云南省病原学阳性肺结核患者利福平耐药趋势分析  

Analysis of the trend of rifampicin drug-resistant among pulmonary tuberculosis patients in Yunnan province

作　　者：袁晨宇 陈连勇[2] 杨星[2] 杨云斌[2] 陈金瓯[2] 叶锦欣 许琳 YUAN Chen-yu;CHEN Lian-yong;YANG Xing;YANG Yun-bin;CHEN Jin-ou;YE Jin-xin;XU Lin(School of Public Health,Kunming Medical University,Kunming,Yunnan 650500,China)

机构地区：[1]昆明医科大学公共卫生学院,云南昆明650500 [2]云南省疾病预防控制中心,云南昆明650022

出　　处：《现代预防医学》2020年第24期4507-4510,共4页Modern Preventive Medicine

摘　　要：目的了解云南省2013-2018年利福平耐药率变化趋势,为云南省制定利福平耐药结核病防治措施和实施政策效果评价提供依据。方法回顾性分析云南省《结核病管理信息系统》登记报告并接受药敏检测的病原学阳性肺结核患者利福平耐药率变化趋势。采用χ2检验对不同特征的组间差异进行检验,二元logistic回归模型分析影响利福平耐药的因素。结果2013-2018年云南省病原学阳性肺结核患者利福平耐药率为7.2%(5.0%~9.2%)(P<0.05)。初治患者和复治患者利福平耐药率均呈下降趋势(P<0.05)。2018年复治患者和初治患者利福平耐药率分别为13.6%和3.3%,与2013年同比分别下降9.3%(P>0.05)、38.9%(P<0.05)。氧氟沙星作为治疗利福平耐药结核病的首选药物,在利福平耐药肺结核患者中耐药率为9.2%(6.2%~17.9%),且呈下降趋势(P<0.05)。二元logistics回归分析结果显示:20~59岁的肺结核患者(OR20~=2.164,95%CI:1.322~3.541、OR40~=2.157,95%CI:1.318~3.530)、其他职业(OR=1.296,95%CI:1.095~1.535)、复治患者发生利福平耐药的风险增高(OR=4.194,95%CI:3.920~4.981),少数民族是利福平耐药产生的保护因素(OR=0.798,95%CI:0.706~0.901)。结论云南省病原学阳性肺结核患者利福平耐药率总体呈下降趋势;应重视初治患者的治疗,防止其转变为复治患者;加强中青年患者的归口管理,提高患者依从性;在保证复治患者药敏筛查全覆盖的同时,继续扩大对初治患者的筛查力度;规范合理的使用氟喹诺酮类药物。Objective To investigate the trend of the rifampicin-resistant rate of Mycobacterium tuberculosis(MTB)strains isolated from positive bacteriological pulmonary tuberculosis patients in Yunnan province between 2013-2018.Methods A retrospective analysis was conducted to describe the trend of the rifampicin-resistant(RR)rate in patients with positive bacteriological pulmonary tuberculosis and accept drug-susceptibility testing(DST)who registered in the tuberculosis management information system(TMIS)in Yunnan province.Between groups with different characteristics were tested by Chisquared and the factors affecting rifampicin resistance were analyzed by binary logistic regression model.Results RR rate was 7.2%(5.0%-9.2%)in positive bacteriological pulmonary tuberculosis patients between 2013-2018.RR rate of the initial treatment and retreatment patients showed a decreasing rate(P<0.05).Compared with 2013,it decreased by 9.3%(P>0.05)and38.9%(P<0.05).Ofloxacin as the preferred drug for the treatment of RR-TB,had a drug resistance rate of 9.2%(6.2%-17.9%)in RR-TB patients,which showed a decreasing rate(P<0.05).Binary logistics regression showed that patients aged 20-59 years(OR20~=2.164,95%CI=1.322-3.541,OR40~=2.157,95%CI=1.318-3.530),other occupation(OR=1.296,95%CI=1.095-1.535),retreatment(OR=4.194,95%CI=3.920-4.981)were risk factors for RR-TB,and ethnic minorities(OR=0.798,95%CI=0.706-0.901)were protective factors for RR-TB.Conclusion RR rate was on the decline in positive bacteriological pulmonary tuberculosis patients in Yunnan province.Attention should be paid to the management and treatment of the initial treatment patients,prevention and control of its transition to the retreatment patients.At the same time strengthened to management of young and middle-aged patients.While ensuring full coverage of drug sensitivity screening for retreatment patients,screening for initial treatment patients should continue to be expanded.Fluoroquinolones should be used regularly and rationally.

关 键 词：肺结核 利福平耐药 趋势分析 

分 类 号：R117[医药卫生—公共卫生与预防医学]