| Objective:Study on the drug resistance and multi-drug resistance of TB patients to first-line anti-tuberculosis drugs in jiangxi province in recent years.Analyzing the demographic and clinical characteristics of drug-resistant and MDR-TB patients.Exploring the main influencing factors of drug resistance and multi-drug resistance.It provides scientific reference for the scientific treatment of tuberculosis in jiangxi province and improves the level of scientific prevention and control of drug-resistant and MDR-TB.Methods:1.Collected the socio-demographic information(gender,age,geographical origin),drug sensitivity information(four first-line anti-tuberculosis drugs),disease clinical treatment information(treatment history,hydrothorax,hemoptysis,cavitation,pulmonary lobe damage)and concurrent disease information(diabetes,bronchiectasis,pneumoconiosis,chronic obstructive pulmonary disease)of 1359 patients admitted and hospitalized in jiangxi provincial chest hospital from 2015 to 2018 with positive culture of mycobacterium tuberculosis and clear drug susceptibility test results.2.Using Excel and SPSS22.0 software,we analyzed the drug resistance rate and multi-drug resistance rate of TB patients,and studied the trend of the total drug resistance rate and multi-drug resistance rate of patients in different groups within four years.To analyze and compare the differences between the drug-resistant(multidrug-resistant)group and the sensitive(non-multidrug-resistant)group in terms of social demography,clinical symptoms of diseases,and concurrent diseases.Furthermore,the correlation factors of drug resistance and multi-drug resistance in TB patients were further analyzed.3.The chi-square test was used to compare the classification data between different groups.When the theoretical frequency of a group of data is less than 5,Fisher's exact probability method is used for analysis and comparison in order toavoid large deviation of chi-square test results.Logistic regression analysis model was used to investigate the correlation between drug resistance and multi-drug resistance in TB patients.Results:1.Drug resistance: Of the 1359 TB patients,the total drug resistance rate was22.74%,of which the drug resistance rate of the first-treated patients was 14.10% and that of the re-treated patients was 45.58%.The rate of multidrug resistance was11.11%,the rate of multidrug resistance was 4.56% in the first treatment and 28.42%in the second treatment.Among the four first-line anti-tuberculous drugs,the drug resistance rates ranged from high to low: INH(16.56%),RFP(13.98%),SM(12.80%),and EMB(4.86%),respectively.The drug resistance rates ranged from high to low:INH(9.13%),SM(8.52%),RFP(6.19%),and EMB(2.13%),respectively.The drug resistance rate of retreatment ranged from high to low: INH(36.19%),RFP(34.58%),SM(24.4%)and EMB(11.53%).2.drug-resistant trend: During the four-year period from 2015 to 2018,there was no significant change in the trend of total drug resistance and multi-drug resistance in all patients.The trend of drug resistance and multidrug resistance of patients in different groups(gender group,age group,regional source group,treatment history group)also showed no significant change.There was no significant difference in drug resistance rate(multi-drug resistance rate)over the years(P> 0.05).3.Clinical characteristics: Among patients with drug resistance,rural patients were significantly higher than urban patients,retreatment patients were significantly higher than first-treatment patients,patients with pulmonary cavity were significantly higher than patients without pulmonary cavity,patients with pulmonary damage were significantly higher than patients without pulmonary damage,and patients with bronchial dilatation were significantly higher than patients without bronchial dilatation.Among patients with multi-drug resistance,rural patients were significantly higher than urban patients,retreatment patients were significantly higher than first-treatment patients,patients with lung damage were significantly higher than those without lung damage,and patients with bronchial dilatation were significantly higher than those without bronchial dilatation.4.Analysis of correlation factor:Logistic regression analysis showed that the factors that increased the risk of drug resistance in TB patients were: rural patients(OR=1.384,95%ci 1.026-1.867),retreatment patients(OR=4.387,95%ci3.272-5.883),and patients with bronchiectasis(OR=1.827,95%ci 1.083-3.084).Factors that increase the risk of multi-drug resistance in TB patients are: rural patients(OR=2.057,95%ci 1.319-3.210),retreaters(OR=7.287,95%ci 4.855-10.939),and patients with pulmonary damage(OR=2.003,95%ci 1.043-3.845).Conclusion:1.From 2015 to 2018,the total drug resistance rate of TB patients was lower than the national average in 2010,but the rate of multi-drug resistance was much higher than the national average in 2010,indicating that the mdr-tb situation was grim.During the four years,the incidence of drug resistance and multi-drug resistance in patients of different groups such as gender,age,region and treatment history was generally stable,with no significant decline trend.2.There was no significant difference in the distribution of drug-resistant and MDR-TB in gender and age.Men and women of all ages are susceptible groups.TB resistance is more common in rural patients,patients receiving treatment,patients with cavities in the lungs,patients with damaged lungs,and patients with bronchiectasis.Mdr-tb is more common in rural patients,patients undergoing treatment,patients with a cavity in the lungs,and patients with abdominal lesions.3.Factors associated with increased risk of drug resistance in TB patients include: rural areas,patients with retreatment and bronchiectasis,and factors associated with increased risk of drug resistance in TB patients include: rural patients,retreaters patients,and patients with pulmonary damage. |
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