上海市松江区2014-2018年耐药结核分歧杆菌流行趋势分析  

Epidemiological trend of drug-resistant Mycobacterium tuberculosis in Songjiang District of Shanghai from 2014 to 2018

作　　者：王艺翔 戴碗琴 刘军[1] 杨翌翔 Wang Yixiang;Dai Wanqin;Liu Jun;Yang Yixiang(Department of Clinical Laboratory,Songjiang Branch,the First People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai 201600,China)

机构地区：[1]上海交通大学附属第一人民医院松江分院检验科,201600

出　　处：《中国基层医药》2020年第18期2224-2228,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：上海市医学重点专科建设计划(ZK2019B09)。

摘　　要：目的分析上海市松江区耐药结核分枝杆菌的流行变化趋势。方法回顾性分析上海市松江区2014年1月至2018年12月培养阳性的1105株结核分枝杆菌复合群,进行菌种鉴定(PNB法、TCH法和28℃培养试验)和药敏试验(四种一线抗结核药),分析其耐药情况。结果1105株结核分枝杆菌中,总耐药率为18.8%(208/1105),其中初治患者的耐药率为17.9%(189/1058),复治患者的耐药率为40.4%(19/47);总耐多药率4.0%(44/1105),其中初治患者的耐多药率为3.4%(36/1058),复治患者的耐多药率为17.0%(8/47)。5年总耐药率、初治患者耐药率、复治患者耐药率、总耐多药率、初治患者耐多药率、复治患者耐多药率均无上升趋势(χ2趋势值分别为4.229、3.871、6.862、2.764、4.930、1.955,均P>0.05)。五年耐多药率分别为2.6%、3.5%、4.4%、4.5%、5.4%,逐年递增。logistic回归分析显示,男性、老年群体、复治患者是上海市松江区结核病高发的因素,且复治患者更易产生耐药(OR=0.321,95%CI:0.175~0.586,P<0.01)和耐多药(OR=0.172,95%CI:0.075~0.394,P<0.01)。结论上海市松江区2014-2018年耐药结核分枝杆菌流行趋势较平稳,耐多药率逐年递增。Objective To analyze the prevalence of drug-resistant Mycobacterium tuberculosis in Songjiang District,Shanghai.Methods A retrospective analysis of 1105 strains of Mycobacterium tuberculosis,which was positive in culture from January 2014 to December 2018 in Songjiang District,Shanghai,was carried out for strain identification(PNB method,TCH method and 28℃culture test)and drug susceptibility test(four first-line anti-tuberculosis drugs).Results The total drug resistance rate was 18.8%(208/1105),of which the resistance rate of newly diagnosed patients was 17.9%(189/1058),and the resistance rate of retreated patients was 40.4%(19/47).The total multidrug resistance rate was 4.0%(44/1105),of which the multidrug-resistant rate of newly diagnosed patients was 3.4%(36/1058),and the multidrug resistance rate of retreated patients was 17.0%(8/47).The five-year total drug resistance rate,the drug resistance rate of newly diagnosed patients,the drug resistance rate of retreatment patients,the total multidrug resistance rate,the multidrug resistance rate of newly diagnosed patients,and the multidrug resistance rate of retreated patients had no upward trend(χ2 trend values:4.229,3.871,6.862,2.764,4.930,1.955,all P>0.05).In the past five years,the multi-drug resistance rates were 2.6%,3.5%,4.4%,4.5%,and 5.4%,respectively,increased year by year.Logistic regression analysis showed that males,elderly people,retreated patients and floating population were the main factors of tuberculosis in our district,and patients with retreatment were more likely to develop drug resistance(OR=0.321,95%CI:0.175-0.586,P<0.01)and multidrug-resistant(OR=0.172,95%CI:0.075-0.394,P<0.01).Conclusion In the past five years,the prevalence of M.tuberculosis in Songjiang District of Shanghai has been relatively stable,and the rate of multidrug resistance has increased year by year.

关 键 词：结核分枝杆菌 广泛耐药结核 疾病流行 男(雄)性 老年人 

分 类 号：R52[医药卫生—内科学] R181.3[医药卫生—临床医学]