2025 年第 3 期 第 20 卷

耐多药肺结核的危险因素及治疗转归分析

Analysis of risk factors and treatment outcomes of multidrug-resistant tuberculosis

作者：马清艳侯莉莉党萍康冠楠

英文作者：Ma Qingyan Hou Lili Dang Ping Kang Guannan

单位：河北省胸科医院（河北省肺病重点实验室）结核四科，石家庄050041

英文单位：The Fourth Department of Tuberculosis Hebei Chest Hospital (Hebei Provincial Key Laboratory of Pulmonary Disease) Shijiazhuang 050041 China

关键词：耐多药肺结核；危险因素；治疗转归

英文关键词：Multidrug-resistanttuberculosis;Riskfactors;Treatmentoutcome

• 摘要：

• 目的 探究耐多药肺结核的危险因素及治疗转归。方法 选取2022年1月至2023年12月河北省胸科医院160例耐多药肺结核患者为耐药组，并选取同期治疗敏感肺结核患者160例为敏感组。将耐药组按照随机数字表法分为观察组和对照组，各80例。对照组采用不含贝达喹啉的方案进行治疗，观察组采用含贝达喹啉的方案进行治疗，2组均持续治疗24周。比较对照组和观察组患者的一般资料、疗效和不良反应的发生情况。多因素Logistic回归分析影响患者发生耐多药肺结核的危险因素。结果 耐药组和敏感组居住地、婚姻状况、抗结核治疗史、有结核空洞、结核病接触史、卡介苗接种史比较差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果表明居住地农村、已婚、有抗结核治疗史、有结核空洞、有结核病接触史、没有卡介苗接种史均是患者发生耐多药肺结核的危险因素（均P＜0.05）。观察组和对照组一般资料比较差异均无统计学意义（均P＞0.05）。观察组总有效率高于对照组［86.2%（69/80）比70.0%（56/80）］（χ2=6.181，P=0.013）。观察组和对照组不良反应发生率比较差异无统计学意义［22.5%（18/80）比15.0%（12/80）］（χ2=1.477，P=0.224）。结论 居住地农村、已婚、有抗结核治疗史、有结核空洞、有结核病接触史、没有卡介苗接种史是患者发生耐多药肺结核的危险因素，应及时采取有效措施，避免耐多药肺结核的发生。对耐多药肺结核患者采用含贝达喹啉的方案进行治疗的效果显著，且具有较好的安全性。

• Objective  To explore the risk factors and treatment outcomes of multidrug-resistant tuberculosis. Methods A total of 160 patients with multidrug-resistant tuberculosis in Hebei Chest Hospital from January 2022 to December 2023 were selected as the drug-resistant group, and 160 patients with sensitive tuberculosis during the same period were selected as the sensitive group. The drug-resistance group was divided into observation group and control group according to the random number table method, with 80 cases in each group. The control group was treated with the regimen without bedaquiline, and the observation group was treated with the regimen containing bedaquiline, both groups received continuous treatment for 24 weeks. The general data, efficacy and adverse reactions of the two groups were compared. Multivariate Logistic regression analysis was used to analyze the risk factors of multidrug-resistant tuberculosis. Results There were significant differences in residence, marital status, anti-tuberculosis treatment history, tuberculosis cavity, tuberculosis contact history, and BCG vaccination history between the drug-resistance group and the sensitive group (all P＜0.05). The results  of multivariate Logistic regression analysis showed that rural residence, married, anti-tuberculosis treatment history, tuberculosis cavity, tuberculosis contact history, and no BCG vaccination history were the risk factors for multidrug-resistant tuberculosis (all P＜0.05). There were no statistically significant differences in general data between the observation group and the control group (all P＞0.05). The total effective rate of the observation group was higher than that of the control group ［86.2%(69/80) vs 70.0%(56/80)］(χ2=6.181, P=0.013). There was no significant difference in the incidence of adverse reactions between the observation group and the control group ［22.5%(18/80) vs 15.0%(12/80)］(χ2=1.477, P=0.224). Conclusion Rural residence, married, anti-tuberculosis treatment history, tuberculosis cavity, tuberculosis contact history and no BCG vaccination history are the risk factors for multidrug-resistant tuberculosis. Effective measures should be taken in time to avoid the occurrence of multidrug-resistant tuberculosis. Bedaquiline-containing regimen is effective and safe in the treatment of patients with multidrug-resistant tuberculosis.