2018—2020年西安市耐药结核病的流行现状及新冠疫情防控对其的影响  

Drug-resistance of MDR-TB in Xi’an between 2018 and 2020 and the impact of COVID-19 epidemic prevention and control on it

作　　者：杨翰 程悦 马怀芬 李于于[3] 韩蓓 YANG Han;CHENG Yue;MA Huaifen;LI Yuyu;HAN Bei(Translational Medicine Center, Xi’an Chest Hospital, Xi’an 710061;School of Public Health, Xi’an Jiaotong University Health Science Center;Tuberculosis Prevention and Control Department, Xi’an Center for Disease Control and Prevention, Xi’an 710061, China)

机构地区：[1]西安市胸科医院转化医学中心,陕西西安710061 [2]西安交通大学医学部公共卫生学院,陕西西安710061 [3]西安市疾病预防控制中心结核病防治科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2021年第4期562-568,共7页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：中央高校基本科研业务费专项资金资助-应急类项目(No.xzy032020015)。

摘　　要：目的了解近3年来西安市耐药结核病的流行现状,以及新冠疫情防控对结核杆菌耐药性的影响,为本地区的结核病防治工作提供依据。方法收集西安市2018年1月—2020年10月确诊的5146例结核患者的痰结核菌培养及药敏试验资料、基本临床信息等,统计分析本地结核患者耐药状况,采用多分类Logistic回归分析患者治疗史与结核菌株耐药性的关联性以及近3年初治、复治患者结核菌株的耐药率变化趋势。结果5146例结核患者的结核杆菌的总耐药率为25.3%,初治、复治患者的总耐药率分别为24.8%、38.22%。近3年初治患者耐多药菌株检出率逐年降低,复治患者耐多药菌株检出率在升高,且复治患者耐多药耐药谱逐渐复杂化,出现了以H+R+S(异烟肼+利福平+链霉素)、H+R+S+E(异烟肼+利福平+链霉素+乙胺丁醇)为主的10种耐药组合,二线用药卡那霉素、氧氟沙星耐药率有上升趋势。2020年的初治、复治患者人数显著下降,但其耐药率和前2年无差异;复治患者中多耐药菌株、耐多药菌株检出率在升高,2020年复治患者发生多耐药的可能性是初治患者的4.28倍(P=0.001,95%CI=1.417~12.930),发生耐多药的可能性是初治患者的5.378倍(P<0.001,95%CI=2.641~10.952)。结论近3年西安市耐药结核病的防控有了一定的成效,但复治患者耐药情况不容乐观,应采取精准积极的干预措施,特别是在疫情防控期间,应加强结核患者的健康管理,避免或减少耐药结核病的发生。Objective To understand the epidemic status of drug-resistant Mycobacteriun tuberculosis in Xi’an in the past three years,and the impact of COVID-19 epidemic during 2020 so as to provide basic information for local multidrug-resistant tuberculosis(MDR-TB)prevention and treatment.Methods Tuberculosis(TB)detected by sputum culture,the corresponding drug susceptibility tests data,and basic clinical information of TB patients diagnosed in Xi’an from January 2018 to October 2020 were collected from the management system;then the epidemic status and the drug resistance status were analyzed.Multinomial logistic regression was used to analyze the relationship between the patients’treatment history and the drug resistance of TB strains,and the trend of changes in the drug resistance rate in retreated patients.Results In the past three years,there was a total drug resistance rate of 25.3%in 5146 strains of MTB,and 24.8%in treatment initiation and 38.22%in retreatment,respectively.The treatment initiation patients showed a decreased MDR-TB detection rate,and the retreated patients had anincreased MDR-TB detection rate.The spectrum of MDR-TB in the retreated patients gradually became more complicated,and the resistance rate of second-line drugs such as Kanamycin and Ofloxacin gradually increased.There were 10 drug-resistant combinations mainly in H+R+S and H+R+S+E.During the year 2020 of COVID-19 epidemic,the number of initial and retreated patients decreased significantly compared with that in 2018 and 2019,but with no difference in the drug-resistance rate.There was an increasing detection rate of PDR and MDR-TB strains in the retreated patients.Multinomial logistic regression results showed that in 2020 the retreated patients had 4.28 times of developing PDR-TB(P=0.001,95%CI=1.417-12.930),and 5.378 times of developing MDR-TB(P<0.001,95%CI=2.641-10.952)than patients of treatment initiation.Conclusion In the past three years,the prevention and control of drug-resistant TB in Xi’an has achieved some progress,but drug

关 键 词：耐药结核分枝杆菌 初治 复治 新冠肺炎疫情 

分 类 号：R195.4[医药卫生—卫生统计学]