深圳市结核分枝杆菌耐药变化趋势的Joinpoint回归分析  

A joinpoint regression analysis of the trends of drug resistance in Mycobacterium tuberculosis in Shenzhen

作　　者：季乐财 余卫业 谭卫国[1] 朱玉梅[1] JI Lecai;YU Weiye;TAN Weiguo;ZHU Yumei(Shenzhen Center For Chronic Disease Control and Prevention,Shenzhen,Guangdong 518020,China)

机构地区：[1]深圳市慢性病防治中心,广东深圳518020

出　　处：《中国热带医学》2018年第10期1025-1028,共4页China Tropical Medicine

基　　金：深圳市科技创新计划基础研究项目(No.JCYJ20160428145728055);深圳市卫计委科研项目(No.SZXJ2017035);深圳市医疗卫生三名工程(No.SZSM201611030)1981

摘　　要：目的探讨深圳市结核分枝杆菌对利福平、异烟肼耐药变化趋势,为结核病防控策略调整提供依据。方法对2002—2017年深圳市登记的所有涂阳肺结核病患者进行痰检,对罗氏培养阳性菌株进行菌型鉴定和耐药检测,采用Joinpoint regression program软件计算年度变化百分比并进行趋势检验。结果共检测19 098株结核分枝杆菌菌株,其中单耐异烟肼1 726株,单耐利福平954株,同时耐异烟肼、利福平812株。2002—2011年深圳市结核分枝杆菌异烟肼耐药率以每年3.81%的平均速率下降(P=0.04);2012—2014年以每年5.34%的平均速率上升(P=0.62);2015—2017年以每年20.82%的平均速率再次下降(P=0.18);2002—2004年深圳市结核分枝杆菌利福平耐药率以每年23.89%的平均速率下降(P=0.13);2005—2015年以每年0.99%的平均速率波动(P=0.15);2016—2017年以每年46.50%的平均速率下降(P=0.01);2002—2010年深圳市结核分枝杆菌同时对异烟肼、利福平耐药率以每年4.16%的平均速率下降(P=0.17);2011—2015年以每年平均2.24%的平均速率上升(P=0.47);2016—2017年以每年14.26%的平均速率上升,呈加快趋势(P=0.69)。结论深圳市结核分枝杆菌对异烟肼、利福平耐药率均呈阶段性变化,其中对异烟肼、利福平单耐药率在波动中呈下降趋势,而耐多药结核分枝杆菌检出率近年来在波动中呈上升趋势,且以传播导致的耐药为主,应该调整防控策略,把重点转移至加强结核病患者的主动发现,做好传染源的隔离,特别是痰检阳性耐多药结核病患者。Objective To explore the trends of drug resistance of Mycobacterium tuberculosis for rifampicin and isoniazidin Shenzhen, and to provide the scientific reference for the control and prevention strategy of TB. Methods Bacterial typeidentification and drug-resistance detection were used to all the patients with smear positive pulmonary tuberculosis registeredin Shenzhen from 2002 to 2017. The trends of drug resistance of Mycobacterium tuberculosis and annual percent changes wereanalyzed by joinpoint regression program. Results A total of 19 098 strains of Mycobacterium tuberculosis were detected,among them, 1 726 strains of isoniazid resistance, 954 strains of rifampicin resistance and 812 strains of multidrug resistance.The isoniazid resistance rate of Mycobacterium tuberculosis in Shenzhen was decreased with an annual percent change（APC） by3.81% from 2002 to 2011（P=0.04）, and then increased with an annual percent change（APC） by 5.34% from 2012 to 2014（P=0.62）. From 2015 to 2017, the average rate decreased again with an APC by 20.82%（P=0.18）. The rate of rifampicin resistancewas decreased with an APC by 23.89% from 2002 to 2004（P=0.13） and fluctuated with an APC by 0.99% from 2005 to 2015（P=0.15）. From 2016 to 2017, the average rate decreased again with an APC by 46.50%（P=0.01）. The multidrug resistancerate of Mycobacterium tuberculosis was decreased with an APC by 4.16% from 2002 to 2010（P=0.17） and increased with anAPC by 2.24% from 2010 to 2015（P=0.47）. From 2016 to 2017, the rate was increased with an APC by 14.26%（P=0.69）.Conclusions The isoniazid and rifampicin drug resistance rates of Mycobacterium tuberculosis in Shenzhen have changed instages, among which, the resistance rate to isoniazid and rifampicin decrease in the fluctuation trend. The detection rate ofmultidrug-resistant Mycobacterium tuberculosis has been increasing in recent years, and it is mainly caused by transmission-induced drug resistance. Therefore, we should adjust the prevention and control str

关 键 词：结核分枝杆菌 耐药率 Joinpoint回归分析 趋势检验 

分 类 号：R512[医药卫生—内科学]