full intermittent chemotherapy of the TB cases.To investigate and analyze the factors of TB drug-resistance in the three cities in Gansu,and provide the available advice for the improvement successful rate of TB cases.ObjectiveTo survey the sustain of drug-resistant and to analyze its levels and characters of the registered and management re-treatment smear positive patients among three citiesTo survey the factors influencing of drug-resistance and the cure rate for the re-treatment smear positive patients among three cities.To carry out the available and suitable methos or stratigies and to improve the cure rate of the re-treatment smear positive patients among three cities.MethodsGannan,Dingxi,Linxia three prefectures which implement the AD and the world XMH project were selected at the first stratify by no percentment aim random sampling method.And to investigate and analyze the sustain of treatment of the re-treatment smear positive patients among three cities,while analyzing drug-resistant levels and characters of the registered and management re-treatment smear positive patients among three cities of the whole year from 2004.9 to 2005.8.Totally 166 re-treatment smear positive pulmonary tuberculosis patients were eligible.1.To analyze retrospectively totally re-treatment smear positive pulmonary tuberculosis patients and use the quantities methods.2.To implement the study and combine the surveillance data and survey sample.SPSS 13.0 was used to analyze data.Chi-square test and multi-variance unconditional logistic regression were used to analyze the factors influencing of the re-treatment smear positive pulmonary tuberculosis patients among the three prefectures..ResultsThe TB drug-resistance and MDR-TB rates of the three prefectures in gansu are 50%and 24.1%,respectively.Those are higher than the national survey levels.among of the whole sputum TB samples,the single resistance rate is 13.9%.The mostly cases of initial resistance resisted to one drug,and those of acquired resistance resisted to multi 4 drugs.There was significant difference among the three prefectures drug-resistance rates.REP is the highest drug resistance rates of the four anti-tb drugs.The drug-resistance rates of INH and REP are 35.5%and 32.5%respectively and higher than the national TB level(31.0%,29.5%).There is no significant deference among the age,sex.nation of the three prefectures.the drug-resistance in the countryside is significant higher than that of the city and town.the others re-treatment smear positive drug-resistance rate in Linxia is the highest of the monitored prefectures(34.0%).The result of this study show that this may associate with factors,such as economic status,education level,accessibility to health care.There are 21.1%of the all patients detected by the TB professial dispensary,However,the initial smear positive TB cases were detected by the general hospital and town private initial,and occupied 51.8%,6.6%,28.9% respectively.The new smear positive TB patients who have not been taught the TB healthy knowledge,have significant higher drug-resistance rate than that of the others.The results of this study shew that the risk factors of MDR-TB rate were living conditions,the education,the model of supervision and the complication,the difference has very significant.To analogize the factors using the multi- Logistic statistics,the living condition,the education,the other disease with TB,and the methods of supervision.It is relate to the population characters of the study units of three prefectures in Gansu including age,sex,education,status and living-conditions.Univariate analysis showed that the following 3 variables were correlated to t he efficacy of re-treatment:drug resistance,different retreated types,and the negative rate of the 2 month treatment.In multivariate analysis,it was confirmed that drug resistance,and the patients age were significantly associated with retreated outcomes.ConclusionThe drug-resistance rate and MDR-TB are both higher than the average level. but the drug-resistance level of three prefectures and the anti-drug resistance rage grade is not same.the drug-resistance rate of Linxia prefecture is significant higher than the other districts.To improve the treatment of drug-resistance cases,and improve the management and supervision of the TB patients,reduce the drug-resistance cases.The drug-resistance in the country is significant higher than that of the city and town,it is shown that we are weak of TB control and prevention in the three prefectures.And the doctors of the universal hospitals and private clinic have not available use the TB drugs.In this study,it is shown that the status of the re-treatment smear positive TB patients is very complicate,the reasons which effect the drug-resistant are more, and which had closely relationship or limited each other.General hospital occupy 50%of all patients the proportion,it is the main factor to lead to re-treatment and drug-resistant.because the TB patients initial treat units were not the TB professional institute but the general or private hospitals,it led that they had not the suitable treatment and management mode beside to irregularly treated and to lead to drug-resistant.The new smear positive TB patients who have not been taught the TB healthy knowledge,have significant higher drug-resistance rate than that of the others.it shows to improve and enhance the health promotion of TB,and to improve the patients awareness of themselves to decline the outgeneral treatment and drug-resistance.There are some main risk factors such as knowledge,the living condition the other disease and the supervision during the initial treatment.It is possible for the traditional custom the female cure rate of TB is lower than the male.the old have high drug-resistance rate.The effect of treatment of the MDR-TB less than that of the single, therefore,enhance management of TB patients during the treatment.and to reduce the drug -resistance of re-treatment of smear positive cases.It not only reduce the TB patients economic burden but also decline the drug-resistance.The TB drug-resistant has been the difficult problem,and the drug-resistant is the main reason,high drug-resistant or MDR-TB reduce the successful rate of treatment.To timely be drug-resistant surveillance and to carry out the available and suitable chemotherapy regimens,withwhile implementing direct observe treatment short-course by the WHO,to reduce the infectious disease of re-treatment smear positive TB patients.
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