Risk Factors For Drug Resistance Tuberculosis And Establishment Of Risk Predictive Model For Acquired Drug Resistance Tuberculosis

ObjectiveTo explore the risk factors of primary drug resistance and acquired drug resistance tuberculosis and establish clinical risk predictive model for the probability of acquired drug resistance tuberculosis. To provide reference for risk assessment and prevention of drug resistance tuberculosis(DR-TB) in local area. MethodsThe study was used case-control design method. 126 cases of DR-TB and 126 cases of non-drug-resistance tuberculosis(non-DR-TB) patients in Jiangsu University affiliated zhenjiang the third hospital from January 1, 2014 to June 30, 2015 were included in this study. The information of these patients were collected in the way of using questionnaires and reviewing medical records. After univariate analysis, we used multivariate logistic regression analysis to determine the independent risk factors of acquired DR-TB, and established the risk predication model of acquired DR-TB. The calibration and discrimination of the model were assessed by the H-L test and the area under the ROC curve, respectively. Results(1) univariate analysis: Compared with the control group, the primary drug resistance tuberculosis group showed age, history of contact with tuberculosis patients, sputum smear results after three months anti-tuberculosis treatment were statistically significant factors(P < 0.05). Compared with the control group, the acquired drug resistance tuberculosis group showed residence, marital status, family income, registration classification, body mass index(BMI), anti-tuberculosis drug induced liver injury, number of tuberculosis foci, tuberculosis cavity, diabetes and sputum smear result after three months anti-tuberculosis treatment were significant statistically factors(P<0.05).(2) mutivariate analysis: We draw the above factors of acquire resistance tuberculosis with statistical significance into multivariate logistical regression analysis. The result showed that residence, registration classification, BMI, anti-tuberculosis drug induced liver injury, the number of tuberculosis foci and sputum smear results after three months anti-tuberculosis treatment were statistically significant factors(P<0.05).(3) The risk predictive model for the probability of acquired drug-resistant TB was: P=ea/(1+ea), a=-4.629+0.975X1+3.397X4+0.881X5+0.936X6+0.965X7+1.500X10, and the “e” stands for exponential function. H-L chi-square test of the model(c2=11.681, P=0.106), area under the ROC curve was 0.855±0.026, P<0.001. When the best diagnostic cut-off point was 0.515, sensitivity and specificity of this predictive model was 0.824 and 0.716, respectively. Conclusion(1) The history of contact with tuberculosis patients is a major risk factor for primary drug-resistant tuberculosis. Compared with non-drug-resistant TB patient, primary drug-resistant tuberculosis patients are with lower age and higher sputum smear positive rate after three months anti-tuberculosis treatment.(2) Drug resistance tuberculosis is mainly acquired in local area. Residence, marital status, family income, registration classification, BIM, anti-tuberculosis drug induced liver injury, the number of TB foci, tuberculosis cavity, diabetes and sputum smear result after three months anti-tuberculosis treatment have certain relationship with acquired drug-resistant TB. Living in rural areas, previous treatment, low body mass index, anti-tuberculosis drug induced liver injury, more than three TB foci and positive sputum smear after three months anti-tuberculosis treatment are major risk factors for acquired DR-TB.(3) According to logistic regression equation, we can establish a risk predictive model for the probability of acquired drug resistance tuberculosis with some predictive value.